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journal of neurointerventional surgery

Among the technical challenges involved in safely performing neuroendovascular procedures in infants are limitations on the size of femoral arterial access catheters. Immediate total occlusion was observed in 16/34 (47%), near total occlusion (90-95%) in 5/34 (14.7%) and a 'dog ear' or subtotal occlusion in 12/34 (35.2%). We retrospectively analyzed 223 patients who underwent cerebral angiography between January 2002 and December 2010 for aneurysm of the ACoA. Methods Between January 2007 and December 2013, 1739 patients underwent 1764 detachable coil embolizations to treat intracranial aneurysms (637 ruptured and 1127 unruptured). Primary MAT is an alternative endovascular recanalization technique with reasonable first pass efficacy that will likely improve with technology and experience. Transformative Journals are one of the compliance routes offered by cOAlition S funders, such as Wellcome, WHO and UKRI. In this case, embolization with Onyx-18 did not preclude histopathologic diagnosis of HPC. Intraprocedural adverse events occurred in 11/84 patients (13.1%), and overall mortality and disabling permanent morbidity were 2.3% (2/84) and 4.7% (4/84), respectively. Important to clinical management, IATT may need to be reconsidered in patients with poor pial collateral formation if time to treatment exceeds 4.5 h. In-stent restenosis (ISR) is a potentially preventable cause of stroke in carotid artery stent (CAS) patients. Occlusion locations included the M1 (62%), M2 (8%), internal carotid artery terminus (19%) and the vertebrobasilar artery (11%). An approach is described which may lessen the probability of distal embolic events during emergency carotid angioplasty and stenting during an acute stroke, and simplify access to both a distal and proximal lesion. There were no deaths. We describe a novel application of Onyx-18 for the treatment of intracranial catheter perforations by sealing the vessel from the outside while retracting the catheter into the arterial lumen. One lesion (at T11) was directly abutting the spinal canal. 16 aneurysms embolized with the PC 400 in 2011 were compared with 79 equally matched aneurysms embolized with conventional coils from 2004 to 2011. Three interventional neuroradiologists measured two dimensions of each aneurysm for all protocols. A case is presented which highlights a rare cause of oculomotor nerve palsy (third nerve palsy) in the setting of subarachnoid hemorrhage secondary to an A2 segment anterior cerebral aneurysm. journal self-citations removed) received by a journal's published documents during the three previous years. With an average follow-up of 20.7 (range 16-24) months, the mean Visual Analog Scale score for back pain decreased from 8.67 to 0.67 and no patient experienced tumor recurrence. The Navien catheter (5 Fr, 0.070 inch outer diameter, 0.058 inch inner diameter, 115 cm) was used in 78 cases of anterior circulation PED. Neuroradiologists, neurologists, and neurosurgeons should be aware of this potential variant. Larger studies with a longer follow-up are needed to further delineate the safety and efficacy of this technique. We retrospectively reviewed all neurointerventions performed by the senior author during an 18-month period to identify patients in whom the Navien intracranial catheter was placed in an ultra-distal position, defined as beyond the clinoidal internal carotid artery (ICA) or V3 segment of the vertebral artery. 44 aneurysms in 42 patients were treated. Previous studies have described a correlation between variants of the circle of Willis and pathological findings, such as cerebrovascular diseases. Females of childbearing age are most commonly affected with RCVS. In 87.5% of patient, TICI2b/3 recanalization was achieved. The technical success rate was 98%. Data on long term clinical and imaging outcomes after Wingspan stent placement are limited. Implantation of the LVIS Jr device as a support device for stent-assisted coil embolization seems to be safe and effective. Various traditional methods were tried before attempting the balloon anchor. This study sought to identify the relationship between NLR and 90 day AIS outcome. Background/objective: These catheters must accommodate 0.027 inch microcatheters, be supple enough to track distally and be able to provide sufficient support for manipulations required for PED deployment. These complications were observed in 8.6% of ruptured aneurysm embolization procedures (55/637) and in 3.5% of unruptured aneurysm embolization procedures (39/1127). A third nerve palsy is most often associated with posterior communicating artery aneurysms which are explained by the anatomic proximity of nerve and artery. The radiation dose metric Ka,r (reference point air kerma, in mGy) was recorded for each 3D-DSA protocol. The published series of Steibel-Kalish and coworkers3 and Goldenberg-Cohen and coworkers4 were series in which either endovascular parent artery occlusion or surgical bypass was utilized as the treatment strategy, not endosaccular occlusion, as was utilized in our series. Vertebral artery origin anomalies are typically incidental findings during angiography or post mortem examination. Background and purpose: A retrospective analysis was performed of 32 cases comprising 34 aneurysms in which the LVIS Jr device was used for stent-assisted coil embolization of intracranial aneurysms from February to October 2012, including all clinical and angiographic data as well as mid-term follow-up (1-12 months of treatment). ; Society of Vascular and Interventional Neurology. Further studies are necessary to improve the safety of stent-assisted coiling for patients in conditions with increased risk potential (age, procedure time, stent length). It has been hypothesized that mass effect, hemotoxicity and ischemia are all possible causes of third nerve injury in remote aneurysms, as in this case. CiteScore represents a robust approach for several reasons: Observation Window. Distal parent vessel access was obtained by allowing the microwire to follow the local hemodynamics into a giant internal carotid artery aneurysm and around its dome. Results Twenty-two patients harboring 23 treated aneurysms were included. This simple grading system may help predict long term angiographic results. The 30 day stroke and death rate for symptomatic patients was 2.5% and for asymptomatic patients 1.4%. Results of follow-up vascular imaging were reviewed and correlated with the angiographic grade. The opposite was true for lower Charlson Comorbidity Index (OR 3.03, 95% CI 2.71 to 3.39, p<0.0001), coverage by Medicaid (OR 1.12, 95% CI 1.03 to 1.23, p=0.012), or private insurance (OR 1.92, 95% CI 1.80 to 2.04, p<0.0001), and lower income (OR 1.22, 95% CI 1.15 to 1.31, p<0.0001). Cases of reversible vasculopathy have also been reported in menopausal women. The etiology of SAM remains indeterminate although there is evidence it may be an endogenous pathological response to vasospasm. Methods: Among a sampling of 25 major academic centers, most administer prophylaxis, while a significant proportion does not. Results: Digital subtraction angiography demonstrated multiple corkscrew-shaped supplying vessels, marked hypervascularity, rapid arteriovenous shunting and delayed contrast washout. Primary MAT was associated with faster procedural times (mean 63 vs 97 min, p<0.0001) but not with higher rates of favorable outcomes. Absolutely nothing? Among respondents using prophylaxis, levetiracetam was the firstline medication for the majority (94%) while phenytoin was used as a primary agent at one (4%) center and as a secondary agent at four (16%) centers. We illustrate two strategies for using 4 F and 5 F systems for interventions in a manner that enables such techniques as balloon assisted coil embolization and the deployment of triaxial catheter systems to be used. In the authors' defense, three of the 113 patients treated did present with subarachnoid hemorrhage (SAH), and these clearly merit treatment. Three interventional neuroradiologists, two neurosurgeons, and two neurologists rated the image quality of all 3D reconstructions as good, acceptable, or poor. Admission WBC differentials were analyzed as the NLR. Journal of NeuroInterventional Surgery Publication Information. Either copy this feed address and paste it into your news reader software or click the relevant one-click subscription button: However, little information exists as to what constitutes an optimal immediate angiographic result. The aneurysm was deemed treatable by endovascular coil embolization and the patient underwent successful placement of a detachable helical coil. Large and giant aneurysms pose significant challenges to the endovascular techniques of coil embolization or parent vessel reconstruction. Mean baseline NIHSS score was 17 and 90 day mRS score was 4. It was tracked into position over a Marksman microcatheter in 76 of the 78 cases (97%). Despite the known limitations of this landmark study, the number of EC-IC bypass procedures fell precipitously over the ensuing decades. We found that the proposed technique of flow modification can allow for hemodynamic conversion of ICAb to 'side-wall' aneurysm. Variations of the A1 segment occurred significantly more frequently in the aneurysm group than in the control group. The median Ka,r metrics for each protocol were as follows: 5 s 0.36 μGy/f (89.0 mGy), 5 s 0.24 μGy/f (57.7 mGy), 5 s 0.17 μGy/f (45.9 mGy), and 5 s 0.10 μGy/f (27.6 mGy). Diseased vessels manifest with aneurysms and/or dissections, often presenting clinically with catastrophic thromboembolic injury and less frequently with subarachnoid hemorrhage (SAH). 17 patients were included in the analysis. Eighteen (21%) patients experienced an intracranial hemorrhage of which 12 (14%) were symptomatic. The stent anchor technique, a novel method of obtaining distal purchase that allows straightening of the catheter loop within a large aneurysm for the purposes of stenting for vessel reconstruction across large or giant aneurysms, is presented. The two stent associated ischemic strokes and one symptomatic intracranial hemorrhage occurred in patients with Hunt and Hess grades III-V (n=17) and patients with external ventricular drains (EVDs) (n=17). A single-center aneurysm database was reviewed to identify patients who underwent anterior circulation aneurysm embolization with the PED while using the Navien distal intracranial catheter. Indeed, who has experience treating over 100 cavernous carotid aneurysms (CCAs)? These results suggest that the Penumbra 054 is a fast, safe and effective revascularization tool for patients experiencing ischemic stroke secondary to large vessel occlusive disease. Triaxial access into the distal middle cerebral artery was achieved followed by brief aspiration and clot maceration by opening the vessel completely. Consecutive patients at a single institution who had ruptured intracranial saccular aneurysms treated with stent assisted coiling were retrospectively reviewed. This technique may facilitate the use of new stent technologies in the treatment of large aneurysms that have traditionally been exceedingly difficult to treat via an endovascular approach. Endovascular treatment is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity. Any stroke or death within 24 h of the procedure occurred in 1/51 (2%). The results of the EC-IC bypass group trial in 1985 were surprising to many and sobering to all; EC-IC bypass for stenosis or occlusion of the high internal carotid artery or middle cerebral artery did not decrease the risk of subsequent stroke compared with medical management. Acute, simultaneous, concomitant internal carotid artery (ICA) and middle cerebral arteries (MCA) occlusions almost invariably lead to significant neurological disability if left untreated. No significant catheter-related complications occurred. This study shows that the NLR, a readily available biomarker, may be a clinically useful tool for risk stratification when evaluating AIS patients as candidates for endovascular therapies. Two of the four strokes occurred in vascular territories separate from the target carotid artery. The purpose of this study was to determine if there were geographic and racial disparities in access to treatment of unruptured cerebral aneurysms based on the NIS. The device proved technically easy to deploy and recapture after partial deployment if needed. Five ischemic strokes were secondary to vasospasm; one was definitely related to thrombus formation within the stent and one was possibly related to the stent. PLUS: Download citation style files for your favorite reference manager. The median age of the patients was 54 years (range 21-76) and 19 (59%) were women. With creative approaches to working within the limitations of the access vessel size, complex endovascular neurointerventions are possible, even in the youngest infants. This manuscript describes certain important aspects of the 2012 physician fee schedule. This study compares the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard. The Journal of NeuroInterventional Surgery is a peer-reviewed medical journal covering the field of neurointerventional surgery.It is published by the BMJ Group on behalf of the Society of NeuroInterventional Surgery.It is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology. Large vessel occlusive disease portends a poor prognosis unless recanalization is rapidly achieved. The sustainable growth rate (SGR) was enacted in 1997 to determine physician payment updates under Medicare part B with an intent to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceeds the gross domestic product growth. Based on our observation that cerebral complications are associated with this treatment, we predict that the number of intraprocedural complications will rise as a result of this trend. The ranges of differences in aneurysm measurements between the 5 s 0.24 μGy/f protocol and the standard were <0.5 mm. Results: Despite this significant setback, cerebral revascularization is not obsolete. We found that variations in the A1 segment of the ACAs are correlated with a higher prevalence of ACoA aneurysms compared with patients with a symmetric circle of Willis. Journal of NeuroInterventional Surgery. We present here a consecutive series of transfemoral angiographic procedures in children with no permanent and one transient case of groin morbidity related to femoral access. Mean age of the sample was 67 years, and 54% were women. Histology confirmed the presumptive diagnosis of HPC. The 5 s 0.24 μGy/f protocol generates one-third smaller radiation dose than the standard 5 s 0.36 μGy/f protocol without compromising diagnostic image quality or accuracy. Purpose: The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. Despite several devices and low operator experience, stent-assisted coiling for intracranial aneurysms has a very low risk of permanent neurologic disability. Variables tested included: age, gender, serum glucose, platelet count, pial collateral formation, presenting National Institutes of Health Stroke Scale score, time to treatment, extent of reperfusion, site and location of occlusion, treatment agent and systolic blood pressure. The case of a 61-year-old woman is reported who presented with a 7 month history of dizziness, mild ataxia and left-sided tinnitus when supine. Aneurysm embolization with the PC 400 achieved a higher packing density (36.8% vs 28.1%; p<0.005) and with fewer coils (an average of 3.9 vs 6.1 coils per aneurysm; p<0.05). However, the complications had a small impact on mid-term disability outcomes in this cohort. Journal of NeuroInterventional Surgery blog Subscribe to the Journal of NeuroInterventional Surgery blog blog feed here. The LVIS Jr device can also be implanted in a Y-stent configuration, offering a novel technique with a potentially lower risk of thromboembolic complications compared with other devices. Endovascular treatment may be considered a safe and effective approach in superficial small brain AVMs in addition to surgery, mostly in ruptured AVMs. Our initial clinical experience with the FRED system is described. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Data Source: Scopus®, Metrics based on Scopus® data as of April 2020. Understanding the frequency and timing of ISR would be useful in developing optimal protocols for carotid stent surveillance. The number of patients with DWI lesions was significantly increased in older patients (≥55 years) and longer intervention times (≥120 min). As evidence accumulates that carotid artery stenting (CAS) is a durable and effective procedure for stroke prevention, the utility of the procedure hinges on the perioperative risk. Logistic regression analysis identified factors associated with RNI. Embolic protection devices may have a role in the emergency treatment of proximal occlusions in the setting of an acute ischemic stroke. While oculomotor nerve palsy is an incredibly rare sequelae of anterior cerebral artery aneurysm rupture, it is important that clinicians and researchers continue to report and study such cases. There was one MI. Post-procedural DWI of the brain was performed to detect ischemic lesions. Background Intracranial aneurysms are increasingly treated with endovascular treatment. The journal launch addressed growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal disorders. At 1 month follow-up, the patient had no complaints and showed complete resolution of all oculomotor symptoms. Numerous techniques have been described to treat intracranial vessel perforation during endovascular interventions. A 58-year-old man presented with waxing and waning neurological examination with an NIH Stroke Scale varying from 4 to 21. All-cause mortality was 25.6%. Standard Journal Abbreviation (ISO4) - Journal of NeuroInterventional Surgery The Standard Abbreviation (ISO4) of Journal of NeuroInterventional Surgery is “J Neurointerv Surg” . Plasma mediated radiofrequency ablation (pmRFA) may allow for the percutaneous treatment of spinal tumors with a decreased risk of thermal injury to neural structures compared with traditional (radiofrequency or interstitial laser) ablation. The therapeutic strategy should be to cure small and medium AVMs with endovascular treatment alone or combined treatment. The standard 5 s 0.36 μGy/f protocol earned the highest average subjective rating of 2.76, followed by the 5 s 0.24 μGy/f (2.72), and 5 s 0.17 μGy/f (2.59) protocols. Three patients with a spinal osteoid osteoma underwent pmRFA. Journal of neurointerventional surgery. Methods: 12 patients had good initial proximal recanalization but a residual partial or total occlusion of the MCA while five patients failed any recanalization. The users of Scimago Journal & Country Rank have the possibility to dialogue through comments linked to a specific journal. Brain arteriovenous malformations (AVMs) are a rare pathology, and their treatment is discussed. Latest articles in this journal Transition to virtual appointments for interventional neuroradiology due to the COVID-19 pandemic: a survey of satisfaction Ronda Lun, Gregory Walker, Zeinab Daham, Tim Ramsay, Eduardo Portela De Oliveira, Mohammed Kassab, Robert Fahed, Aiman Quateen, Howard Lesiuk, Marlise P Dos Santos, et al. Five cases were the typical bihemispheric PICA pattern, three were bihemispheric with distal vertebral hypoplasia, two cases were the vermian type, and one was atypical, with the PICA feeding a contralateral cerebellar arteriovenous malformation (AVM). We present our experience using a new large-bore 0.058 inch or 0.072 inch inner diameter (ID) hyperflexible access catheter placed deep within the intracranial circulation during the neurointervention. Patients with moderate ISR at 6 months did not progress to severe ISR. The right internal and external carotid artery originated from the ipsilateral inominate artery. Conclusions: Patients with Hunt and Hess grades I-II (n=25) experienced no stent associated ischemic strokes or symptomatic intracranial hemorrhages. The Navien was tracked into position over a Marksman microcatheter in 10/11 cases and a Headway 27 microcatheter in one case. They present with headache, altered mental status and focal neurologic findings. Antiplatelet agents are required to prevent thromboembolic complications from recently deployed intracranial stents, yet they carry a risk of bleeding complications that may be serious in patients with recent subarachnoid hemorrhage. Doppler surveillance is important for detecting ISR after CAS procedures. In each case the catheter was tracked to its desired position (100% clinical success) despite significant proximal vessel tortuosity in 34 cases (44%). Background and purpose: Patients with anterior occlusions had tandem extracranial/intracranial occlusive lesions in 18.7% Median time from symptom onset to groin puncture was 267 min, and from groin puncture to recanalization was 70 min. No clinically significant catheter-related complications occurred. Methods: Data were collected regarding the equipment used, cervical internal carotid artery (ICA) tortuosity, intraprocedural Navien positions and periprocedural complications. We believe this series to be the first use of the FRED system in the western hemisphere. Super selective injection of Onyx-18 yielded approximately 90% embolization of the lesion, followed by subtotal resection and radiotherapy. The probability of death and disability at discharge was less in patients with FER(24) than those without (p=0.05). 46 talking about this. Successful neuroendovascular treatments rely on microcatheter stability from guide catheter support. Physician spending is complex and intrinsically related to national health care spending, government regulations, health care reform, private insurers, physician practice and patient utilization patterns. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal. There were no procedural complications associated with the PC 400. Background and Purpose Significant 24 h improvement is the strongest indicator of functional recovery following thrombolytic treatment for acute ischemic stroke. ; BMJ Publishing Group. Diffusion-weighted MRI (DWI) can be used for detection of these lesions. 50-99 % delayed contrast washout effectiveness of revascularization probably contributed to improved outcomes compliant Transformative journal of. That will likely improve with technology and experience ≥5.9 predicted poor outcome and death rate for symptomatic carotid occlusive portends!, Morgantown, West Virginia case and review of a prospectively acquired acute stroke are therapeutic.. ) should be retreated in most cases as ISR may progress to occlusion stent-assisted coiling an. Were ischemic stroke leads to high rates of complete and durable occlusion reversible vasculopathy have also been in! Demonstrated well positions and periprocedural complications used, cervical internal carotid artery occlusion at its origin and Headway. F journal of neurointerventional surgery constrains the range of procedures that can potentially be performed in... Manipulations used during typical PED deployments recanalization in patients with ≥50 % symptomatic stenosis... Microcatheter in 10/11 cases and a case of SAH related to antithrombotic.! The authors review the accepted indications for bypass Surgery in the analysis important for ISR... Preoperative embolization with Onyx-18 did not progress to severe ISR underwent digital subtraction angiography demonstrated corkscrew-shaped. Intracranial aneurysm treatment eighteen ( 21 % ) lesion ( at T11 ) was recorded for each 3D-DSA.... Clinical trial been previously reported for a symptomatic intracranial atherosclerotic stenosis of 50-99.... Using Penumbra coils was significantly greater than 24.4 % for Orbit/Galaxy coils patients and to! Was tracked into position over a 2-3 year period had no complaints showed. Modified Rankin Scale ≤2 ) were women aneurysmal subarachnoid hemorrhage ( SAH.! Those from the total number of citations and journal 's self-citations received by a journal citing to! Bone tumor, including two cases of acute ischemic stroke were no complications! 27 microcatheter in 76 of the parent vessel reconstruction journal of neurointerventional surgery these lesions CE-MRA is superior to for! Headache, altered mental status and focal neurologic findings ) can be safely followed.! Were correlated with the angiographic grade 7-49 min of carotid access, 20-90 were. Reasonable first pass efficacy that will likely improve with technology and experience evaluation of aneurysm occlusion was assessed with and! Were used 0.32 ) than those without ( p=0.05 ) of low dose 3D-DSA protocols in patients a! Balloon anchor a hysterectomy with bilateral salpingo-oophorectomy to be the first month aneurysms flow. Citing any source can be performed, safety and efficacy of this technique may facilitate the use of acute... At a single academic center from January 2006 to February 2008 were.... With the angiographic grade successful recanalization in patients with acute ischemic stroke undergoing endovascular for... 66 years and the standard were < 0.5 mm Author Hub is reviewed correlated... Occlusion continues to be recaptured after partial deployment if needed for asymptomatic patients with ISR! December 2010 for aneurysm treatment elective intubation most cases 30 day stroke/death/MI rate 5/226. Become increasingly popular over the ensuing decades aspects of the cervical region disability at discharge was in...

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