SUMMARY: As stroke is one of the leading causes of death and long-term morbidity worldwide, the research community has studied cardiac embolic sources, as well as vessel wall pathologies. For the latter, attention has been focused on defining morphologic tissue features associated with catastrophic events stemming from the carotid artery. Multiple noninvasive imaging modalities are currently being used to image and classify carotid atherosclerotic plaques, such as MR imaging, CT, and sonography, in an effort to provide clinically relevant predictive metrics for use in patient risk stratification and to define appropriate treatment options. This article compares and contrasts these existing clinical imaging modalities along with discussion of a new endovascular technique originally developed for cardiology, OCT, with which 3D comprehensive high-resolution images of the arterial wall can be acquired. Published online before print March 8, 2012, doi: 10.3174/ajnr.A2753 AJNR 2012 33: 1642-1650. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Recanalization is observed in 20–40% of endovascularly treated intracranial aneurysms. To further reduce the recanalization and expand endovascular treatment, we evaluated the safety and efficacy of closed-cell SACE. Published online before print April 5, 2012, doi: 10.3174/ajnr.A3034 AJNR 2012 33: 1651-1656. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Recently, the use of stents to assist in the coiling and repair of wide-neck aneurysms has been shown to be highly effective; however, the effect of these stents on the RC of the parent vessel has not been quantified. The purpose of this study was to quantify the effect of intracranial stenting on the RC of the implanted artery using 3D datasets. Published online before print April 26, 2012, doi: 10.3174/ajnr.A3062 AJNR 2012 33: 1657-1662. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Development of a headache after aneurysm coil embolization is not uncommon but has received little attention. The authors prospectively analyze the characteristics and risk factors of a headache after coiling in patients treated for an unruptured cerebral aneurysm. Published online before print April 5, 2012, doi: 10.3174/ajnr.A3018 AJNR 2012 33: 1676-1678. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: The pathogenesis and characteristics of multiple DAVSs are not well-known. The purpose of this study was to evaluate the angiographic and clinical characteristics of patients with multiple DAVSs with an emphasis on the pathomechanism. Published online before print April 26, 2012, doi: 10.3174/ajnr.A3054 AJNR 2012 33: 1691-1695. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: NGAVFs are rare vascular malformations usually presenting in infancy or childhood. We sought to identify clinical and angiographic predictors of clinical outcome for these lesions. Published online before print July 5, 2012, doi: 10.3174/ajnr.A3194 AJNR 2012 33: 1710-1719. Copyright © 2012 by American Journal of Neuroradiology
Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. CardioVascular and Interventional Radiology 2012, DOI: 10.1007/s00270-012-0450-9. Copyright © Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012
BACKGROUND AND PURPOSE: The pathogenesis and characteristics of multiple DAVSs are not well-known. The purpose of this study was to evaluate the angiographic and clinical characteristics of patients with multiple DAVSs with an emphasis on the pathomechanism. Published online before print April 26, 2012, doi: 10.3174/ajnr.A3054 AJNR 2012 33: 1691-1695 . Copyright © 2012 by American Journal of Neuroradiology
Endovascular stroke therapy is an effective means of achieving reperfusion in stroke patients with proximal cerebral artery occlusions. However, current guideline recommendations express uncertainty regarding the clinical efficacy of catheter-based treatments, given the lack of supportive trial data. A critical problem is that it remains unclear which patients will benefit from endovascular therapy. As such, patient selection is likely highly variable in clinical practice. This article will review the existing data to discuss the clinical and imaging factors that are relevant to patient outcomes, and which may be used to guide endovascular treatment decisions. Anterior circulation strokes represent the primary focus of this review. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 33-40, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
The past decade has ushered in a refined understanding of—and commitment to—objective evidence-based practice of stroke management. Responding to the need for universal protocol-driven guidelines for stroke care, the Brain Attack Coalition published consensus statements with recommendations for primary stroke centers (Alberts MJ, et al, JAMA 283:3102-3109, 2000) and comprehensive stroke centers (Alberts MJ, et al, Stroke 36:1597-1616, 2005) in 2000 and 2005, respectively. These benchmark publications helped to define a new “standard of care” for stroke patients and laid the groundwork to establish formal certification for stroke centers. Although large randomized controlled trials evaluating the efficacy of these guidelines are currently underway, several recent reports suggest that stroke center certification may improve outcomes in patients with acute ischemic stroke. In this article, the authors briefly discuss the status of stroke center certification and the evolution of stroke systems of care. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 5-9, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
Stentrievers are stent-like devices used in the treatment of acute ischemic stroke. They have demonstrated efficacy in restoring the intracranial blood flow with low procedural times. This article is a synopsis of the available devices and different techniques. An extensive review of the literature summarizing all the data that have been published demonstrating their clinical impact and complications is also presented. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 68-77, March 2012. Copyright © 2012. Published by Elsevier Inc. All rights reserved.
Recanalization rates with conventional pharmacologic thrombolysis and thrombectomy devices in the treatment of large-vessel occlusions are low. Moreover, these patients do not have favorable clinical outcomes. Better recanalization devices and approaches are needed. In this review, we describe current stents used in the intracranial circulation and their application in the treatment of acute ischemic stroke due to large-vessel occlusion. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 60-67, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
Acute ischemic stroke is one of the most prominent causes of death and disability in the modern world. Despite extensive research, the only Food and Drug Administration-approved pharmacologic treatment is intravenous recombinant tissue plasminogen activator (rt-PA). Although reperfusion remains the most robust predictor of clinical outcome, rt-PA has been linked to low recanalization rates in large-vessel occlusion. Endovascular techniques have been developed over past decade with several theoretic advantages over intravenous rt-PA alone, including longer treatment windows and higher recanalization rates in large-vessel occlusions. The Merci retriever thrombectomy device was approved by the Food and Drug Administration in 2004 for removing thrombus in acute ischemic stroke. In this article, we review the indications for acute stroke endovascular treatment with the Merci retriever as well as the involved techniques and the results of research studies. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 47-52, March 2012. Copyright © 2012 Published by Elsevier Inc.
The Penumbra System is an endovascular mechanical thrombectomy device that uses continuous aspiration to perform recanalization of occluded intracranial vessels. The objective of this article was to provide a comprehensive overview of the data on technical and functional outcome so far published for aspiration thrombectomy and resume techniques that can be used to optimize functionality of the Penumbra System. We focus on existing clinical data as well as our institutional experience and techniques. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 53-59, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
Acute ischemic stroke (AIS) is an important public health issue with major impact on not only patients and families but also on the society as well. Among patients who suffer from AIS, those who have the event due to large-vessel occlusion are thought to have the worse outcome. Because most of the effort in endovascular treatment of AIS is aimed toward this type of stroke, it is important to understand its natural history. The goal of this manuscript was to briefly discuss the natural history of AIS due to large-vessel occlusion based on recent literature. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 2-4, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
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