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ESTUDIOS


01 julio 2012

RADIOLOGY. Carotid Artery Atherosclerosis: Effect of Intensive Lipid Therapy on the Vasa Vasorum—Evaluation by Using Dynamic Contrast-enhanced MR Imaging

Li Dong, MD, Williams S. Kerwin, PhD, Huijun Chen, PhD, Baocheng Chu, MD, PhD, Hunter R. Underhill, MD, Moni Blazej Neradilek, PhD, Thomas S. Hatsukami, MD, Chun Yuan, PhD and Xue-Qiao Zhao, MD

Purpose: To investigate whether short-term, intensive lipid therapy leads to changes in microvascular characteristics, as measured by using dynamic contrast material–enhanced (DCE) magnetic resonance (MR) imaging. July 2011 Radiology, 260, 224-231. Copyright © RSNA, 2011

29 mayo 2012

CIRCULATION. Thrombolytic Therapy of Acute Stroke

Steven K. Feske, MD

The therapy of acute stroke has advanced dramatically over the last 15 years with the use of intravenous tPA and intra-arterial catheter-based revascularization techniques. At their best, these therapies allow the physician to arrest the progression of what would otherwise become a devastating stroke. Yet, the majority of patients with stroke still do not benefit from these therapies either because the brief time window of benefit and safety imposes administrative, medical, and logistical demands that have not been met or because, even when applied early, these therapies are effective in only some patients. Therefore, it is important that we expand access to and implement currently available therapies as efficiently as possible. In addition, we must continue to refine these therapies and to develop new ones. This review provides a focused update on the current therapy of acute stroke. Circulation. 2012; 125: 2662-2666 doi: 10.1161/​CIRCULATIONAHA.111.060087. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 mayo 2012

JOURNAL OF NEUROSURGERY. Cerebral dural arteriovenous fistulas and aneurysms

Bradley A. Gross, M.D., Alexander E. Ropper, M.D., and Rose Du, M.D., Ph.D.

Object: The association of aneurysms and cerebral arteriovenous malformations is well established in the literature. Aside from a small number of case reports and small patient series, this association has not been well explored with cerebral dural arteriovenous fistulas (DAVFs). This study was designed to elucidate this relationship in the authors own patient cohort with DAVFs. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E2. DOI: 10.3171/2011.12.FOCUS11336.

01 mayo 2012

NEUROSURGERY. Vein of Galen Malformations in Neonates: New Management Paradigms for Improving Outcomes

Berenstein, Alex MD; Fifi, Johanna T. MD; Niimi, Yasunari MD; Presti, Salvatore MD; Ortiz, Rafael MD; Ghatan, Saadi MD; Rosenn, Barak MD; Sorscher, Michelle CPNP; Molofsky, Walter MD

BACKGROUND: Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved. OBJECTIVE: To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs. Neurosurgery: May 2012 - Volume 70 - Issue 5 - p 1207–1214 doi: 10.1227/NEU.0b013e3182417be3. Copyright © by the Congress of Neurological Surgeons

01 mayo 0212

JOURNAL OF NEUROSURGERY. Carotid-cavernous fistulas

Jason A. Ellis, M.D, Hannah Goldstein, B.S, E. Sander Connolly Jr., M.D, and Philip M. Meyers, M.D

Carotid-cavernous fistulas (CCFs) are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The characteristic clinical features seen in patients with CCFs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Once routinely treated with open surgical procedures, including carotid ligation or trapping and cavernous sinus exploration, endovascular therapy is now the treatment modality of choice in many cases. The authors provide a review of CCFs, detailing the current classification and clinical management of these lesions. Therapeutic options including conservative management, open surgery, endovascular intervention, and radiosurgical therapy are presented. The complications and treatment results as reported in the contemporary literature are also reviewed. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E9. DOI: 10.3171/2012.2.FOCUS1223.

12 junio 2012

CIRCULATION. Reversal of Warfarin : Case-Based Practice Recommendations

David A. Garcia, MD; Mark A. Crowther, MD

Case Presentation: A 74-year-old woman presents to the emergency department with bruising. She takes warfarin for atrial fibrillation. She has recently begun taking trimethoprim/sulfamethoxazole. Her international normalized ratio (INR) is reported as 8.6. Circulation. 2012; 125: 2944-2947 doi: 10.1161/​CIRCULATIONAHA.111.081489. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

24 mayo 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Closed-Cell Stent for Coil Embolization of Intracranial Aneurysms: Clinical and Angiographic Results

A.K. Wakhloo, I. Linfante, C.F. Silva, E.A. Samaniego, G. Dabus, V. Etezadi, G. Spilberg and M.J. Gounis

BACKGROUND AND PURPOSE: Recanalization is observed in 20–40% of endovascularly treated intracranial aneurysms. To further reduce the recanalization and expand endovascular treatment, we evaluated the safety and efficacy of closed-cell SACE. Published online before print April 5, 2012, doi: 10.3174/ajnr.A3034. Copyright © 2012 American Society of Neuroradiology

22 marzo 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Atherosclerosis and Stent-Vessel Interactions in Human Carotid Arteries

M.R. Jones, G.F. Attizzani, C.A. Given II, W.H. Brooks, M.A. Costa and H.G. Bezerra

BACKGROUND AND PURPOSE: Carotid artery–related stroke is largely an embolic disease that has been correlated with inflammation, plaque rupture, and thrombus formation in “vulnerable” atherosclerotic plaque. Nevertheless, current guidelines for carotid revascularization in asymptomatic patients rely on the calculation of stenosis for risk assessment, a parameter that has been viewed with increasing skepticism. Intravascular OCT is an imaging technique that offers high axial resolution (10 µm), allowing an unprecedented micron-level assessment of human carotid plaque morphology. This observational article reports the first successful use of the newest iteration of this technology, FDOCT without balloon occlusion to assess human carotid artery disease and carotid stent-vessel interaction in vivo. Published online before print March 15, 2012, doi: 10.3174/ajnr.A3016. Copyright © 2012 American Society of Neuroradiology

01 junio 2011

CIRCULATION. Current Status of Endovascular Stroke Treatment

Philip M. Meyers, MD, FAHA; H. Christian Schumacher, MD; E. Sander Connolly Jr, MD; Eric J. Heyer, MD, PhD; William A. Gray, MD, FAHA; Randall T. Higashida, MD, FAHA

Stroke is the third-leading cause of death in the United States, Canada, Europe, and Japan. According to American Heart Association statistics, there are now 795 000 new strokes each year, resulting in 200 000 deaths, or 1 of every 16 deaths, per year in the United States.1 Ischemic stroke represents 80% of the total, and hemorrhagic stroke makes up the remainder. Stroke is the leading cause of adult disability in both North America and Medicare reimbursement for long-term adult care. The National Institutes of Health (NIH) estimate that stroke costs exceed $73 billion in US healthcare dollars per year.1 Improved treatments are needed to reduce the burden of human suffering and to lessen the financial burden on society. Circulation. 2011; 123: 2591-2601 doi: 10.1161. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

08 marzo 2012

STROKE. Randomized Trial of Clazosentan in Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Endovascular Coiling

R. Loch Macdonald, MD, PhD; Randall T. Higashida, MD; Emanuela Keller, MD; Stephan A. Mayer, MD; Andy Molyneux, MD; Andreas Raabe, MD; Peter Vajkoczy, MD; Isabel Wanke, MD; Doris Bach, MSc; Aline Frey, PharmD; Pegah Nowbakht, PhD; Sébastien Roux, MD; Neal Kassell, MD

Background and Purpose—Clazosentan, an endothelin receptor antagonist, has been shown to reduce vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). CONSCIOUS-3 assessed whether clazosentan reduced vasospasm-related morbidity and all-cause mortality postaSAH secured by endovascular coiling. Stroke. 2012; 43: 1463-1469 Published online before print March 8, 2012. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628

14 junio 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Coil Protection Using Small Helical Coils for Wide-Neck Intracranial Aneurysms: A Novel Approach

Y.D. Cho, J.Y. Lee, J.H. Seo, S.J. Lee, H.-S. Kang, J.E. Kim, O.-K. Kwon, Y.J. Son and M.H. Han

BACKGROUND AND PURPOSE: A number of remodeling or protective techniques available to treat wide-neck intracranial aneurysms are increasingly being used, provided that the shape/type of aneurysm, vessel diameter, and inherent course of the vessel are conducive to their use. The purpose of this study was to describe a novel method using coil protection for treatment of wide-neck aneurysms. Published online before print June 14, 2012, doi: 10.3174/ajnr.A3157. Copyright © 2012 American Society of Neuroradiology

08 marzo 2012

AMERICAN JOURNAL OF NEURORADIOLOGY. Vascular Wall Imaging of Vulnerable Atherosclerotic Carotid Plaques: Current State of the Art and Potential Future of Endovascular Optical Coherence Tomography

B.A. Standish, J. Spears, T.R. Marotta, W. Montanera and V.X.D. Yang

SUMMARY: As stroke is one of the leading causes of death and long-term morbidity worldwide, the research community has studied cardiac embolic sources, as well as vessel wall pathologies. For the latter, attention has been focused on defining morphologic tissue features associated with catastrophic events stemming from the carotid artery. Multiple noninvasive imaging modalities are currently being used to image and classify carotid atherosclerotic plaques, such as MR imaging, CT, and sonography, in an effort to provide clinically relevant predictive metrics for use in patient risk stratification and to define appropriate treatment options. This article compares and contrasts these existing clinical imaging modalities along with discussion of a new endovascular technique originally developed for cardiology, OCT, with which 3D comprehensive high-resolution images of the arterial wall can be acquired. Published online before print March 8, 2012, doi: 10.3174/ajnr.A2753. Copyright © 2012 American Society of Neuroradiology

01 mayo 2012

JOURNAL OF NEUROSURGERY. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx

Nohra Chalouhi, M.D, Aaron S. Dumont, M.D, Stavropoula Tjoumakaris, M.D, L. Fernando Gonzalez, M.D, Jurij R. Bilyk, M.D, Ciro Randazzo, M.D, David Hasan, M.D, Richard T. Dalyai, M.D, Robert Rosenwasser, M.D, and Pascal Jabbour, M.D.

Object: Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E13. DOI: 10.3171/2012.1.FOCUS123.

01 mayo 2012

JOURNAL OF NEUROSURGERY. Recurrence of “cured” dural arteriovenous fistulas after Onyx embolization

Peter Adamczyk, M.D., Arun Paul Amar, M.D., William J. Mack, M.D., and Donald W. Larsen, M.D., M.B.A.

Endovascular embolization with Onyx has been increasingly used to treat intracranial and spinal dural arteriovenous fistulas (DAVFs). Several case series have been published in recent years reporting high DAVF cure rates with this technique. Although it is seldom reported, DAVF recurrence may occur despite initial “cure.” The authors present 3 separate cases of a recurrent DAVF after successful transarterial Onyx embolization. Despite adequate Onyx penetration into the fistula and draining vein, these cases demonstrate that DAVF recanalization may reappear with filling from previous or newly recruited arterial feeders. Other published reports of DAVF recurrence are examined, and potential contributory factors are discussed. These cases highlight the need for awareness of this possible phenomenon and suggest that follow-up angiography should be considered in patients treated with catheter embolization. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E12. DOI: 10.3171/2012.2.FOCUS1224.

05 abril 2011

NEURORADIOLOGY. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

Peter W. A. Willems, Patamintita Taeshineetanakul, Barry Schenk, Patrick A. Brouwer, Karel G. Terbrugge and Timo Krings

Introduction: We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA). Neuroradiology Volume 54, Number 2 (2012), 123-131, DOI: 10.1007/s00234-011-0864-0. Copyright The Author(s) 2011. This article is published with open access at Springerlink.com

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