01 mayo 2012

STROKE. Manual Aspiration Thrombectomy. Adjunctive Endovascular Recanalization Technique in Acute Stroke Interventions

Brian Jankowitz, MD; Amin Aghaebrahim, MD; Alexandra Zirra; Oana Spataru, MD; Syed Zaidi, MD; Mouhammad Jumaa, MD; Gerardo Ruiz-Ares, MD; Michael Horowitz, MD; Tudor G. Jovin, MD

Background and Purpose—We evaluated recanalization rates, clinical outcomes, and safety when manual aspiration thrombectomy is used in conjunction with other thrombolytic modalities in a consecutive case series of patients with large vessel intracranial occlusion.

01 mayo 2012

STROKE. Mechanism of Ischemic Infarct in Spontaneous Cervical Artery Dissection

Audrey Morel, MD; Olivier Naggara, MD, PhD; Emmanuel Touzé, MD, PhD; Jean Raymond, MD; Jean-Louis Mas, MD, PhD; Jean-Francois Meder, MD, PhD; Catherine Oppenheim, MD, PhD

Background and Purpose—It is unclear whether strokes in patients with spontaneous cervical artery dissection (CAD) are due to secondary thromboembolism or to a reduction in cerebral blood flow from the primary cervical lesion. The aim of this study was to identify the most likely mechanism of stroke using cervical and cerebral imaging parameters in patients with CAD.

01 mayo 2012

STROKE. Postradiosurgery Hemorrhage Rates of Arteriovenous Malformations of the Brain. Influencing Factors and Evolution With Time

Vera Parkhutik, MD; Aida Lago, MD, PhD; José Ignacio Tembl, MD; Juan Francisco Vázquez, MD; Fernando Aparici, MD; Esperanza Mainar, MD; Víctor Vázquez, MD

Background and Purpose—The long-term benefit of radiosurgery of brain arteriovenous malformations (AVM), especially nonhemorrhagic cases, is controversial. We calculated hemorrhage rates pre- and posttreatment and analyzed the risk factors for bleeding based on cases followed at our site.

01 mayo 2012

STROKE. Silent Intralesional Microhemorrhage as a Risk Factor for Brain Arteriovenous Malformation Rupture

Yi Guo, MD; Tara Saunders, MD; Hua Su, MD; Helen Kim, PhD; Deniz Akkoc, BS; David A. Saloner, PhD; Steven W. Hetts, MD; Christopher Hess, MD, PhD; Michael T. Lawton, MD; Andrew W. Bollen, MD, DVM; Tony Pourmohamad, MA; Charles E. McCulloch, PhD; Tarik Tihan, MD, PhD; William L. Young, MD for the University of California, San Francisco Brain Arteriovenous Malformation (UCSF bAVM) Study Project

Background and Purpose—We investigated whether brain arteriovenous malformation silent intralesional microhemorrhage, that is, asymptomatic bleeding in the nidal compartment, might serve as a marker for increased risk of symptomatic intracranial hemorrhage (ICH). We evaluated 2 markers to assess the occurrence of silent intralesional microhemorrhage: neuroradiological assessment of evidence of old hemorrhage—imaging evidence of bleeding before the outcome events–and hemosiderin positivity in hematoxylin and eosin-stained paraffin block sections.

01 mayo 2012

AMERICAN JOURNAL OF ROENTGENOLOGY. New Criteria for the Sonographic Diagnosis of a Plaque Ulcer in the Extracranial Carotid Artery

Mutsuko Muraki, Taisei Mikami, Tetsuyuki Yoshimoto, Shin Fujimoto, Kohichi Tokuda, Sadao Kaneko and Takeshi Kashiwaba

OBJECTIVE. The diagnostic power of carotid sonography in detecting plaque ulcers may be inadequate when using the conventional criteria. We aimed to evaluate the usefulness of new criteria that we devised through a preliminary analysis of 50 endarterectomy cases before the present series.

01 abril 2012

CIRCULATION. Common Carotid Artery Dissection Caused by a Frontal Thrust in Kendo (Japanese Swordsmanship)

Rieko Suzuki, MD; Masato Osaki, MD; Kaoru Endo, MD; Tatsuo Amano, MD; Kazuo Minematsu, MD, PhD; Kazunori Toyoda, MD, PhD

A 66-year-old right-handed man suddenly developed left hemiplegia after an opponent thrust at his neck with a bamboo sword during a practice game of Kendo (Japanese swordsmanship; Figure 1). Fifty minutes later, he visited our emergency service. His blood pressure was 77/55 mm Hg in the left arm but could not be measured in the right arm; his right radial artery was initially pulseless but became palpable 1 hour later. He was somnolent and had left unilateral spatial neglect, left complete hemiplegia, and left-sided sensory disturbance. Enhanced computed tomography (CT) showed an occlusion 15 mm distal to the origin of the right common carotid artery (CCA) without any abnormal findings at the aorta and innominate and right subclavian arteries. On emergent carotid ultrasonography, an intraluminal filling defect occupied the right CCA and swung back and forth with pulsation. He was diagnosed as having ischemic stroke, possibly caused by traumatic CCA dissection, although an infarct was not identified on brain CT.

28 abril 2013

WORLD JOURNAL OF RADIOLOGY. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

Bora Korkmazer, Burak Kocak, Ercan Tureci, Civan Islak, Naci Kocer and Osman Kizilkilic.

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

01 mayo 2012

CIRCULATION. Multiple Biomarkers and Risk of Clinical and Subclinical Vascular Brain Injury. The Framingham Offspring Study

Aleksandra Pikula, MD; Alexa S. Beiser, PhD; Charles DeCarli, MD; Jayandra J. Himali, MSc; Stephanie Debette, MD, PhD; Rhoda Au, PhD; Jacob Selhub, PhD; Geoffrey H. Toffler, MD; Thomas J. Wang, MD; James B. Meigs, MD, MPH; Margaret Kelly-Hayes, RN, DEd; Carlos S. Kase, MD; Philip A. Wolf, MD; Ramachandran S. Vasan, MD; Sudha Seshadri, MD

Background—Several biomarkers have been individually associated with vascular brain injury, but no prior study has explored the simultaneous association of a biologically plausible panel of biomarkers with the incidence of stroke/transient ischemic attack and the prevalence of subclinical brain injury.

01 mayo 2012

STROKE. An Admission Bioclinical Score to Predict 1-Year Outcomes in Patients Undergoing Aneurysm Coiling

Vincent Degos, MD, PhD; Christian C. Apfel, MD, PhD; Paola Sanchez, MD, PhD; Chantal Colonne, MD; Isabelle Renuit, MD; Frédéric Clarençon, MD; Aurélien Nouet, MD; Anne Laure Boch, MD; Tony Pourmohamad, MA; Helen Kim, PhD; Pierre Antoine Gourraud, PhD; William L. Young, MD; Louis Puybasset, MD, PhD

Background and Purpose—A number of scores were developed to predict outcomes after clipping for subarachnoid hemorrhages, yet there is no score for patients undergoing endovascular treatment. Our goal was to develop, compare, and validate a predictive score for 1-year outcomes in patients with coiled subarachnoid hemorrhage.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke.The ReFlow (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke) Study

Christian Roth, MD; Wolfgang Reith, MD; Silke Walter, MD; Stefanie Behnke, MD; Michael Kettner, MD; Julio Viera, MD; Umut Yilmaz, MD; Maria Alexandrou, MD; Maria Politi, MD; Panagiotis Kostopoulos, MD; Heiko Körner, MD; Christoph Krick, MD; Anton Haass, MD; Klaus Fassbender, MD; Panagiotis Papanagiotou, MD

Objectives: This study sought to assess the feasibility and safety of a recently described technique of mechanical recanalization with the help of a stent-like device.

01 mayo 2012

STROKE. Clinical Prediction Rule to Estimate the Absolute 3-Year Risk of Major Cardiovascular Events After Carotid Endarterectomy

Guus W. van Lammeren, MD; Louise M. Catanzariti, MSc; Linda M. Peelen, PhD; Jean-Paul P.M. de Vries, MD, PhD; Dominique P.V. de Kleijn, PhD; Frans L. Moll, MD, PhD; Gerard Pasterkamp, MD, PhD; Michiel L. Bots, MD, PhD

Background and Purpose—Prognosis after carotid endarterectomy is mainly determined by the occurrence of major adverse cardiovascular events (MACEs). Optimal medical treatment to reduce risk is the mainstay of MACE prevention. The level of risk of MACE may determine the initiation and aggressiveness of medical treatment, yet a prediction rule to assess that absolute MACE risk after carotid endarterectomy is currently unavailable.

01 mayo 2012

JACC. First In Vivo Application of Microwave Radiometry in Human Carotids. A New Noninvasive Method for Detection of Local Inflammatory Activation

Konstantinos Toutouzas, MD; Charalampos Grassos, MD; Maria Drakopoulou, MD; Andreas Synetos, MD; Eleftherios Tsiamis, MD; Constantina Aggeli, MD; Konstantinos Stathogiannis, MD; Dimitrios Klettas, MD; Nikolaos Kavantzas, MD; Georgios Agrogiannis, MD; Efstratios Patsouris, MD; Christos Klonaris, MD; Nikolaos Liasis, MD; Dimitrios Tousoulis, MD; Elias Siores, BSc, MSc, PhD; Christodoulos Stefanadis, MD

Objectives: This study investigated whether temperature differences: 1) can be measured in vivo noninvasively by microwave radiometry (MR); and 2) are associated with ultrasound and histological findings.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Asymptomatic Cerebral Lesions in Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting

Klaudija Bijuklic, MD; Andreas Wandler, MD; Thilo Tübler, MD; Joachim Schofer, MD, PhD

Objectives: This study sought to analyze the impact of new asymptomatic cerebral ischemic lesions, found in diffusion-weighted magnetic resonance imaging (DW-MRI) after carotid artery stenting (CAS) in relation to other risk factors for major adverse cerebral and cardiovascular events (MACCE) defined as death, stroke, and myocardial infarction.

01 mayo 2012

STROKE. Hemodynamic Differences Between Unruptured and Ruptured Intracranial Aneurysms During Observation

Hiroyuki Takao, MD, PhD; Yuichi Murayama, MD; Shinobu Otsuka, MS; Yi Qian, PhD; Ashraf Mohamed, PhD; Shunsuke Masuda; Makoto Yamamoto, PhD; Toshiaki Abe, MD

Background and Purpose—We evaluated several hemodynamic parameters for the prediction of rupture in a data set of initially unruptured aneurysms, including aneurysms that ruptured during follow-up observation.

01 abril 2013

JACC. Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events in Patients Undergoing Protected Carotid Stenting. Results of the Randomized ARMYDA-9 CAROTID Study

Giuseppe Patti, MD; Fabrizio Tomai, MD; Rosetta Melfi, MD; Elisabetta Ricottini, MD; Michele Macrì, MD; Pietro Sedati, MD; Arianna Giardina, MD; Cristina Aurigemma, MD; Mario Leporace, MD; Andrea D Ambrosio, MD; Germano Di Sciascio, MD

Objectives This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.