Background and Purpose: We investigated predictors for acute and persisting periprocedural ischemic brain lesions among patients with symptomatic carotid stenosis randomized to stenting or endarterectomy in the International Carotid Stenting Study.
Background and Purpose: Reperfusion injury can be revealed as delayed gadolinium enhancement in the subarachnoid space on a fluid-attenuated inversion recovery image, which is designated as a hyperintense acute reperfusion marker (HARM). We sought to investigate the occurrence and predictors of HARM and its association with new ischemic infarcts after carotid revascularization.
Background and Purpose: We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial.
Background and Purpose: We sought to assess the geographic proximity of patients with stroke in California to centers that performed specific threshold volumes of mechanical embolectomy procedures each year.
Background and Purpose: Despite the absence of definitive data from randomized clinical trials on the comparative effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic carotid stenosis, the use of CAS has been expanding and seems to be displacing the use of CEA in some parts of the United States.
Background and Purpose: Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions.
Background and Purpose: Significant stenosis of the internal carotid artery (ICA) is an established stroke risk factor. Recent evidence suggests that features within the atherosclerotic plaque also have prognostic value. The purpose of this study was to correlate the enhancement of the vasa vasorum (VV) overlying the carotid artery plaque with acute neurological symptoms in patients with 50% to 70% ICA stenosis.
Background and Purpose: Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device).
Background and Purpose: Compared with carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS) is associated with a higher risk of procedural stroke or death especially in patients with symptomatic stenosis. However, after the perioperative period, risk is similar with both treatments, suggesting that CAS could be an acceptable option in selected patients.
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.
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