23 febrero 2016

STROKE. Clinical Sciences. Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke. A Matched-Pairs Analysis

Anne Broeg-Morvay, MD*; Pasquale Mordasini, MD, MSc*; Corrado Bernasconi, MD, PhD; Monika Bühlmann, MD; Frauke Pult, MD; Marcel Arnold, MD; Gerhard Schroth, MD; Simon Jung, MD; Heinrich P. Mattle, MD; Jan Gralla, MD, MSc*; Urs Fischer, MD, MSc*

Background and Purpose: Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear.

25 febrero 2016

STROKE. Clinical Sciences. Association Between Time From Stroke Onset and Fluid-Attenuated Inversion Recovery Lesion Intensity Is Modified by Status of Collateral Circulation

Anke Wouters, MD; Patrick Dupont, PhD; Soren Christensen, PhD; Bo Norrving, MD; Rico Laage, PhD; Götz Thomalla, PhD; Greg Albers, MD; Vincent Thijs, MD; Robin Lemmens, MD

Background and Purpose: In patients with acute stroke, the intensity of a fluid-attenuated inversion recovery (FLAIR) lesion in the region of diffusion restriction is associated with time from symptom onset. We hypothesized that collateral status as assessed by the hypoperfusion intensity ratio could modify the association between time from stroke onset and FLAIR lesion intensity.

08 marzo 2016

STROKE. Clinical Sciences. Association Between Time to Reperfusion and Outcome Is Primarily Driven by the Time From Imaging to Reperfusion

Marc Ribo, MD; Carlos A. Molina, MD; Erik Cobo, PhD; Neus Cerdà, PhD; Alejandro Tomasello, MD; Helena Quesada, MD; Maria Angeles De Miquel, MD; Mónica Millan, MD; Carlos Castaño, MD; Xabier Urra, MD; Luis Sanroman, MD, PhD; Antoni Dàvalos, MD; Tudor Jovin, MD, for the REVASCAT Trial Investigators*

Background and Purpose: A progressive decline in the odds of favorable outcome as time to reperfusion increases is well known. However, the impact of specific workflow intervals is not clear.

17 febrero 2016

STROKE. Clinical Sciences. Inflammatory Markers and Outcomes After Lacunar Stroke. Levels of Inflammatory Markers in Treatment of Stroke Study

Amelia K. Boehme, PhD, MSPH; Leslie A. McClure, PhD; Yu Zhang, MS; Jorge M. Luna, MS; Oscar H. Del Brutto, MD; Oscar R. Benavente, MD; Mitchell S.V. Elkind, MD, MS

Background and Purpose: We hypothesized that concentrations of interleukin 6 (IL-6), serum amyloid A, tumor necrosis factor-α receptor 1, CD40 ligand, and monocyte chemoattractant protein 1 would predict recurrent ischemic stroke and major vascular events after recent lacunar stroke.

02 febrero 2016

STROKE. Clinical Sciences. Documentation of Improved Outcomes for Intracranial Aneurysm Management Over a 15-Year Interval

Michelle H. Chua, BS; Christoph J. Griessenauer, MD; Christopher J. Stapleton, MD; Lucy He, MD; Ajith J. Thomas, MD; Christopher S. Ogilvy, MD

Background and Purpose: Despite rapid advancements in intracranial aneurysm management, there is no evidence as of yet that this has translated into improvement in overall prognosis.

17 febrero 2016

STROKE. Clinical Sciences. Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Maxim Mokin, MD, PhD; Ashish Sonig, MD, MS; Sananthan Sivakanthan, BS; Zeguang Ren, MD, PhD; Lucas Elijovich, MD; Adam Arthur, MD, MPH; Nitin Goyal, MD; Peter Kan, MD, MPH; Edward Duckworth, MD; Erol Veznedaroglu, MD; Mandy J. Binning, MD; Kenneth M. Liebman, MD; Vikas Rao, MD; Raymond D. Turner IV, MD; Aquilla S. Turk, DO; Blaise W. Baxter, MD; Guilherme Dabus, MD; Italo Linfante, MD; Kenneth V. Snyder, MD, PhD; Elad I. Levy, MD, MBA; Adnan H. Siddiqui, MD, PhD

Background and Purpose: Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes.

26 enero 2016

STROKE. Clinical Sciences. Cortical Venous Filling on Dynamic Computed Tomographic Angiography. A Novel Predictor of Clinical Outcome in Patients With Acute Middle Cerebral Artery Stroke

Ido R. van den Wijngaard, MD; Marieke J.H. Wermer, MD, PhD; Jelis Boiten, MD, PhD; Ale Algra, MD, PhD; Ghislaine Holswilder, MSc; Frederick J.A. Meijer, MD, PhD; Diederik W.J. Dippel, MD, PhD; Birgitta K. Velthuis, MD, PhD; Charles B.L.M. Majoie, MD, PhD; Marianne A.A. van Walderveen, MD, PhD

Background and Purpose: Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome.

14 enero 2016

STROKE. Clinical Sciences. Thrombus Length Estimation on Delayed Gadolinium–Enhanced T1

Shenqiang Yan, MD; Qingmeng Chen, MM; Mengjun Xu, MD; Jianzhong Sun, MB; David S. Liebeskind, MD; Min Lou, MD, PhD

Background and Purpose: Previous studies revealed a close relationship between thrombus length and recanalization rate after intravenous thrombolysis (IVT). As a novel approach, we prospectively adjusted the order of sequence acquisition to obtain delayed gadolinium–enhanced T1 (dGE-T1) and thereby assess thrombus length on dGE-T1 to evaluate its predictive value for recanalization after IVT.

28 enero 2016

STROKE. Clinical Sciences. Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke

Olvert A. Berkhemer, MD*; Ivo G.H. Jansen, MD*; Debbie Beumer, MD; Puck S.S. Fransen, MD; Lucie A. van den Berg, MD; Albert J. Yoo, MD; Hester F. Lingsma, PhD; Marieke E.S. Sprengers, MD, PhD; Sjoerd F.M. Jenniskens, MD, PhD; Geert J. Lycklama à Nijeholt, MD, PhD; Marianne A.A. van Walderveen, MD, PhD; René van den Berg, MD, PhD; Joseph C.J. Bot, MD, PhD; Ludo F.M. Beenen, MD; Anna M.M. Boers, MSc; Cornelis H. Slump, PhD; Yvo B.W.E.M. Roos, MD, PhD*; Robert J. van Oostenbrugge, MD, PhD*; Diederik W.J. Dippel, MD, PhD*; Aad van der Lugt, MD, PhD*; Wim H. van Zwam, MD, PhD*; Henk A. Marquering, PhD*; Charles B.L.M. Majoie, MD, PhD*, on behalf of the MR CLEAN Investigators

Background and Purpose: Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).

04 febrero 2016

STROKE. Clinical Sciences. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke

Emilie M.M. Santos, MSc*; Henk A. Marquering, PhD*; Mark D. den Blanken, MSc; Olvert A. Berkhemer, MD, MSc; Anna M.M. Boers, MSc; Albert J. Yoo, MD; Ludo F. Beenen, MD; Kilian M. Treurniet, MD, MSc; Carrie Wismans, BSc; Kim van Noort, BSc; Hester F. Lingsma, PhD; Diederik W.J. Dippel, MD, PhD; Aad van der Lugt, MD; Wim H. van Zwam, MD, PhD; Yvo B.W.E.M. Roos, MD, PhD; Robert J. van Oostenbrugge, MD; Wiro J. Niessen, PhD; Charles B. Majoie, MD, PhD, on behalf of the MR CLEAN Investigators

Background and Purpose: Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment intra-arterial treatment success. We hypothesize that the combination of computed tomographic angiography and noncontrast computed tomography imaging allows measurement of contrast agent penetrating a permeable thrombus, and it is associated with improved outcome.

01 abril 2016

JOURNAL OF NEUROSURGERY. Long-term treatment outcome of venous-predominant arteriovenous malformation

Jin Pyeong Jeon, MD1, Jeong Eun Kim, MD2, Jun Hyong Ahn, MD1, Won-Sang Cho, MD2, Young Dae Cho, MD3, Young-Je Son, MD2, Jae Seung Bang, MD2, Hyun-Seung Kang, MD2, Chul-Ho Sohn, MD3, Hyun-Tai Chung, PhD2, Chang Wan Oh, MD2, and Dong Gyu Kim, MD2

OBJECT: Treatment strategies for venous-predominant arteriovenous malformation (vp-AVM) remain unclear due to the limited number of cases and a lack of long-term outcomes. The purpose of this study was to report the authors’ experience with treatment outcomes with a review of the pertinent literature in patients with vp-AVM.

01 abril 2016

JOURNAL OF NEUROSURGERY. Correlation between angiographic transit times and neurological status on admission in patients with aneurysmal subarachnoid hemorrhage

Alexander Ivanov, MD1, Andreas Linninger, PhD1,2, Chih-Yang Hsu, BS2, Sepideh Amin-Hanjani, MD1, Victor A. Aletich, MD1, Fady T. Charbel, MD1, and Ali Alaraj, MD1

OBJECT: The use of digital subtraction angiography (DSA) for semiquantitative cerebral blood flow(CBF) assessment is a new technique. The aim of this study was to determine whether patients with aneurysmal subarachnoid hemorrhage (aSAH) with higher Hunt and Hess grades also had higher angiographic contrast transit times (TTs) than patients with lower grades.

05 noviembre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Radiation Doses in Patient Eye Lenses during Interventional Neuroradiology Procedures

R.M. Sánchez, E. Vañó, J.M. Fernández, S. Rosati and L. López-Ibor

BACKGROUND AND PURPOSE: Eye lenses are among the most sensitive organs to x-ray radiation and may be considered at risk during neurointerventional radiology procedures. The threshold dose to produce eye lens opacities has been recently reduced to 500 mGy by the International Commission on Radiologic Protection. In this article, the authors investigated the radiation doses delivered to patients´ eyes during interventional neuroradiology procedures at a university hospital.

29 octubre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Retrospective Analysis of Delayed Intraparenchymal Hemorrhage after Flow-Diverter Treatment: Presentation of a Retrospective Multicenter Trial

A. Benaissa, C. Tomas, F. Clarençon, N. Sourour, D. Herbreteau, L. Spelle, S. Gallas, A.-C. Januel, A.L. Gaultier and L. Pierot

BACKGROUND AND PURPOSE: Intracranial aneurysm treatment with flow diverters has shown satisfying results in terms of aneurysm occlusion, and while some cases of delayed intraparenchymal hemorrhage have been described, no systematic analysis of the risk factors affecting its occurrence has been conducted in a large series of patients. This retrospective analysis of delayed intraparenchymal hemorrhage after flow-diverter treatment is a multicenter, retrospective study using a large series of treated patients to analyze factors affecting the occurrence of delayed intraparenchymal hemorrhage.

19 noviembre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Intravenous C-Arm Conebeam CT Angiography following Long-Term Flow-Diverter Implantation: Technologic Evaluation and Preliminary Results

S.C.H. Yu, K.T. Lee, T.W.W. Lau, G.K.C. Wong, V.K.Y. Pang and K.Y. Chan

BACKGROUND AND PURPOSE: A noninvasive investigation with high spatial resolution and without metal artifacts is necessary for long-term imaging follow-up after flow-diverter implantation. We aimed to evaluate the diagnostic value of conebeam CT angiography with intravenous contrast enhancement in the assessment of vascular status following implantation of the Pipeline Embolization Device and to analyze the preliminary results of vascular status following long-term Pipeline Embolization Device implantation.