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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]
  • 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
  • Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue
           and/or Depression
    • Abstract: Background: Endovascular treatment of impaired cerebrospinal venous outflow has been suggested to improve the overall quality of life in multiple sclerosis (MS) patients. Fatigue and depression are key factors in measuring the quality of life in MS patients. Objective: In the present study, we investigated the correlation between anomalous venous outflow and the seriousness of fatigue and depression in MS patients and healthy controls. Methods: Five cerebrospinal venous outflow parameters were measured in 20 MS patients and age- and sex-matched controls using extra- and transcranial Colour Doppler sonography. All patients and volunteers filled out the Fatigue Severity Scale (FSS) and Hospital Anxiety Depression Subscale (HADS). Results: Nine abnormal parameters were found in 8 MS patients, whereas five abnormal parameters were found in 3 healthy controls (no significant difference). Only 1 MS patient met the criteria for chronic cerebrospinal venous insufficiency compared to 2 healthy controls. No significant differences were found in the FSS and HADS scores between patients with and without abnormal cerebrospinal venous outflow parameters. Conclusions: We found no significantly impaired cerebrospinal venous outflow in patients with MS versus sex- and age-matched controls. Furthermore, we did not find any correlation between anxiety or depression and impaired venous outflow in MS patients. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:193-200
  • Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the
    • 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
  • 10th International Stroke Summit, June 13-15, 2014, Nanjing, China:
    • Abstract:
      Intervent Neurol 2013;2:169-177
  • 6th Annual Meeting of the Society of Vascular and Interventional
           Neurology, October 26-27, 2013, Houston, Texas: Abstracts
    • Abstract:
      Intervent Neurol 2013;2:57-96
  • Predictors and Outcomes of Suspected Heparin-Induced Thrombocytopenia in
           Subarachnoid Hemorrhage Patients
    • Abstract: Background: Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients. Objective: To study the risk factors and outcomes of SAH patients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test. Methods: All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively. Results: We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×109/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge. Conclusion: The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:160-168
  • Computed Tomography Angiography in the Stroke Outcomes and Neuroimaging of
           Intracranial Atherosclerosis (SONIA) Study
    • Abstract: Background: The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) study validated noninvasive imaging tests of intracranial atherosclerosis against catheter angiography in a prospective, blinded, multicenter setting. Critical evaluation of transcranial Doppler (TCD) and magnetic resonance angiography in the SONIA study standardized their performance and interpretation. We performed a similar analysis of computed tomography angiography (CTA) for the detection of intracranial stenosis. Methods: Multicenter standardization of image acquisition and blinded, central interpretation of CTA performance were conducted in concert with the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. Measurements of the intracranial arterial diameter were obtained to derive stenosis values. Correlation with catheter angiography was used to assess CTA performance characteristics. Results: CTA measurements of intracranial stenosis were obtained in 120 vessel segments, with angiographic correlation in 52. CTA was performed as a noninvasive study prior to conventional angiography. CTA stenoses of 50-99% or a flow gap were identified in 15 of 52 vessel segments, stenoses of
  • Intra-Arterial Treatment of Acute Ischemic Stroke: Better Outcome with
           Stent Retrievers
    • Abstract: Background: Intra-arterial treatment is increasingly used in acute ischemic stroke. Recently, new devices have become available, aiming at better recanalization rates and outcome. We present a series of patients with acute stroke of the anterior circulation treated with intra-arterial therapy using intra-arterial thrombolysis and different types of mechanical devices. Methods: We prospectively gathered clinical and radiological data of all patients with acute anterior stroke who were treated with intra-arterial therapy in a Dutch teaching hospital between 2009 and 2011. Patients were grouped according to the intra-arterial treatment strategy and analyzed for poor outcome (modified Rankin Scale score >2 or death), complications and recanalization rate with the Poisson regression. Results: Eighty-four patients were treated with intra-arterial therapy, 13 with intra-arterial thrombolysis only (ND group), 22 with a Merci device (MERCI group) and 49 with a stent retriever (SR group). Overall, 52 patients (62%) had poor outcome of whom 17 (20%) died. There was a trend towards poorer outcome in the ND group (adjusted RR 1.18; 95% CI 0.74-1.88) and the MERCI group (adjusted RR 1.17; 95% CI 0.79-1.74) compared with the SR group. Furthermore, failed recanalization occurred more often in the ND group (adjusted RR 2.59; 95% CI 1.50-4.49) and MERCI group (adjusted RR 2.32; 95% CI 1.33-4.05) compared with the SR group. Conclusion: We found higher recanalization rates with SRs. However, this resulted only in a trend towards better clinical outcome. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:144-152
  • Idiopathic Intracranial Hypertension: A Systematic Analysis of Transverse
           Sinus Stenting
    • Abstract: Background: Idiopathic intracranial hypertension (IIH) is a disorder characterized by signs and symptoms of increased intracranial pressure without structural cause seen on conventional imaging. Hallmark treatment after failed medical management has been CSF shunting or optic nerve fenestration with the objective of preserving vision. Recently, there have been multiple case reports and case series on dural sinus stenting for this disorder. Objective: We aim to review all published cases and case series of dural sinus stenting for IIH, with analysis of patients' presenting symptoms, objective findings (CSF pressures, papilledema, pressure gradients across dural sinuses), follow-up of objective findings, and complications. Methods: A Medline search was performed to identify studies meeting prespecified criteria of a case report or case series of patients treated with dural sinus stent placement for IIH. The papers were reviewed and data were extracted. Results: A total of 22 studies were identified, of which 19 studies (including a total of 207 patients) met the criteria and were included in the analysis. Only three major complications related to the procedure were identified. Headaches resolved or improved in 81% of patients. Papilledema improved in 90% of cases (172 of 189 patients). Sinus pressure decreased from an average of 30.3 to 15 mm Hg. Sinus pressure gradient decreased from 18.5 mm Hg (n = 185) to 3.2 mm Hg (n = 172). Stenting had an overall symptom improvement rate of 87%. Conclusion: Although all published case reports and case series are nonrandomized, the low complication and high symptom improvement rate make dural sinus stenting for IIH a potential alternative surgical treatment. Standardized patient selection and randomization trials or registry are warranted. © 2014 S. Karger AG, Basel
      Intervent Neurol 2013;2:132-143
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