Background and Purpose: Women are more likely to have a worse outcome after an acute stroke than men. Some studies have suggested that women also benefit less from intravenous thrombolysis after an acute ischemic stroke, but others found no sex differences in safety and efficacy. We aimed to evaluate differences in 3-month outcome between sexes in intravenous tissue-type plasminogen activator–treated patients registered in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register.
Background and Purpose: Flow-induced hemodynamic forces are critical in extra- and intracranial arterial caliber regulation and have been proposed to mediate intracranial aneurysm (IA) formation and rupture. We hypothesized that vascular structural control may be impaired in patients harboring brain aneurysms and sought to examine any differences in extradural internal carotid artery (ICA) caliber profiles.
Background and Purpose: A high rate of postprocedure complications in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial has raised concerns whether such results are representative of intracranial stent placement in actual routine practice.
OBJECTIVE. The purpose of this study was to determine the safety and efficacy of percutaneous vertebroplasty and interventional tumor removal in the management of metastatic spinal tumors and malignant vertebral compression fractures.
AIM: To evaluate the changes of intracranial blood flow after carotid artery stenting (CAS), using the flow assessment application “Flow-Insight”, which was developed in our department.
Cranial dural arteriovenous fistulas (DAVFs) are an uncommon but important cause of long-term morbidity and mortality, with an annual neurologic event rate of 15% (1). A DAVF is an abnormal direct connection between meningeal arteries and dural sinuses. High pressure in the sinus can result in both retrograde drainage into the venous sinus and retrograde cortical venous drainage. Digital subtraction angiography (DSA) is the standard of reference for the diagnosis and for tailoring the appropriate treatment by endovascular and/or surgical means. Apart from offering a high diagnostic performance in the detection of a DAVF, DSA enables the visualization of feeding arteries as well as the identification of the venous drainage pattern, including retrograde drainage into subarachnoid veins. The latter determines the grading of DAVF, which is important for estimating the risk of clinical complications. Importantly, the presence of retrograde cortical venous drainage or venous ectasia is considered a marker of high bleeding risk from DAVFs (1–3). However, DSA remains an invasive tool, with a potential risk, albeit very low, of severe periprocedural complications, and exposes both patients and medical staff to ionizing radiation (4). Numerous noninvasive imaging methods, such as time-resolved contrast material–enhanced magnetic resonance (MR) angiography (5) and susceptibility-weighted imaging (6,7), have demonstrated their value in the detection of DAVF. However, they all failed to enable the correct classification of DAVFs according to their bleeding risk on the basis of the Cognard classification (8). The major drawback of such MR investigations is that it is impossible to combine both optimized temporal and spatial resolution, which are necessary to appreciate the dynamic characteristics of a DAVF (eg, antegrade or retrograde venous flow) and to define precisely vessels involved in the DAVF. Accelerated four-dimensional (4D) flow imaging techniques based on phase-contrast MR imaging sequences open the possibility of capturing quantitative flow dynamics with high isotropic spatial resolution in a clinically acceptable acquisition time (9). We hypothesized that, by enabling global flow tracking in selected vessels (10), cartography of vessels implicated in cranial DAVFs could be performed. Our aim was to assess the feasibility of a selective flow-tracking cartographic procedure applied to 4D flow imaging and to demonstrate its usefulness in the characterization of DAVFs.
Hemorrhage and calcification are common pathologic components of many intracranial diseases. Reliable differentiation between hemorrhages and calcifications is crucial for accurate diagnosis, prognosis, and therapy optimization. For example, the presence of a hemorrhage may suggest a possible stroke, traumatic brain injury, or a malignant tumor, whereas the presence of calcifications is suggestive of different diseases, such as Sturge-Weber syndrome, tuberous sclerosis, neurocysticercosis, or craniopharyngiomas (1,2). The differentiation of intracranial microbleeds from multiple calcified cysticercus granulomas is essential for choosing an appropriate treatment for patients affected by both neurocysticercosis and hypertension (3).
OBJECTIVE. Spontaneous subarachnoid hemorrhage (SAH) typically prompts a search for an underlying ruptured saccular aneurysm, which is the most common nontraumatic cause. Depending on the clinical presentation and pattern of SAH, the differential diagnosis may include a diverse group of causes other than aneurysm rupture.
OBJECTIVE. The objective of this article is to describe an approach to imaging CSF shunts. Topics reviewed include the components and imaging appearances of the most common types of shunts and the utility of different imaging modalities for the evaluation of shunt failure. Complications discussed include mechanical failure, infection, ventricular loculation, overdrainage, and unique complications related to each shunt type.
OBJECTIVE. Varying anatomic characteristics and clinical and radiologic manifestations are diagnostic challenges in the evaluation of the cerebral vein and of venous sinus diseases. The purpose of this article is to introduce bone subtraction CT venography and review normal variations and diseases involving the cerebral veins and venous sinuses.
Background: Given the controversy regarding whether carotid endarterectomy (CEA) or carotid artery stenting (CAS) may be superior for stroke prevention, it is uncertain how recent clinical evidence, guidelines, and reimbursement policies have influenced the volume and outcomes after these procedures.
Objectives: This study sought to randomly compare cerebral protection with ANGIOGUARD (Cordis Corporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa, California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions were analyzed.
Objectives: The purpose of the prospective, multicenter, nonrandomized CABANA study was to evaluate periprocedural clinical outcomes in high surgical risk patients with carotid artery stenosis treated with the Carotid WALLSTENT plus FilterWire EZ Embolic Protection System by a diverse group of clinicians.
Background: Recurrent vascular events remain a major source of morbidity and mortality after stroke or transient ischemic attack (TIA). The IRIS Trial is evaluating an approach to secondary prevention based on the established association between insulin resistance and increased risk for ischemic vascular events. Specifically, IRIS will test the effectiveness of pioglitazone, an insulin-sensitizing drug of the thiazolidinedione class, for reducing the risk for stroke and myocardial infarction (MI) among insulin resistant, nondiabetic patients with a recent ischemic stroke or TIA.
Multiple randomized, controlled trials have shown the efficacy of the use of intravenous tissue plasminogen activator (t-PA), administered up to 4.5 hours after the onset of symptoms of acute ischemic stroke.1,2 However, the global effect of this therapy has been limited, largely because of the narrow time window available for treatment and the risk of symptomatic intracerebral hemorrhage. Although endovascular approaches, including thrombectomy devices, have been shown to achieve greater rates of recanalization than the use of intravenous t-PA, no randomized, controlled trial has been completed comparing clinical outcomes versus standard medical care. Moreover, the potential to benefit from interventions in late time windows (≥3 hours) may be increased when they are coupled with brain imaging to select patients who are the most likely to benefit.
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