03 abril 2014

STROKE. Clinical Sciences. Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy

Nishant K. Mishra, MBBS, PhD, FESO; Gregory W. Albers, MD; Søren Christensen, PhD; Michael Marks, MD; Scott Hamilton, PhD; Matus Straka, PhD; John T.P. Liggins, MSc; Stephanie Kemp, BS; Michael Mlynash, MD, MS; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 Investigators

Background and Purpose: The Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) study has shown that clinical response to endovascular reperfusion differs between patients with and without perfusion–diffusion (perfusion-weighted imaging–diffusion-weighted imaging, PWI–DWI) mismatch: patients with mismatch have a favorable clinical response to reperfusion, whereas patients without mismatch do not. This study examined whether alternative mismatch criteria can also differentiate patients according to their response to reperfusion.

01 abril 2014

STROKE. Clinical Sciences. Early Intensive Versus Minimally Invasive Approach to Postoperative Hemodynamic Management After Subarachnoid Hemorrhage

Tatsushi Mutoh, MD, DVM, PhD; Ken Kazumata, MD; Shunsuke Terasaka, MD; Yasuyuki Taki, MD, PhD; Akifumi Suzuki, MD; Tatsuya Ishikawa, MD

Background and Purpose: The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but the effects of EGDT on clinical outcomes are still unclear. This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy.

20 marzo 2014

STROKE. Clinical Sciences. Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms

Daan Backes, MD; Mervyn D.I. Vergouwen, MD, PhD; Birgitta K. Velthuis, MD, PhD; Irene C. van der Schaaf, MD, PhD; A. Stijntje E. Bor, MD; Ale Algra, MD, PhD; Gabriel J.E. Rinkel, MD, FRCPE

Background and Purpose: Prediction of the risk of rupture of unruptured intracranial aneurysms is mainly based on aneurysm size and location. Previous studies identified features of aneurysm shape and flow angles as additional risk factors for aneurysm rupture, but these studies were at risk for confounding by patient-specific risk factors such as hypertension and age. In this study, we avoided this risk by comparing characteristics of ruptured and unruptured aneurysms in patients with both aneurysmal subarachnoid hemorrhage and multiple intracranial aneurysms.

20 febrero 2014

STROKE. Clinical Sciences. Early Diffusion-Weighted Imaging Reversal After Endovascular Reperfusion Is Typically Transient in Patients Imaged 3 to 6 Hours After Onset

Manabu Inoue, MD, PhD; Michael Mlynash, MD, MS; Soren Christensen, PhD; Hayley M. Wheeler, BS; Matus Straka, PhD; Aaryani Tipirneni, MS; Stephanie M. Kemp, BS; Greg Zaharchuk, MD, PhD; Jean-Marc Olivot, MD, PhD; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; Gregory W. Albers, MD; for the DEFUSE 2 Investigators

Background and Purpose: The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient.

25 febrero 2014

STROKE. Clinical Sciences. Increasing Use of Computed Tomographic Perfusion and Computed Tomographic Angiograms in Acute Ischemic Stroke From 2006 to 2010

Achala Vagal, MD; Karthikeyan Meganathan, MS; Dawn O. Kleindorfer, MD; Opeolu Adeoye, MD, MS; Richard Hornung, PhD; Pooja Khatri, MD, MSc

Background and Purpose: Our objective was to study nationwide utilization trends of computed tomographic (CT) angiogram (CTA) and CT perfusion (CTP) in acute ischemic stroke and particularly in the context of use of reperfusion therapies.

25 febrero 2014

STROKE. Clinical Sciences. Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

Michael P. Marks, MD; Maarten G. Lansberg, MD; Michael Mlynash, MD; Jean-Marc Olivot, MD; Matus Straka, PhD; Stephanie Kemp, BS; Ryan McTaggart, MD; Manabu Inoue, MD; Greg Zaharchuk, MD, PhD; Roland Bammer, PhD; Gregory W. Albers, MD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Investigators

Background and Purpose: Our aim was to determine the relationships between angiographic collaterals and diffusion/perfusion findings, subsequent infarct growth, and clinical outcome in patients undergoing endovascular therapy for ischemic stroke.

04 marzo 2014

STROKE. Clinical Sciences. Outcomes of a Contemporary Cohort of 536 Consecutive Patients With Acute Ischemic Stroke Treated With Endovascular Therapy

Sònia Abilleira, MD, PhD; Pere Cardona, MD; Marc Ribó, MD, PhD; Mònica Millán, MD, PhD; Víctor Obach, MD, PhD; Jaume Roquer, MD, PhD; David Cánovas, MD; Joan Martí-Fàbregas, MD, PhD; Francisco Rubio, MD, PhD; José Álvarez-Sabín, MD, PhD; Antoni Dávalos, MD, PhD; Ángel Chamorro, MD, PhD; Maria Angeles de Miquel, MD, PhD; Alejandro Tomasello, MD, PhD; Carlos Castaño, MD, PhD; Juan M. Macho, MD, PhD; Aida Ribera, BSc, PhD; Miquel Gallofré, MD, PhD; on behalf of the Catalan Stroke Code and Reperfusion Consortium

Background and Purpose: We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome.

13 abril 2014

STROKE. Clinical Sciences. Stroke Thrombolysis. Save a Minute, Save a Day

Atte Meretoja, MD; Mahsa Keshtkaran, MSc; Jeffrey L. Saver, MD; Turgut Tatlisumak, MD; Mark W. Parsons, MD; Markku Kaste, MD; Stephen M. Davis, MD; Geoffrey A. Donnan, MD; Leonid Churilov, PhD

Background and Purpose: Stroke thrombolysis is highly time-critical, but data on long-term effects of small reductions in treatment delays have not been available. Our objective was to quantify patient lifetime benefits gained from faster treatment.

13 marzo 2014

STROKE. Basic Sciences. Extravascular Optical Coherence Tomography. Evaluation of Carotid Atherosclerosis and Pravastatin Therapy

Robert T. Wicks, MD*; Yong Huang, PhD*; Kang Zhang, PhD; Mingtao Zhao, PhD; Betty M. Tyler, BA; Ian Suk, CMI; Lee Hwang, MD; Jacob Ruzevick, BS; George Jallo, MD; Henry Brem, MD; Gustavo Pradilla, MD; Jin U. Kang, PhD

Background and Purpose: Extravascular optical coherence tomography (OCT), as a noninvasive imaging methodology with micrometer resolution, was evaluated in a murine model of carotid atherosclerosis by way of assessing the efficacy of pravastatin therapy.

06 marzo 2014

STROKE. Clinical Sciences. Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Marián Muchada, MD; Marta Rubiera, MD, PhD; David Rodriguez-Luna, MD, PhD; Jorge Pagola, MD, PhD; Alan Flores, MD; Julia Kallas, MD; Estela Sanjuan, RN; Pilar Meler, RN; Jose Alvarez-Sabin, MD, PhD; Marc Ribo, MD, PhD; Carlos A. Molina, MD, PhD

Background and Purpose: The effect of tissue-type plasminogen activator on functional outcome decreases progressively over time. However, given the differential pattern of arterial occlusion, stroke severity, and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aimed to identify the impact of time-to-treatment according to stroke severity on functional outcome in patients with acute ischemic stroke.

10 julio 2014

AMERICAN JOURNAL OF NEURORADIOLOGY. Current and Emerging MR Imaging Techniques for the Diagnosis and Management of CSF Flow Disorders: A Review of Phase-Contrast and Time–Spatial Labeling Inversion Pulse

S. Yamada, K. Tsuchiya, W.G. Bradley, M. Law, M.L. Winkler, M.T. Borzage, M. Miyazaki, E.J. Kelly and J.G. McComb

SUMMARY: This article provides an overview of phase-contrast and time–spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time–spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time–spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns.

01 mayo 2015

RADIOLOGY. Carotid Artery Plaque Morphology and Composition in Relation to Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA)

Anna E. H. Zavodni, MD, Bruce A. Wasserman, MD, Robyn L. McClelland, PhD, Antoinette S. Gomes, MD, Aaron R. Folsom, MD, MPH, Joseph F. Polak, MD, MPH, João A. C. Lima, MD, David A. Bluemke, MD, PhD,

Atherosclerosis is a systemic disease process, and carotid artery imaging provides a useful surrogate marker of generalized vascular health. On the basis of autopsy studies, specific features of an atherosclerotic plaque represent unstable plaque that is prone to rupture (1–4). Features of vulnerable plaque include a lipid core with a thin fibrous cap and ulceration, and identification of a vulnerable plaque may serve as a marker with which to identify the “vulnerable patient” at risk for subsequent cardiovascular events (5,6).

01 abril 2015

RADIOLOGY. Intracranial Dural Arteriovenous Fistulas: Evaluation with 3-T Four-dimensional MR Angiography Using Arterial Spin Labeling

Yasuhiko Iryo, MD, Toshinori Hirai, MD, Yutaka Kai, MD, Masanobu Nakamura, RT, Yoshinori Shigematsu, MD, Mika Kitajima, MD, Minako Azuma, MD, Masanori Komi, RT, Kosuke Morita, RT, Yasuyuki Yamashita, MD

The high spatial and temporal resolution of intraarterial digital subtraction angiography (DSA) facilitates the accurate assessment of intracranial dural arteriovenous fistulas (AVFs) and their location, as well as the identification of their feeders and drainers. DSA, however, is an invasive method that involves exposure to radiation and requires the injection of iodinated contrast medium. Therefore, a noninvasive method is required to diagnose AVFs and follow up patients with intracranial dural AVFs.

01 enero 2015

JOURNAL OF VASCULAR SURGERY. Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Kevin Brown, MD , Dina S. Itum, MD , Joshua Preiss , Yazan Duwayri, MD , Ravi K. Veeraswamy, MD , Atef Salam, MD , Thomas F. Dodson, MD , Luke P. Brewster, MD

Objective: The external carotid artery (ECA) can be an important source of cerebral blood flow in cases of high-grade internal carotid artery stenosis or occlusion. However, the treatment of the ECA is fundamentally different between carotid endarterectomy (CEA) and carotid artery stenting (CAS). CEA is routinely associated with endarterectomy of the ECA, whereas CAS excludes the ECA from direct flow. We hypothesize that these differences make ECA occlusion more common after CAS. Further, the impact of CAS on blood flow into the ECA is interesting because the flow from the stent into the ECA is altered in a way that may promote local inflammation and may influence in-stent restenosis (ISR). Thus, our objective was to use our institutional database to identify whether CAS increased the rate of ECA occlusion and, if it did, whether ECA occlusion was associated with ISR.

01 febrero 2015

ENDOVASCULAR TODAY. Cerebral AVMs and Dural AVFs: Pathology and Management

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

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