ABSTRACT
Anterior communicating artery aneurysms are the most common intracranial aneurysm and have a high risk of rupture which can lead to morbidity and mortality. Traditionally, intracranial aneurysms were treated by clipping with neurosurgical access. However, certain patients may prefer less invasive approaches or not represent open surgical candidates. Flow diverters, including flow-redirection endoluminal devices (FRED), are new-generation stents that are placed endovascularly by transfemoral or transradial access. Recent studies have demonstrated that FRED is both safe and effective, with complete occlusion of aneurysms in over 90% of patients. This case highlights an interesting phenomenon of post-flow diversion circulatory remodeling, where flow diverter treatment can alter the circle of Willis anatomy and physiology.
ABSTRACT
Thrombolysis for acute ischemic stroke has predominantly been with alteplase for over a quarter of a century. In recent years, with trials showing evidence of higher rates of successful reperfusion, similar safety profile and efficacy of tenecteplase (TNK) as compared to alteplase, TNK has now emerged as another potential choice for thrombolysis in acute ischemic stroke. In this review, we will focus on these recent advances, aiming: (1) to provide a brief overview of thrombolysis in stroke; (2) to provide comparisons between alteplase and TNK for clinical, imaging, and safety outcomes; (3) to focus on key subgroups of interest to understand if there is an advantage of using TNK over alteplase or vice-versa, to review available evidence on role of TNK in intra-arterial thrombolysis, as bridging therapy and in mobile stroke units; and (4) to summarize what to expect in the near future from recently completed trials and propose areas for future research on this evolving topic. We present compelling data from several trials regarding the safety and efficacy of TNK in acute ischemic stroke along with completed yet unpublished trials that will help provide insight into these unanswered questions.
ABSTRACT
Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.
ABSTRACT
Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.
ABSTRACT
PURPOSE: The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. MATERIALS AND METHODS: Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b–3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. RESULTS: Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b–3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0–2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0–1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). CONCLUSION: Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.