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ESTUDIOS


01 agosto 2013

STROKE. Importance of Cerebral Artery Recanalization in Patients With Stroke With and Without Neurological Improvement After Intravenous Thrombolysis

Tatiana V. Kharitonova, MD, PhD; Teresa P. Melo, MD; Grethe Andersen, MD, DMSc; Jose A. Egido, MD, FESO; José Castillo, MD, PhD; Nils Wahlgren, MD, FESO on behalf of the SITS investigators

Background and Purpose—Recanalization status after intravenous thrombolysis (IVT) in patients with ischemic stroke is a reference point to proceed with a rescue reperfusion intervention, although early neurological improvement (NI) may preclude endovascular procedures. We aimed to evaluate the importance of restoration of blood flow at the arterial occlusion site in subgroups of patients with stroke stratified by early NI after IVT.

01 septiembre 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Coiling for Paraclinoid Aneurysms: Time to Make Way for Flow Diverters?

BACKGROUND AND PURPOSE: Paraclinoid aneurysms represent challenging lesions for which endovascular techniques have gained widespread application in their treatment. A new endovascular strategy, flow diversion, is gaining importance in the treatment of these aneurysms. Before embracing flow diversion in larger numbers of patients with paraclinoid aneurysms, it is important to know the safety and efficacy of “traditional” endovascular methods for these aneurysms. We review complications and outcomes of patients with unruptured paraclinoid aneurysms treated with coils, with or without balloon and stent assistance, over the past 12 years at our institution.

01 agosto 2012

STROKE. Long-term Excess Mortality in Pediatric Patients With Cerebral Aneurysms

Päivi Koroknay-Pál, MD, PhD; Aki Laakso, MD, PhD; Hanna Lehto, MD; Karri Seppä, MSc; Riku Kivisaari, MD, PhD; Juha Hernesniemi, MD, PhD; Mika Niemelä, MD, PhD

Background and Purpose—Knowledge of the long-term excess mortality in pediatric aneurysm patients is lacking. The aim of this study was to assess the long-term excess mortality of 102 pediatric patients with cerebral aneurysm treated at the department of neurosurgery at Helsinki University Central Hospital between 1937 and 2009.

01 julio 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Point-of-Care Testing for Anticoagulation Monitoring in Neuroendovascular Procedures

H.M. Husseina, A.L. Georgiadisa and A.I. Qureshia

SUMMARY: POC testing is defined as diagnostic testing at or near the site of patient care. Rapid measurement of the intensity of anticoagulation and, more recently, platelet inhibition allows dose titration of adjuvant medications such a heparin and antiplatelet agents during neuroendovascular procedures. However, knowledge among practicing physicians regarding the pathophysiologic basis of these measurements and variations in knowledge about the differences among devices is often limited. This review discusses the role of anticoagulation in endovascular procedures and the currently available POC tests for anticoagulation monitoring.

01 agosto 2012

STROKE. Timing of Aneurysm Treatment After Subarachnoid Hemorrhage. Relationship With Delayed Cerebral Ischemia and Poor Outcome

Sanne M. Dorhout Mees, MD; Andrew J. Molyneux, MD, PhD; Richard S. Kerr, MD, PhD; Ale Algra, MD, PhD; Gabriel J.E. Rinkel, MD, PhD

Background and Purpose—The ideal timing of coiling or clipping after aneurysmal subarachnoid hemorrhage is unknown. Within the International Subarachnoid Aneurysm Trial we assessed differences in incidence of delayed cerebral ischemia and clinical outcome between different timings of treatment.

01 septiembre 2013

ENDOVASCULAR TODAY. CREST-2: Guiding Treatments for Asymptomatic Carotid Disease

By Brajesh K. Lal, MD; James F. Meschia, MD; and Thomas G. Brott, MD

In 2010, a grant proposal to evaluate the best approach for managing patients with high-grade primary carotid atherosclerotic stenosis was first submitted for funding to the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH). In this conception, CREST-2 was to be a single randomized trial with two treatment arms: best revascularization (either carotid endarterectomy [CEA] or carotid artery stenting [CAS]) and intensive medical management versus intensive medical management alone.

01 agosto 2012

STROKE. Multimodal Recanalization Therapy in Acute Basilar Artery Occlusion. Long-Term Functional Outcome and Quality of Life

Caroline Ottomeyer, MD; Judith Zeller; Gunther Fesl, MD; Markus Holtmannspötter, MD; Christian Opherk, MD; Andreas Bender, MD; Martin Dichgans, MD; Hartmut Brückmann, MD; Thomas Pfefferkorn, MD

Background and Purpose—Multimodal recanalization therapy in patients with acute basilar artery occlusion provides high recanalization rates. A substantial subset of treated patients survives with only minor or moderate functional handicap. However, long-term functional outcome and quality of life in these patients have rarely been systematically analyzed.

01 septiembre 2013

NEUROSURGERY. A Multicenter Study of Stent-Assisted Coiling of Cerebral Aneurysms With a Y Configuration

Fargen, Kyle M. MD, MPH*; Mocco, J MD, MS‡; Neal, Dan MS*; Dewan, Michael C. MD‡; Reavey-Cantwell, John MD, MS§; Woo, Henry H. MD¶; Fiorella, David J. MD¶; Mokin, Maxim MD, PhD‖; Siddiqui, Adnan H. MD, PhD||; Turk, Aquilla S. DO#; Turner, Raymond D. MD#; Chaudry, Imran MD#; Kalani, M. Yashar S. MD, PhD**; Albuquerque, Felipe MD**; Hoh, Brian L. MD*

BACKGROUND: Stent-assisted coiling with 2 stents in a Y configuration is a technique for coiling complex wide-neck bifurcation aneurysms.

01 agosto 2013

AMERICAN JOURNAL OF NEURORADIOLOGY. Comparison of 10 TTP and Tmax Estimation Techniques for MR Perfusion-Diffusion Mismatch Quantification in Acute Stroke

N.D. Forkerta, P. Kaesemanna, A. Treszlb, S. Siemonsenc, B. Chengd, H. Handelse, J. Fiehlerc and G. Thomallad

BACKGROUND AND PURPOSE: The mismatch between lesions identified in perfusion- and diffusion-weighted MR imaging is typically used to identify tissue at risk of infarction in acute stroke. The purpose of this study was to analyze the variability of mismatch volumes resulting from different time-to-peak or time-to-maximum estimation techniques used for hypoperfused tissue definition.

01 agosto 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Computerized Occlusion Rating: A Superior Predictor of Aneurysm Rebleeding for Ruptured Embolized Aneurysms

C. Sherifd,e,f, A. Grubera, E. Schusterb, E. Lahnsteinerb, D. Gibsonf, H. Milavecb,e, B. Feichterb,e, M. Wiesenderb,e, C. Dorfera, M. Krawagnaa, A. Di Ievaa,c, G. Bavinszkia and E. Knospa

BACKGROUND AND PURPOSE: The initial angiographic occlusion rate is the strongest predictor of later rebleeding in previously ruptured coil-embolized cerebral aneurysms. Angiographic estimations of aneurysmal occlusion rates are, however, subjective in nature and confounded by methodologic problems. COR has been developed, and its superiority has been experimentally established to overcome subjective bias. The purpose of this study was to assess the clinical value of COR as a more objective predictor of aneurysm rebleeding when compared with SOR as described in the Raymond Classification.

28 agosto 2013

WORLD JOURNAL OF RADIOLOGY. Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty

Hidenari Hirata, Akio Hiwatashi, Takashi Yoshiura, Osamu Togao, Koji Yamashita, Hironori Kamano, Kazufumi Kikuchi and Hiroshi Honda.

We are the first to report a case that showed spontaneous resolution of epidural hematoma which was related to a steroid-induced osteoporotic compression fracture. The patient had a painful fracture with an intravertebral cleft at L1 accompanying an epidural hematoma posteriorly. Immediate pain relief was achieved after percutaneous vertebroplasty. Complete resolution of hematoma was noted three months after procedure. We theorized that intravertebral stability after treatment might have played a role in this patient.

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