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Journal Cover Interventional Neurology
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     ISSN (Print) 1664-9737 - ISSN (Online) 1664-5545
     Published by Karger Homepage  [104 journals]
  • Endovascular Revascularization for Basilar Artery Occlusion
    • Abstract: Basilar artery occlusion is one of the most devastating neurological conditions known to man. Though rare, patients with clinical syndromes localized to this anatomical region are often referred to acute stroke and endovascular units. Recent studies evaluating the efficacy of endovascular approaches to stroke have focused on anterior circulation syndromes. In this review, we examine the approaches to stroke syndromes due to basilar artery thrombosis. We share the relevant data for intravenous and intra-arterial tissue plasminogen activator as well as mechanical approaches to restoring perfusion in this critical area of the brain.
      Intervent Neurol 2014;3:31-40
       
  • Pulmonary Arteriovenous Malformation as a Cause of Embolic Stroke: Case
           Report and Review of the Literature
    • Abstract: Background: Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary arteries and veins responsible for right-to-left shunting that could induce the development of embolic stroke. Summary: We describe an 82-year-old woman without history of respiratory or neurological diseases, who presented at our observation unit with acute onset of cerebral ischemia. Clinical, laboratory and radiological findings diagnosed a PAVM. Key Messages: Usually, endovascular procedures based on embolization or, alternatively, surgery represent the recommended treatment. However, both hormonal therapy and thrombolytic therapy can be used. In our patient, treatment with warfarin induced a remission of symptoms. This strategy should be tested in larger studies.
      Intervent Neurol 2014;3:27-30
       
  • Stent Placement for Severe Stenosis of the Left Common Carotid Artery with
           Internal-to-External Carotid Steal
    • Abstract: We report the case of a 64-year-old male with internal carotid artery (ICA)-to-external carotid artery (ECA) steal due to severe stenosis of the common carotid artery (CCA). Left CCA occlusion was initially diagnosed on 3-dimensional time-of-flight magnetic resonance angiography, but digital subtraction angiography revealed severe stenosis of the left CCA and retrograde flow through the left ICA feeding the left ECA. Diverted blood flow from ECA to ICA in cases with occlusion or severe stenosis of the CCA represents a well-known alternative collateral flow pattern called ECA-to-ICA steal. However, collateral flow from ICA to ECA is rarely observed and may be termed ICA-to-ECA steal. We treated CCA stenosis in our patient by carotid artery stenting (CAS) because his CCA stenosis had been gradually progressing since the initial ischaemic attack. Antegrade ICA flow subsequently recovered. To the best of our knowledge, this is the first report of ICA-to-ECA steal normalised by the treatment of CCA stenosis using CAS. © 2014 S. Karger AG, Basel
      Intervent Neurol 2014;3:22-26
       
  • Hemodynamic Changes and Baroreflex Sensitivity Associated with Carotid
           Endarterectomy and Carotid Artery Stenting
    • Abstract: Atherosclerotic carotid lesion is a major cause of stroke which accounts for up to 20% of ischemic stroke. Aggressive treatment of carotid stenosis may prevent stroke. Currently, carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the first-line treatments for severe carotid stenosis. CEA is superior to medical therapy in preventing stroke and cardiovascular death. CAS has emerged as an alternative to CEA in recent years due to its less invasive nature. However, both CEA and CAS may be associated with adverse hemodynamic changes as well as a variation of carotid baroreflex sensitivity. There is no consensus on which of these two methods is more advantageous concerning the procedure-related hemodynamic changes. This article reviews the hemodynamic changes and baroreflex sensitivity after CEA and CAS. © 2014 S. Karger AG, Basel
      Intervent Neurol 2014;3:13-21
       
  • Intercavernous Sinus Dural Arteriovenous Fistula Treated with Transvenous
           Coil Embolization: A Case Report
    • Abstract: The blood supply to the region of the cavernous sinus is provided by interconnecting branches of the internal and external carotid arteries, and it is from these vessels that dural arteriovenous fistulas (DAVFs) arise. It is very rare that DAVFs are located at the intercavernous sinuses region; in this case, a proper localization of the fistulous site is of extreme importance in order to successfully eliminate the disease. Here, we describe a case of a 65-year-old female with intercavernous sinus DAVF. A complete obliteration of the fistulous points was performed by coil embolization through a transvenous approach. © 2014 S. Karger AG, Basel
      Intervent Neurol 2014;3:9-12
       
  • Normal Findings on Pretreatment Transcranial Ultrasound in Patients
           Treated with Sonothrombolysis
    • Abstract: In populations with a high (≥14) median National Institute of Health Stroke Score (NIHSS), a normal finding of Thrombolysis in Brain Ischemia grade 5 (TIBI 5) in the artery of interest has been reported to be an unusual finding when transcranial ultrasound is performed during thrombolysis. In such instances, a stroke mimic can be suspected, but there are alternative pathophysiological explanations. In this case series, the median NIHSS was relatively low (5), and 33% (6/18) of the patients treated with thrombolysis had TIBI 5 in the artery of interest at the time of treatment initiation. These 6 patients had normal findings on the computerized tomography angiography. Only 33% (2/6) of these patients were stroke mimics, the remaining had either lacunar (n = 2) or cortical strokes (n = 2). These cortical stroke patients probably had a pretreatment recanalization marked by partial symptom regression before treatment onset. Compared to patients with TIBI
       
  • Contents Vol. 2, 2013
    • Abstract:
      Intervent Neurol 2013;2:I-IV
       
  • Predictors and Outcomes Associated with Rescue Therapy in SWIFT
    • Abstract: Introduction: In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, rescue therapy was used when the Solitaire or Merci device was unable to restore vessel patency. Markers for nonrecanalization in acute stroke have been reported for intravenous tissue plasminogen activator; however, similar predictors are not known for endovascular therapy. We sought to identify predictors and outcomes associated with rescue therapy in the SWIFT trial. Methods: Rescue therapy included the use of an alternative device, agent, or maneuver following failure to recanalize with three retrieval attempts using the initial device. Clinical, angiographic, and demographic data was reviewed. Results: Among a total of 144 patients enrolled, 43 (29.9%) required rescue therapy. We used the same baseline demographics for patients with and without rescue therapy. Rescue therapy was used in a higher percentage of patients randomized to the Merci group compared with the Solitaire group (43 vs. 21%, p = 0.009). Patients with rescue therapy experienced a longer recanalization time (p < 0.001), a lower percentage of successful recanalization (p < 0.001), and a lower percentage of good outcome (p = 0.009). In multivariate analysis, patients randomized to the Merci group (OR 3.99, 95% CI 1.58, 10.10) and age >80 years (OR 3.51, 95% CI 1.06, 11.64) were predictors of rescue therapy. Conclusions: Merci treatment group and age were predictors of rescue therapy, while a trend toward an increased need of rescue therapy was observed with hypertension and proximal clot location. Rescue therapy was associated with fewer good outcomes. These findings may reflect targets for improvement in endovascular therapy. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:178-182
       
  • Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the
           Literature
    • Abstract: In recent decades, with the improvement of radiotherapy (RT) technology and comprehensive treatment, the survival rate of head and neck malignancies has gained remarkable progress. Vascular injury and subsequent carotid stenosis following RT, as the backbone of treatment, have received increasing attention. Many investigations have demonstrated that radiation can result in the increase in carotid intima-media thickness, carotid stenosis and consequently lead to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. In this review, we will examine the incidence of radiation-induced carotid artery stenosis, its morphological and histological characteristics, as well as its pathogenesis. The treatment and prevention methods, including follow-up strategies, will also be discussed at the end of the present review. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:183-192
       
  • Hyperbaric Oxygen Therapy in Acute Ischemic Stroke: A Review
    • Abstract: Stroke, also known as cerebrovascular disease, is a common and serious neurological disease, which is also the fourth leading cause of death in the United States so far. Hyperbaric medicine, as an emerging interdisciplinary subject, has been applied in the treatment of cerebral vascular diseases since the 1960s. Now it is widely used to treat a variety of clinical disorders, especially hypoxia-induced disorders. However, owing to the complex mechanisms of hyperbaric oxygen (HBO) treatment, the therapeutic time window and the undefined dose as well as some common clinical side effects (such as middle ear barotrauma), the widespread promotion and application of HBO was hindered, slowing down the hyperbaric medicine development. In August 2013, the US Food and Drug Administration declared artery occlusion as one of the 13 specific indications for HBO therapy. This provides opportunities, to some extent, for the further development of hyperbaric medicine. Currently, the mechanisms of HBO therapy for ischemic stroke are still not very clear. This review focuses on the potential mechanisms of HBO therapy in acute ischemic stroke as well as the time window. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:201-211
       
 
 
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