Objectives: The benefit of carotid endarterectomy (CEA) may be diminished by cranial nerve injury (CNI). Using a quality improvement registry, we aimed to identify the nerves affected, duration of symptoms (transient vs. persistent), and clinical predictors of CNI.
Introduction: This article in the EuroIntervention Tools & Techniques series provides the "How-to-do" for carotid artery stenting (CAS) plus tips & tricks, and brings to you the knowledge to obtain good results thus providing a safe therapy. The dynamic images can be viewed at www.eurointervention.org Endovascular carotid intervention was developed due to a need to provide a less-invasive and less-traumatic revascularisation strategy for patients considered high-risk for open surgery. The rapid advancement in endovascular technologies and techniques over the last 10 years has resulted in the evolution of CAS to a refined procedure with great potential to be applied to routine carotid revascularisation practice. The benchmark for perioperative stroke or death for carotid revascularisation is the limit of 6% for symptomatic and 3% for asymptomatic patients.
Introduction: Endovascular treatment with coils is an established treatment for intracranial aneurysms, despite the risk of reopening the aneurysm after the treatment (1). Approximately 10% of the patients need additional treatment with coils at some time during follow-up due to the reopening (2). Magnetic resonance (MR) angiography is increasingly used as a noninvasive alternative to the standard follow-up with intraarterial digital subtraction angiography (DSA) in patients with coiled aneurysms (3). Besides its safety, MR angiography is performed in an outpatient setting and creates less discomfort for patients than does intraarterial DSA. The test characteristics and cost-effectiveness of MR angiography compared with those of intraarterial DSA are good (4,5), but more insight in the subsequent image-based additional treatment decisions is desirable before MR angiography is implemented as a standard follow-up imaging technique. We investigated whether therapeutic decision making can be solely based on MR angiographic findings by comparing treatment decisions based on findings of MR angiography and intraarterial DSA in the follow-up of patients with coil-treated aneurysms who were examined by using both imaging techniques.
OBJECTIVE. The purpose of this study was to determine the utilization by specialty and guidance method for vertebral augmentation (including vertebroplasty and kyphoplasty) in the United States from 2001 to 2010.
Introduction: Although coil placement has been accepted as a treatment for intracranial aneurysms, unfavorable aneurysm features, such as wide neck, large size, fusiform morphology, and posttreatment recanalization, remain important challenges (1–6). Stent-assisted coil placement has been developed to address these challenges but has been associated with relatively high rates of aneurysm recurrence and procedure-induced mortality (4). Such limitations of coil placement have fueled the continual search for better endovascular options for treatment of intracranial aneurysms. Endovascular placement of flow diversion devices such as the pipeline embolization device (PED) (ev3 Neurovascular, Irvine, Calif) for endoluminal circumferential reconstruction of segmental vascular defects as a treatment for intracranial aneurysms is gaining widespread acceptance (7–10). The purpose of this study was to evaluate the midterm clinical and angiographic outcomes after PED placement for intracranial aneurysms.
In order to further improve the impact of the continuously evolving neurointerventional techniques, the interventional neuroradiologist needs to have at his disposal more powerful techniques to image the central nervous system. With the recent development of diagnostics techniques that are computed tomography and magnetic resonance based we are now able to assess not just morphology, but also physiology, physiopathology and function. This review discusses the place of diagnostic techniques in the evaluation that the interventional neuroradiologist hast to make when confronted with patients. We provide an overview of current techniques for the brain and spine.
Background and Purpose—The frequent use of a longer time window for recanalization therapy in patients with basilar artery occlusion (BAO) in daily practice is not supported by any scientific evidence. We investigated the relationship between time to recanalization therapy and functional outcome in BAO with data from the Basilar Artery International Cooperation Study (BASICS).
Background and Purpose—Impairments in cerebrovascular reserve (CVR) have been variably associated with increased risk of ischemic events and may stratify stroke risk in patients with high-grade internal carotid artery stenosis or occlusion. The purpose of this study is to perform a systematic review and meta-analysis to summarize the association of CVR impairment and stroke risk.
Background—Carotid intima-media thickening is associated with increased cardiovascular risk in humans. We discovered that intima formation and cell proliferation in response to carotid injury is greater in SJL/J (SJL) in comparison with C3HeB/FeJ (C3H/F) mice. The purpose of this study was to identify candidate genes contributing to intima formation.
BACKGROUND AND PURPOSE: SACE is performed for complex aneurysms. There are several configurations of stent placement for bifurcation aneurysms. We investigated hemodynamics among 8 different configurations of stent placement, which may relate to the recanalization rate.
Background and Purpose—There is evidence that high-volume hospitals may produce better patient outcomes. We aimed to identify whether there were any associations between hospital thrombolysis volume and speed of thrombolysis (tissue-type plasminogen activator [tPA]) administration in patients with ischemic stroke.
Introduction: The purpose of this study was to quantify the reduction in patient radiation dose by X-ray imaging technology using image noise reduction and system settings for neuroangiography and to assess its impact on the working habits of the physician.
BACKGROUND AND PURPOSE: Arteriovenous malformations are an important etiology of hemorrhagic stroke. However, current imaging modalities and risk do not provide insights into individual AVM hemodynamics and its role in pathophysiology. The aims of this study are to determine whether intracranial 4D flow MR imaging can provide insights into arteriovenous malformation hemodynamics independent of the Spetzler-Martin grade and to report the changes in flow observed during staged embolization.
Background and Purpose—Conjugate eye deviation (CED) occurs frequently in patients with acute stroke. The purpose of this study was to elucidate the factors that correlate with CED as well as the relationship between CED and outcomes in patients with acute intracerebral hemorrhage.
Background: Three recent, simultaneous publications report the neutral results of three randomized studies (SYNTHESIS Expansion, Interventional Management of Stroke (IMS) III, and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE)) comparing IV thrombolysis therapy or standard care (MR RESCUE) to the endovascular treatment (EVT) of acute ischemic stroke (AIS) [1–3]. The results of these three trials might lead to the erroneous conclusion that endovascular treatment has no or little place in the management of AIS. However, careful analysis of the IMS III, SYNTHESIS, and MR RESCUE studies is mandatory prior to assessment of the value of EVT of AIS. Also, the limits of the current and future trials should be outlined.
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