TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Elements of a Stroke Center

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Use of Stentrievers in Acute Stroke: Tips, Tricks, and Current Results

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Techniques and Results: Intracranial Stenting

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Acute Stroke: Techniques and Results With the Merci Retriever

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Techniques and Results—Penumbra Aspiration Catheter

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. The Natural History of Acute Ischemic Stroke Due to Intracranial Large-Vessel Occlusion: What Do We Know?

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.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Current Indications and Results of Thrombolysis by Intravenous Recombinant Tissue Plasminogen Activator

A number of landmark trials have proven the efficacy of thrombolysis by intravenous recombinant tissue plasminogen activator in the acute phase of the ischemic stroke. Despite the recently extended time window of 4.5 hours, the number of people who are being treated in most centers is low. Several reasons seem to account for this, including poor recognition of symptoms, delays in emergency transport, low levels of public awareness, or age limits originally imposed by drug regulatory rules. Trials are ongoing to possibly extend the indications to the treatment. A major effort is to extend the time window by bridging the treatment with neuroprotective approaches, or by identifying subgroups that may particularly benefit from recanalization and reperfusion. Procedures using ultrasounds or alternative intravenous compounds are also being investigated with promising results. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 10-18, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.

TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY. Intra-arterial Thrombolysis: Tissue Plasminogen Activator and Other Thrombolytic Agents

Recanalization rates with the administration of intravenous tissue plasminogen activator in acute ischemic stroke are low. Adjuvant endovascular techniques that achieve recanalization by direct intra-arterial (IA) delivery of thrombolytics, mechanical clot retrieval, clot aspiration, and stenting may complement intravenous pharmacotherapy. IA thrombolytics can be administered within 6 hours of symptom onset in anterior circulation strokes and within 24 hours in posterior circulation strokes. This review describes the indications, patient selection, and technique for IA administration of thrombolytics. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 41-46, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.

NEUROSURGERY. Magnetic Resonance Imaging-Based Oxygen Challenge Technique Replaced PET in Ischemic Penumbra

NEUROSURGERY. The Role of Notch in Development and Regression of Vascular Fistulas

The pathogenesis behind vascular malformations resulting from vascular dilatation or shunting remains unclear despite many years of genetics and proteonomics studies. Lesions such as arteriovenous malformations (AVMs), cavernous malformations, telangiectasias, and aneurysms likely result from abnormal embryonal genetic development and/or post-natal alteration in protein expression. In each of these lesions there is likely a multi-factorial cascade that results in abnormal vascular development and/or proliferation. Neurosurgery: August 2012 - Volume 71 - Issue 2 - p N18–N19 doi: 10.1227/01.neu.0000417533.23118.e1. Copyright © by the Congress of Neurological Surgeons

NEUROSURGERY. Hemorrhage From Arteriovenous Malformations During Pregnancy

BACKGROUND: Previous hemorrhage, deep venous drainage, and deep location are established risk factors for arteriovenous malformation (AVM) hemorrhage. Although pregnancy is an assumed risk factor, there is a relative paucity of data to support this neurosurgical tenet. Neurosurgery: August 2012 - Volume 71 - Issue 2 - p 349–356 doi: 10.1227/NEU.0b013e318256c34b. Copyright © by the Congress of Neurological Surgeons

AMERICAN JOURNAL OF NEURORADIOLOGY. Proteomic Analysis of Aneurysm Healing Mechanism after Coil Embolization: Comparison of Dense Packing with Loose Packing

BACKGROUND AND PURPOSE: In clinical practice, durability of occlusion following coil embolization is superior in densely packed, compared with loosely packed, aneurysms. In a rabbit model, we probed, by using proteomics tools, the biologic mechanisms associated with densely packed and completely occluded aneurysms, compared with loosely packed and incompletely occluded aneurysms, to explore the biologic mechanisms of intra-aneurysmal healing following embolization. AJNR Am J Neuroradiol 33:1177– 81
Jun-Jul 2012
www.ajnr.org. Copyright © 2012 by American Journal of Neuroradiology

AMERICAN JOURNAL OF NEURORADIOLOGY. Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

BACKGROUND AND PURPOSE: Cerebral venous thrombosis is a rare entity that can be difficult to manage. Most patients with cerebral sinus thrombosis recover after treatment with heparin, but a subgroup of severe cerebral venous sinus thrombosis has a poor prognosis. Those patients may benefit from intrasinus thrombolysis. The purpose of this research was to carry out a retrospective analysis of patients with severe cerebral venous sinus thrombosis, and to study the safety and efficacy of intrasinus thrombolysis in patients with cerebral venous sinus thrombosis unresponsive to conventional heparin therapy. AJNR Am J Neuroradiol 33:1187–90
Jun-Jul 2012
www.ajnr.org. Copyright © 2012 by American Journal of Neuroradiology

STROKE. Intracranial Stenting With Wingspan

Intracranial atherosclerotic disease (ICAD) is a major cause of stroke and yet there are no proven effective treatments for it. Medical therapy has been associated with a high rate of recurrence, particularly in those with the most severe stenoses who have a 22.5% risk of stroke or death in the first year after a stroke. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.

STROKE. Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study

Background and Purpose—Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study). Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628