Use of new aspiration thrombectomy delivery catheter: a multicenter experience.

Background And Objectives: Large-bore aspiration catheters have demonstrated better recanalization times and higher first-pass effects in large vessel occlusions. However, vessel tortuosity and branching vessels can hinder navigability, potentially increasing the 'ledge effect', procedural times, and the risk of vessel injury. Recently, a newly designed delivery catheter (Carrier Delivery Catheter (CDC), Balt, France) has been introduced to the US market.

Super-large bore catheter in the treatment of large vessel occlusions: initial multicenter experience.

Purpose: Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs).

Objective: To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available.

A Novel Case of Deep Temporal Artery (DTA) Embolization for Recurrent Subacute-Chronic Subdural Hematoma.

Subdural hemorrhage (SDH) is a common neurological disease. In past, SDHs were managed either conservatively (non-surgically) or with surgical evacuation (burr hole versus craniotomy) depending on the severity. Surgical evacuation has major challenges including high recurrence rate, stoppage and reversal of antiplatelet or anticoagulation agents, risk of general anesthesia and surgery in elderly patients with multiple comorbidities.

Retrieval of Migrated Coils From Distal Cerebral Vasculature Using Stent Retriever: A Case Series.

The incidence of coil dislocation during an endovascular embolization of intracranial aneurysm is low but it can lead to serious thrombo-embolic complications. Therefore, coil displacement/migration often requires either retrieval or fixation of the errant coil with a stent. There are no standard recommended methods of coil retrieval.

Internal Carotid Artery Agenesis: A Rare Entity.

Congenital absence of the internal carotid artery (ICA) is an extremely rare entity that occurs due to insult during the embryonic development of the ICA. Various intracranial collateral pathways develop to compensate for the ICA agenesis. Patients can present with aneurysmal subarachnoid hemorrhage, stroke-like symptoms, or other neurological symptoms due to compression of brain structures from enlarged collateral pathways/aneurysms.

Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP).

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment.

Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging.

Methods: Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment.

Safety and Clinical Outcomes after Transverse Venous Sinus Stenting for Treatment of Refractory Idiopathic Intracranial Hypertension: Single Center Experience.

Background: Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure of unknown etiology. Unilateral or bilateral transverse sinus (TS) or transverse-sigmoid junction stenosis is present in about 30%-93% of these patients. There is an ongoing debate on whether venous sinus stenosis is the cause of IIH or a result of it.

Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement.

Background: One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel.

Objective: To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure.

Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access.

A 5-month-old infant was to be treated with elective transarterial embolization for a vein of Galen aneurysmal malformation (VGAM). A team of endovascular surgical neuroradiologists, pediatric interventional radiologists, and pediatric cardiologists attempted conventional femoral arterial access, which was unsuccessful given the small caliber of the femoral arteries and superimposed severe vasospasm. Thereafter, eventual arterial access was achieved by navigating from the venous to the arterial system across the patent foramen ovale following a right femoral venous access.

Intracranial vascular calcification is protective from vasospasm after aneurysmal subarachnoid hemorrhage.

Vasospasm after aneurysmal subarachnoid hemorrhage was noted in some studies to be less frequent and less severe in older age. One hypothesis is that atherosclerosis makes arteries too stiff to spasm. The objective of this study was to assess the association between intracranial calcification, a marker for atherosclerosis, and vasospasm.

Should ischemic stroke patients with aphasia or high National Institutes of Health stroke scale score undergo preprocedural intubation and endovascular treatment?

Background: Presence of aphasia or severe neurologic deficits is considered an indication for preprocedural intubation (PPI) for endovascular treatment (ET) in acute ischemic stroke patients. We determined the feasibility, technical success rates, and outcomes of ET without PPI in 2 groups of patients: those with aphasia and those with an admission NIHSS score of 20 or more.

Methods: The rates of intraprocedural intubation (IPI), good functional outcome at discharge (modified Rankin Scale score of 0-2), mortality, and intracerebral hemorrhage (ICH) were compared between those who did or did not undergo PPI in the above-mentioned patient groups.

Factors associated with length of hospitalization in patients admitted with transient ischemic attack in United States.

Background And Purpose: Approximately 70% of all patients presenting with transient ischemic attack are admitted to the hospital in United States. The duration and cost of hospitalization and associated factors are poorly understood. This article seeks to identify the proportion and determinants of prolonged hospitalization and to determine the impact on hospital charges using nationally representative data.

Long-term clinical and angiographic outcomes in patients with spontaneous cervico-cranial arterial dissections treated with stent placement.

Background: Limited data exist regarding the long-term clinical and angiographic outcomes of patients with spontaneous cervico-cranial arterial dissection treated with stent placement.

Objective: To report the immediate and long-term clinical and angiographic outcomes of patients who received stent placement for spontaneous cervico-cranial arterial dissection.

Methods: We reviewed clinical and angiographic data of consecutive patients with spontaneous, cervico-cranial arterial dissection treated with stent placement.

Combination of noninvasive neurovascular imaging modalities in stroke patients: patterns of use and impact on need for digital subtraction angiography.

Background: The diagnostic work-up of acute stroke relies on the use of proper imaging studies. We sought to determine the use of a combination of 2 noninvasive tests, namely magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) in diagnosing vascular lesions and the necessity for a subsequent digital subtraction angiography (DSA) for the definitive diagnosis.

Methods: Patients admitted to 2 comprehensive stroke centers between January 2008 and July 2010 who had an equivocal initial noninvasive test were reviewed.

Long-term clinical and angiographic outcomes in patients with cervico-cranial dissections treated with stent placement: a meta-analysis of case series.

Limited clinical and angiographic data exists for patients with spontaneous or traumatic cervico-cranial dissections treated with stent placement. We reviewed clinical and angiographic data on consecutive patients admitted to our hospital with spontaneous, traumatic, and iatrogenic cervico-cranial dissections treated with stent placement to study immediate and long-term clinical and angiographic outcomes. Additional patients were identified using pertinent studies published between 1980 and 2009, using a search of the PubMed, Cochrane, and Ovid libraries.

Determinants of neurologic deterioration and stroke-free survival after spontaneous cervicocranial dissections: a multicenter study.

Patients with spontaneous cervicocranial dissection (SCCD) may experience new or recurrent ischemic events despite antiplatelet or anticoagulant therapy. Treatment with stent placement is an available option; however, the literature on patient selection is limited. Thus, identifying patients at high risk for neurologic deterioration after SCCD is of critical importance.

Increased rate of aspiration pneumonia and poor discharge outcome among acute ischemic stroke patients following intubation for endovascular treatment.

Background: An increased risk of aspiration pneumonia among acute ischemic stroke patients following intubation for endovascular treatment may explain the higher rates of poor outcomes among patients requiring general anesthesia compared with those performed under local sedation.

Methods: Rates of aspiration pneumonia and its contribution to poor outcome at discharge (modified Rankin score ≥ 3), and in-hospital mortality were analyzed among endovascularly treated acute ischemic stroke patients at two university-affiliated comprehensive stroke centers. Logistic regression model was used to assess the contribution of intubation and aspiration pneumonia on poor outcome after adjusting for potential confounders.

Thrombolytic treatment of patients with acute ischemic stroke related to underlying arterial dissection in the United States.

Objective: To determine the outcomes related to thrombolytic treatment of an acute ischemic stroke secondary to an arterial dissection in a large national cohort.

Design: Retrospective database study.

Setting: Nationwide Inpatient Sample data files from 2005 to 2008.

Comparison of single versus multiple spontaneous extra- and/or intracranial arterial dissection.

Background: Anecdotal data suggest that approximately 20% of patients with a spontaneous extra- and/or intracranial arterial dissection have multiple arterial involvement. Limited data exist regarding the clinical and angiographic characteristics of patients with multiple arterial dissections. We compared the clinical and angiographic features of patients with spontaneous multiple extra- and/or intracranial arterial dissections with those who have a single arterial dissection.

Agreement in endovascular thrombolysis patient selection based on interpretation of presenting CT and CT-P changes in ischemic stroke patients.

Background: To evaluate the agreement in patient selection based on computed tomography (CT) and CT-perfusion (CT-P) imaging interpretation between stroke specialists in stroke patients considered for endovascular treatment.

Methods: All endovascular-treated acute ischemic stroke patients were identified through a prospective database from two comprehensive stroke centers; 25 consecutively treated patients were used for this analysis. Initial CT images and CT-P data were independently interpreted by five board eligible/certified vascular neurologists with additional endovascular training to decide whether or not to select the patient for endovascular treatment.

Impact of percutaneous transluminal angioplasty for treatment of cerebral vasospasm on subarachnoid hemorrhage patient outcomes.

Background: Percutaneous transluminal angioplasty (PTA) has been introduced for treatment of symptomatic cerebral vasospasm in patients with subarachnoid hemorrhage (SAH). While angiographic improvement is consistently reported, clinical improvement following the procedure varies, and limited data is available regarding overall impact on outcome.

Methods: The authors performed a retrospective analysis of all hospital admissions with aneurysmal SAH over a 6 year period.

Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older.

Objectives: The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (i.v. rt-PA), or endovascular intervention with or without i.

Low risk of intracranial and systemic hemorrhages in patients on dual antiplatelet treatment beyond 1 month following neuroendovascular angioplasty and/or stent placement.

Background: Aspirin and clopidogrel treatment beyond 1 month in patients undergoing angioplasty and/or stent placement within the extra- and/or intracranial arteries is not defined.

Objective: To determine the incidence of intracranial and systemic bleeding events, recurrent ischemic stroke, and death in patients treated with dual antiplatelets for greater than 1 month.

Methods: We determined rates of hemorrhage, stroke, or death in consecutive patients with extra- or intracranial lesions, treated with dual antiplatelets after angioplasty and/or stent procedures.

A comparison of Computed Tomography perfusion-guided and time-guided endovascular treatments for patients with acute ischemic stroke.

Background And Purpose: The role of CT perfusion (CT-P) imaging for the selection of patients with acute ischemic stroke who may benefit from endovascular treatment is not defined. The objective of this study was to determine whether CT-P-guided endovascular treatment improves clinical outcomes compared with standard endovascular treatment based on the time interval between symptom onset and presentation and noncontrast cranial CT imaging.

Methods: A retrospective study was performed comparing the clinical characteristics, complications, and clinical outcomes of patients with acute ischemic stroke who were treated using endovascular modalities based on either CT-P imaging (CT-P-guided) or time interval between symptom onset and presentation and absence of intracerebral hemorrhage or extensive ischemic changes on noncontrast cranial CT scan (time-guided).

Does mild deficit for patients with stroke justify the use of intravenous tissue plasminogen activator?

Intravenous (IV) tissue plasminogen activator (t-PA) is an effective medication currently used to treat acute ischemic stroke within 3 hours of symptom onset in patients with an identifiable clinical deficit measured using the National Institutes of Health Stroke Scale (NIHSS). Some reports suggest that patients with milder acute ischemic stroke may improve spontaneously and may not benefit additionally from IV thrombolysis. The objective of this retrospective study was to assess the outcomes of patients at our stroke center who received IV t-PA treatment for acute ischemic stroke, within 3 hours of symptom onset, outside the setting of a clinical trial and had a NIHSS score of less than or equal to 10 compared with historic control subjects.