01 marzo 2015

ENDOVASCULAR TODAY. Treatment Options for Cerebral AVMs and Dural AVFs

Lyahn K. Hwang, BS; Vivek A. Kumar, PhD; Ravi R. Vissapragada, MD; Karen Y. Lui, MD; Matthew R. Fusco, MD; Christopher S. Ogilvy, MD; and Ajith J. Thomas, MD

The second of a three-part series on diagnosing, treating, and researching management options for intracranial malformations.

01 abril 2014

JOURNAL OF ENDOVASCULAR THERAPY. Hospital Reimbursement for Carotid Stenting and Endarterectomy

Melissa J. Donovan, MD, MPA Daniel E. Ramirez, MD Gregory D. Crenshaw, MD Taylor A. Smith, MD Hernan A. Bazan, MD W. Charles Sternbergh III, MD⇑

Purpose: To investigate the cost-effectiveness of carotid endarterectomy (CEA) vs. carotid artery stenting (CAS) in terms of hospital reimbursement.

01 mayo 2014

RSNA: Radiology. Accurate Diagnosis of Small Cerebral Aneurysms ≤5 mm in Diameter with 3.0-T MR Angiography

Ming-Hua Li, MD, PhD, Yong-Dong Li, MD, PhD, Bin-Xian Gu, MD, Ying-Sheng Cheng, MD, PhD, Wu Wang, MD, Hua-Qiao Tan, MD, PhD, Yuan-Chang Chen, MD, PhD, From the Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, 600 Yi Shan Rd, Shanghai 200233, China.

Introduction: Because of rapid improvements in imaging techniques, increasing numbers of cerebral aneurysms are now detected with computed tomographic (CT) angiography and magnetic resonance (MR) angiography (1–8). The reported accuracy of MR angiography in the detection of cerebral aneurysms is approximately 90%, with better results for larger aneurysms and poorer results for smaller aneurysms (1,9,10). Small cerebral aneurysms are generally classified as those with a diameter of 5 mm or less (11), and they present particular technical challenges for the neuroradiologist. Early MR angiography studies have shown limited diagnostic accuracy in the detection of small cerebral aneurysms (12,13).

01 mayo 2015

NEUROSURGERY. Unruptured Intracranial Aneurysms in Children With Sickle Cell Disease: Analysis of 18 Aneurysms in 5 Patients

Saini, Surbhi MD*,‡; Speller-Brown, Barbara DNP*; Wyse, Emily BS§; Meier, Emily R. MD*,‡; Carpenter, Jessica MD‡,¶; Fasano, Ross M. MD*,‡; Pearl, Monica S. MD§,‖

BACKGROUND: Intracranial aneurysms (IAs) are rare in the general pediatric population and account for <2% of all cerebral aneurysms. Only 7 children with sickle hemoglobinopathy and IAs have been reported, the majority of which were discovered after rupture.

01 mayo 2015

NEUROSURGERY. Treatment Outcomes of Unruptured Arteriovenous Malformations With a Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Patients

Nerva, John D. MD*; Mantovani, Alessandra MD*; Barber, Jason MS*; Kim, Louis J. MD*,‡; Rockhill, Jason K. MD, PhD*,§; Hallam, Danial K. MD*,‡; Ghodke, Basavaraj V. MD*,‡; Sekhar, Laligam N. MD*,‡

BACKGROUND: The design and conclusions of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial are controversial, and its structure limits analysis of patients who could potentially benefit from treatment.

01 mayo 2015

NEUROSURGERY. Long-term Functional Outcomes and Predictors of Shunt-Dependent Hydrocephalus After Treatment of Ruptured Intracranial Aneurysms in the BRAT Trial: Revisiting the Clip vs Coil Debate

Zaidi, Hasan A. MD; Montoure, Andrew BS; Elhadi, Ali MD, PhD; Nakaji, Peter MD; McDougall, Cameron G. MD; Albuquerque, Felipe C. MD; Spetzler, Robert F. MD; Zabramski, Joseph M. MD

BACKGROUND: Acute hydrocephalus is a well-known sequela of aneurysmal subarachnoid hemorrhage (SAH). Controversy exists about whether open microsurgical methods serve to reduce shunt dependency compared with endovascular techniques.

01 abril 2015

NEUROSURGERY. A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke Caused by Proximal Arterial Occlusion in the Anterior Circulation

Starke, Robert M. MD, MSc; Connolly, E. Sander MD; Komotar, Ricardo J. MD

Significant time and expenditure have been devoted to therapies for acute ischemic stroke, a worldwide leading cause of morbidity and mortality.1,2 Currently, there are limited therapies approved for ischemic stroke, including care at a stroke center, initiation of aspirin, and revascularization with recombinant tissue-type plasminogen activator.

01 abril 2015

NEUROSURGERY. Stereotactic Radiosurgery for Intracranial Meningiomas: Current Concepts and Future Perspectives

Mansouri, Alireza MD*,‡; Guha, Daipayan MD*,‡; Klironomos, George MD, PhD*,‡; Larjani, Soroush BSc‡; Zadeh, Gelareh MD, PhD*,‡; Kondziolka, Douglas MD, Msc§

Abstract: Meningiomas are among the most common adult brain tumors. Although the optimal management of meningiomas would provide complete elimination of the lesion, this cannot always be accomplished safely through resection. Therefore, other therapeutic modalities, such as stereotactic radiosurgery (as primary or adjunctive therapy), have emerged. In the current review, we have provided an overview of the historical outcomes of various radiosurgical modalities applied in the management of meningiomas. Furthermore, we provide a discussion on key factors (eg World Health Organization grade, lesion size, and lesion location) that affect tumor control and adverse event rates. We discuss recent changes in our understanding of meningiomas, based on molecular and genetic markers, and how these will change our perspective on the management of meningiomas. We conclude by outlining the areas in which knowledge gaps persist and provide suggestions as to how these can be addressed

26 marzo 2015

STROKE. Clinical Sciences. Four-Year Follow-Up of Transient Ischemic Attacks, Strokes, and Mimics. A Retrospective Transient Ischemic Attack Clinic Cohort Study

Dipankar Dutta, FRCP; Emily Bowen, MRCP; Chris Foy, MSc

Background and Purpose: There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database.

07 abril 2015

STROKE. Clinical Sciences. Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke

Lucie A. van den Berg, MD; Diederik L.H. Koelman, BSc; Olvert A. Berkhemer, MD; Anouk D. Rozeman, MD; Puck S.S. Fransen, MD; Debbie Beumer, MD; Diederik W. Dippel, MD, PhD; Aad van der Lugt, MD, PhD; Robert J. van Oostenbrugge, MD, PhD; Wim H. van Zwam, MD, PhD; Patrick A. Brouwer, MD; Sjoerd Jenniskens, MD; Jelis Boiten, MD, PhD; Geert A. Lycklama à Nijeholt, MD, PhD; Jan Albert Vos, MD, PhD; Wouter J. Schonewille, MD, PhD; Charles B.L.M. Majoie, MD, PhD; Yvo B.W.E.M. Roos, MD, PhD; for the MR CLEAN pretrial study group

Background and Purpose: Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT.

18 marzo 2014

STROKE. Clinical Sciences. Incident Stroke Is Associated With Common Carotid Artery Diameter and Not Common Carotid Artery Intima-Media Thickness

Joseph F. Polak, MD, MPH; Ralph L. Sacco, MD, MS; Wendy S. Post, MD, MS; Dhananjay Vaidya, MBBS, PhD, MPH; Martinson Kweku Arnan, MD, MPA; Daniel H. O’Leary, MD

Background and Purpose: The common carotid artery interadventitial diameter is measured on ultrasound images as the distance between the media-adventitia interfaces of the near and far walls. It is associated with common carotid intima-media thickness (IMT) and left ventricular mass and might therefore also have an association with incident stroke.

08 abril 2014

STROKE. Clinical Sciences. Volume of Carotid Artery Ulceration as a Predictor of Cardiovascular Events

Mariya Kuk; Thapat Wannarong, MD; Vadim Beletsky, MD; Grace Parraga, PhD; Aaron Fenster, PhD; J. David Spence, MD

Background and Purpose: Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).

03 abril 2014

STROKE. Clinical Sciences. Challenges of Decision Making Regarding Futility in a Randomized Trial. The Interventional Management of Stroke III Experience

Sharon D. Yeatts, PhD; Renee H. Martin, PhD; Christopher S. Coffey, PhD; Patrick D. Lyden, MD; Lydia D. Foster, MS; Robert F. Woolson, PhD; Joseph P. Broderick, MD; Marco R. Di Tullio, MD; Charles A. Jungreis, MD; Yuko Y. Palesch, PhD; for the IMS III Investigators

Background and Purpose: Interventional Management of Stroke (IMS) III is a randomized, parallel arm trial comparing the approach of intravenous tissue-type plasminogen activator followed by endovascular treatment with intravenous tissue-type plasminogen activator alone in patients with acute ischemic stroke presenting <3 hours of symptom onset. The trial intended to enroll 900 subjects to ensure adequate statistical power to detect an absolute 10% difference in the percentage of subjects with good outcome, defined as modified Rankin Scale score of 0 to 2 at 3 months. In April 2012, after 656 subjects were randomized, further enrollment was terminated by the National Institute of Neurological Disorders and Stroke based on the prespecified criterion for futility using conditional power <20%

03 abril 2014

STROKE. Clinical Sciences. Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Simon C.H. Yu, MD; Winnie X.Y. Zou, PhD; Yannie O.Y. Soo, MD; Lily Wang, MD; Joyce Wai Yi Hui, FRCR; Anne Y.Y. Chan, MD; Kwok Tung Lee, MSc; Vincent H.L. Ip, MD; Florence S.Y. Fan, MD; Annie L.C. Chan, MSc; Lawrence K.S. Wong, MD; Thomas W. Leung, MD

Background and Purpose: We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control.

25 marzo 2014

STROKE. Clinical Sciences. North American SOLITAIRE Stent-Retriever Acute Stroke Registry Choice of Anesthesia and Outcomes

Alex Abou-Chebl, MD; Ossama O. Zaidat, MD, MS; Alicia C. Castonguay, PhD; Rishi Gupta, MD; Chung-Huan J. Sun, MD; Coleman O. Martin, MD; William E. Holloway, MD; Nils Mueller-Kronast, MD; Joey D. English, MD; Italo Linfante, MD; Guilherme Dabus, MD; Timothy W. Malisch, MD; Franklin A. Marden, MD; Hormozd Bozorgchami, MD; Andrew Xavier, MD; Ansaar T. Rai, MD; Micahel T. Froehler, MD, PhD; Aamir Badruddin, MD; Thanh N. Nguyen, MD, FRCPC; Muhammad Taqi, MD; Michael G. Abraham, MD; Vallabh Janardhan, MD; Hashem Shaltoni, MD; Roberta Novakovic, MD; Albert J. Yoo, MD; Peng R. Chen, MD; Gavin W. Britz, MD; Ritesh Kaushal, MD; Ashish Nanda, MD; Mohammad A. Issa, MD; Raul G. Nogueira, MD

Background and Purpose: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy.