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Journal Cover Interventional Neurology
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   Full-text available via subscription Subscription journal  (Not entitled to full-text)
   ISSN (Print) 1664-9737 - ISSN (Online) 1664-5545
   Published by Karger Homepage  [105 journals]
  • Endovascular Embolization of Intracranial Infectious Aneurysms in Patients
           Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate
    • Abstract: Introduction: Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Methods: Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Results: Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Conclusions: Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.
      Intervent Neurol 2017;6:82-89
       
  • Embolization of Sacral Dural Arteriovenous Fistulas: A Case Series and
           Literature Review
    • Abstract: The authors report 2 cases of sacral dural arteriovenous fistula (AVF) presenting with gradual neurologic decline characterized by progressive lower extremity weakness and bowel and bladder incontinence. Spinal angiography demonstrated a sacral dural AVF with perimedullary vein engorgement and drainage extending to the level of the cervical spine in both cases. The fistulas were completely obliterated with n-BCA (n-butyl cyanoacrylate) embolic agent in one case, and with ethylene vinyl alcohol (Onyx) in the second, resulting in improvement of the symptoms in both patients. The unique features of this case report include the rare location of the fistula's origin, the necessity for complete spinal angiography, and the use of intraoperative monitoring in one case to guide embolization treatment.
      Intervent Neurol 2017;6:73-81
       
  • Mechanical Thrombectomy in Pregnancy: Report of 2 Cases and Review of the
           Literature
    • Abstract: Background: Mechanical thrombectomy has recently proved extremely effective in improving the outcome of patients with large vessel occlusion. Despite this, questions still remain over certain cohorts of patients that were excluded from the large randomised controlled trials. One such cohort includes pregnant patients. Although thromboembolic stroke is uncommon in pregnancy, the outcome from this pathology can be devastating. Summary: We present 2 cases of mechanical thrombectomy in pregnancy both of which underwent successful flow restoration without complications. We discuss the incidence of stroke in pregnancy, potential pitfalls of imaging, radiation protection issues, and the role of thrombolysis as well as the available literature on mechanical thrombectomy in this cohort. Key Message: Thrombectomy in pregnancy can be performed safely with no significant changes required to the procedure itself. Radiation exposure during the procedure should be minimised and shielding used to prevent scatter radiation to the fetus; however, given the potential risks of thrombolysis in this cohort of patients, mechanical thrombectomy should be considered in all stages of pregnancy.
      Intervent Neurol 2017;6:49-56
       
  • Simultaneous Kissing Stenting: A Valuable Technique for Reconstructing the
           Stenotic Initial Segment of the Right Subclavian Artery
    • Abstract: Atherosclerotic stenosis or occlusion often involves the subclavian artery. For lesions that are close to the orifice of the right subclavian artery, stenting of the right subclavian artery itself blocks the pathway from the innominate artery to the right carotid artery and causes problems in patients with multiple angiostenosis, especially involving the right carotid system. In this study, we report 2 cases using simultaneous kissing stenting (SKS) of the right subclavian artery and the right carotid artery to relieve right subclavian stenosis and maintain right carotid system patency. Standard stenting methods were used to perform SKS. Two self-expanding stents were implanted simultaneously into the initial segment of the right subclavian artery and the right carotid artery, forming a “Y” shape, with the overlap of the proximal segments in the innominate artery ≥5 mm. After SKS, the stenosed right subclavian artery was dilated, and the patency of the right carotid system was maintained. The symptoms of patients were relieved and the stents were intact at several months of follow-up. In conclusion, SKS of the right subclavian artery and the right carotid artery might be a safe and effective procedure when the stenotic or occlusive lesion in the initial segment of the right subclavian artery is close to the orifice, and lesions (or potential ones) exist in the right carotid system.
      Intervent Neurol 2017;6:65-72
       
  • Risk of Intracranial Hemorrhage after Endovascular Treatment for Acute
           Ischemic Stroke: Systematic Review and Meta-Analysis
    • Abstract: Background: Intracranial hemorrhage is a major complication of endovascular treatment in patients with acute ischemic stroke. Controlled clinical trials reported varied incidences of intracranial hemorrhage after endovascular treatment. This meta-analysis aimed to estimate whether endovascular treatment, compared with medical treatment, increases the risk of intracranial hemorrhage in patients with acute ischemic stroke. Methods: The current publications on endovascular treatment for acute ischemic stroke were systematically reviewed. Rates of intracranial hemorrhage after endovascular treatment for acute ischemic stroke reported in controlled clinical trials were pooled and analyzed. Random and fixed-effect models were used to pool the outcomes. For analyzing their individual risks, intracranial hemorrhages after endovascular treatment were classified as symptomatic and asymptomatic. Results: Eleven studies involving 1,499 patients with endovascular treatment and 1,320 patients with medical treatment were included. After pooling the data, the risk of any intracranial hemorrhage was significantly higher in patients with endovascular treatment than in patients with medical treatment (35.0 vs. 19.0%, OR = 2.55, 95% CI: 1.64-3.97, p < 0.00001). The risk of asymptomatic intracranial hemorrhage was also significantly higher in patients with endovascular treatment than in those with medical treatment (28 vs. 12%, OR = 3.16, 95% CI: 1.62-6.16, p < 0.001). However, the risks of symptomatic intracranial hemorrhage were similar in patients with endovascular treatment and in those with medical treatment (5.6 vs. 5.2%, OR = 1.09, 95% CI: 0.79-1.50, p = 0.61). Conclusion: Although the risk of any intracranial hemorrhage may increase after endovascular treatment, the risk of symptomatic intracranial hemorrhage may remain similar as compared with medical treatment.
      Intervent Neurol 2017;6:57-64
       
  • Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of
           
    • Abstract: Background: One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel. Objective: To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure. Methods: A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 month postprocedure followed by aspirin daily monotherapy. The primary efficacy end point was the 30-day composite occurrence of death, cerebral infarction, transient ischemic attack, and in-stent thrombosis. The primary safety end point was bleeding. Results: Twelve subjects (mean age ± SD, 66 ± 12 years; 9 males) were enrolled and underwent internal carotid artery angioplasty and stent placement. None of the subjects who successfully followed the study protocol experienced any complications at the 1- and 3-month follow-ups. One patient had a protocol deviation due to concurrent use of enoxaparin (1 mg/kg twice daily) in addition to aspirin and cilostazol, resulting in a fatal symptomatic intracerebral hemorrhage following successful stent placement on postprocedure day 1. One patient discontinued cilostazol after the first dose secondary to dizziness. Conclusion: The use of cilostazol and aspirin for internal carotid artery stent placement appears to be safe, but protocol compliance needs to be emphasized.
      Intervent Neurol 2017;6:42-48
       
  • Comparison of 3-Month Stroke Disability and Quality of Life across
           Modified Rankin Scale Categories
    • Abstract: Background and Purpose: Modified Rankin Scale (mRS) score 0-2 has been used to define “good outcome” while stroke patients with mRS 3 are grouped with mRS 4-6 as having “poor outcome.” Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse. Methods: Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections. Results: Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed. Conclusions: Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.
      Intervent Neurol 2017;6:36-41
       
  • Title Page
    • Abstract:
      Intervent Neurol 2016;5(suppl 1):I-II
       
  • 9th Annual Meeting. 4th Annual Stroke Center Workshop (6M Conference).
           Society of Vascular and Interventional Neurology. November 16-19,
           Brooklyn, New York, N.Y.: Abstracts
    • Abstract:
      Intervent Neurol 2016;5(suppl 1):1-94
       
  • Salvage of Herniated Flow Diverters Using Stent and Balloon Anchoring
           Techniques: A Technical Note
    • Abstract: Background: The pipeline embolization device (PED; Medtronic, MN, USA) can sometimes herniate into the aneurysmal sac in an unexpected manner during or shortly after its deployment due to device foreshortening. In this report, we describe 2 endovascular techniques, which can be used to reposition a herniated PED construct into a more favorable alignment. Summary: In a 67-year-old patient who had an intraprocedural herniation of a PED device into a giant cavernous aneurysm, a stent anchor technique was used to reverse the herniation, reorient the PED construct, and achieve successful flow diversion. In a different patient with a giant superior hypophyseal aneurysm, a balloon anchor technique followed by deployment of an LVIS Jr (Microvention, Tustin, CA, USA) stent was used to reverse the herniation into the aneurysmal sac. Key Messages: Stent anchor and balloon anchor techniques as described here can be used to reposition PED constructs, which have unexpectedly herniated into the aneurysm sac during attempted flow diversion for the treatment of giant aneurysms.
      Intervent Neurol 2017;6:31-35
       
 
 
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