NEURORADIOLOGY. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome

Wiebke Kurre, Kai Bansemir, Marta Aguilar Pérez, Rosa Martinez Moreno, Elisabeth Schmid, Hansjörg Bäzner, Hans Henkes

Introduction: In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet.

CIRCULATION. Mortality and Cerebrovascular Events After Heart Rhythm Disorder Management Procedures

Justin Z. Lee , Jayna Ling , Nancy N. Diehl , David O. Hodge , Deepak Padmanabhan , Ammar M. Killu , Malini Madhavan , Peter A. Noseworthy , Suraj Kapa , Christopher J. McLeod , Yong-Mei Cha , Abhishek J. Deshmukh , Komandoor Srivathsan , Fred M. Kusumoto , Win-Kuang Shen , Paul A. Friedman , Thomas M. Munger , Samuel J. Asirvatham , Douglas L. Packer , and Siva K. Mulpuru

Background: Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures is an essential step for the development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and characterize death and CVEs (stroke or transient ischemic attack) after HRDM procedures over a 17-year period.

CIRCULATION. Carotid Stent Fractures Are Not Associated With Adverse Events

Ido Weinberg, Joshua A. Beckman, Jon S. Matsumura, Kenneth Rosenfield, Gary M. Ansel, Seemant Chaturvedi, William Gray, D. Chris Metzger, Tom Riles, Yu Shu, Lawrence Wechsler and Michael R. Jaff

Background: The impact of carotid artery stent fractures on the incidence of adverse clinical events remains unclear. The objective of this study is to report the stent fracture rate and its association with in-stent restenosis and adverse outcomes in the ACT-1 trial (Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Subjects Who Are at Standard Risk for Carotid Endarterectomy With Significant Extracranial Carotid Stenotic Disease).

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Intracranial hemorrhage in a patient with sub‐massive pulmonary embolism treated with EkoSonic endovascular system directed thrombolysis

Sarju Ganatra MD, Arjun Majithia MD, Yun‐Ting Eric Yeh MD, Michael S. Levy MD

Ultrasound‐assisted catheter‐directed thrombolysis therapy has emerged more recently as a management strategy for patients with intermediate risk pulmonary embolism and has shown promising results in clinical trials by early reversal of right ventricle dilation, reduced pulmonary hypertension, and decreased anatomic thrombus burden. This therapeutic strategy requires a small fraction of the systemic fibrinolytic dose and is therefore associated with a reduced bleeding risk. Although intracranial hemorrhage has not been reported in clinical trials, it is a possible complication. Here we report the first case of intracranial hemorrhage related to the use of EkoSonic™ Endovascular System directed thrombolysis in a patient with large bilateral pulmonary embolism without any identifiable bleeding risks.

Mechanical Thrombectomy in Patients Presenting with NIHSS Score <6: A Safety and Efficacy Analysis

Rawad Abbas, MD Nabeel A. Herial, MD, MPH Kareem El Naamani, MD Ahmad Sweid, MD Joshua H. Weinberg, MD Karl John Habashy, BS Stavropoula Tjoumakaris, MD Michael R. Gooch, MD Robert H. Rosenwasser, MD, MBA Pascal Jabbour, MD

Background and Objectives Groundbreaking trials have shown the tremendous efficacy of mechanical thrombectomy for large vessel occlusions. Currently, mechanical thrombectomy is limited to patients with NIHSS scores ≥6. We investigated the feasibility and safety of MT in patients presenting with NIHSS scores <6.

Geometric Features Associated with Middle Cerebral Artery Bifurcation Aneurysm Formation: A Matched Case-Control Study

Jian Zhang, MD 1 Anil Can, MD 1 Pui Man Rosalind Lai, MD Srinivasan Mukundan, MD, PhD Victor M. Castro, MS Dmitriy Dligach, PhD Sean Finan, BS Vivian S. Gainer, MS Nancy A. Shadick, MD, MPH Guergana Savova, PhD Shawn N. Murphy, MD, PhD Tianxi Cai, PhD Scott T. Weiss, MD, MS Rose. Du, MD, PhD

Objectives The pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. We aimed to identify image-based morphological parameters that were associated with middle cerebral artery (MCA) bifurcation aneurysms.

Platelet Distribution Width: A Significant Predictor of Poor Outcome After Mechanical Thrombectomy

Ye Li, PhD Tao Li, PhD Lili Zhao, PhD Yiheng Zhang, MD Xiaoya Wang, MD Yulun Wu, MD Ziwei Lu, MD Jialiang Lu, MD Meijuan Dang, PhD Heying Wang, MD Yating Jian, MD Xiaoyun Lu, PhD Xiaofei Yang, PhD Songhua Fan, MD, PhD Lei Zhang, MD Yu Jiang, MD, PhD Guogang Luo, MD, PhD Guilian Zhang, MD, PhD

Objectives Elevated platelet distribution width (PDW) is a recognized marker of platelet activity. Herein, we investigated the association between admission PDW values and clinical outcome at 3 months in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).

Histological Analysis of Carotid Plaques: The Predictors of Stroke Risk

Norbert Svoboda, MD Richard Voldřich, MD Václav Mandys Tomas Hrbáč, PhD Petra Kešnerová, MD Martin Roubec, PhD David Školoudík David Netuka

Highlights • Foamy macrophages and thrombosis are significant predictors of symptomatic carotid artery stenosis. • Symptomatic plaques were significantly more frequently classified as AHA type VI than AHA type IV-V compared to asymptomatic ones. • A complex plaque structure (AHA type VI) is, rather than the single histological features, predictive of plaque instability.

Association Between CT Angiogram Collaterals and CT Perfusion in Delayed Time Windows for Large Vessel Occlusion Ischemic Strokes

Sriharsha Voleti, BS Yasmin N Aziz, MD Johnathan Vidovich, MD Brendan Corcoran, MD Bin Zhang, PhD Eva Mistry, MBBS Vivek Khandwala, PhD Pooja Khatri, MD, MSc Thomas Tomsick, MD Lily Wang, MBBS Abdelkader Mahammedi, MD Achala Vagal, MD, MS

Objectives Recent endovascular trials have established the use of CT perfusion (CTP) in endovascular treatment selection for patients with large vessel occlusions (LVO). However, the relationship between CTP and collateral circulation is unclear in delayed time windows. We explored the relationship between CT Angiogram (CTA) collaterals and CTP parameters in delayed time windows (6-24 hours).

Outcomes of Mechanical Thrombectomy for Ischemic Stroke in Nonagenarians: A 10-Year Institutional Experience

Fareed Jumah, MD Bharath Raju, MD Elizabeth E. Ginalis, MD Omar Ashraf, MD Michael S. Rallo, B.S. Vinayak Narayan, MD Taha Nisar, MD Priyank Khandelwal, MD Sudipta Roychowdhury, MD Emad Nourollah-Zadeh, MD Gaurav Gupta, MD Anil Nanda, M.D., M.P.H. Hai Sun, MD, PhD

Background Nonagenarians have been underrepresented in stroke trials that established endovascular treatment as the standard for acute ischemic stroke (AIS). Evidence remains inconclusive regarding the efficacy of thrombectomy in this population.

Flow Diversion for Acutely Ruptured Intracranial Aneurysms Treatment: A Retrospective Study and Literature Review

Andrea Giorgianni, MD Edoardo Agosti, MD Stefano Molinaro, MD Alberto Vito Terrana, MD Francesco Alberto Vizzari, MD Luca Nativo, MD Kanwaljeet Garg, MCh Giuseppe Craparo, MD Vinicio Conti, MD Davide Locatelli, MD Fabio Baruzzi, MD Luca Valvassori, MD Giuseppe Lanzino, MD

Objective Flow diversion is becoming an increasingly established practice for the treatment of acutely ruptured intracranial aneurysms. In this study the authors present a literature review and meta-analysis, adding a retrospective review of institutional registry on emergency treatment of aRIA with flow diverter stent.

Red Cell Distribution Width as a Predictor of One-Year Prognosis and Mortality of Endovascular Therapy for Acute Anterior Circulation Ischemic Stroke

Zhengyang Wang ,Yin Liu

Objectives To investigate if Red cell distribution width (RDW) can predict long-term prognosis in patients with acute ischemic stroke (AIS) receiving endovascular therapy (EVT).

Acute Treatment of Isolated Posterior Cerebral Artery Occlusion: Single Center Experience

runo Cunha Mariana Baptista Jaime Pamplona Rui Carvalho Catarina Perry da Câmara Marta Alves Ana Luísa Papoila Ana Paiva Nunes João Reis Isabel Fragata

Background and objectives Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO.

Influence of Thrombocytopenia on the Outcome of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Mirjana Ždraljević Tatjana Pekmezović Predrag Stanarčević Ivan Vukašinović Ivana Berisavac Marko Ercegovac Filip Vitošević Dragoslav Nestorović Vladimir Cvetić Višnja Padjen Maja Stefanović- Budimkić Tamara Švabić Medjedović Dejana R. Jovanović

Objectives Mechanical thrombectomy (MT) has become leading treatment option for acute ischemic stroke (AIS) due to large vessels occlusion (LVO). Platelet counts may affect outcome in patients with AIS or transient ischemic attack. The aim of our study was to determine the influence of thrombocytopenia on the safety and efficacy of MT in patients with AIS due to anterior circulation LVO.

Usefulness of Silent Magnetic Resonance Angiography in the Follow-Up of Endovascular-Treated Intracranial Aneurysm: A Prospective Study

Song Tan, MD Yuzhao Lu, MD Bin Li, MD Qin Wu, MD Xiaobing Zhou, MD Yang Wang, MD

Objectives To prospectively evaluate the clinical usefulness of Silent magnetic resonance angiography (Silent MRA) in the follow-up of endovascular-treated intracranial aneurysms by comparing it with time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA).