Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Cardioembolic Stroke

OBJECTIVE: Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. METHODS: Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. RESULTS: The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome (mRS≤2) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001). CONCLUSION: Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury / 대한신경손상학회지

OBJECTIVE: Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI. METHODS: We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups. RESULTS: During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups. CONCLUSION: Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.

Atypical Extraventricular Neurocytoma

The authors report a case of atypical extraventricular neurocytoma (EVN) transformed from EVN which had been initially diagnosed as an oligodendroglioma 15 years ago. An 8-year-old boy underwent a surgical resection for a right frontal mass which was initially diagnosed as oligodendroglioma. When the tumor recurred 15 years later, a secondary operation was performed, followed by salvage gamma knife treatment. The recurrent tumor was diagnosed as an atypical EVN. The initial specimen was reviewed and immunohistochemistry revealed a strong positivity for synaptophysin. The diagnosis of the initial tumor was revised as an EVN. The patient maintained a stable disease state for 15 years after the first operation, and was followed up for one year without any complications or disease progression after the second operation. We diagnosed an atypical extraventricular neurocytoma transformed from EVN which had been initially diagnosed as an oligodendroglioma 15 years earlier. We emphasize that EVN should be included in the differential diagnosis of oligodendroglioma.

Comparison of Aneurysmal Clip-induced Artifacts in 64- and 16-row Multislice Computed Tomography Angiograms / 대한뇌혈관외과학회지

OBJECTIVE: The aim of this study was to compare titanium and cobalt alloy clip induced artifacts in 16- and 64-row multislice computed tomography angiograms. METHODS: A total of 40 intracranial aneurysms in 37 patients treated using titanium or cobalt-alloy clips were enrolled in this study. Computed tomography angiography (CTA) was performed using a 16-row (12 aneurysms; cobalt-alloy clips in 8 and titanium clips in 4) or 64-row (28 aneurysms; cobalt-alloy clips in 14 and titanium clips in 14) multislice CT machine after surgical clipping. Clip-induced artifacts were divided into white and black components, and artifact sizes were quantified by measuring the areas of these components. RESULTS: The titanium clips (634.9 +/- 308.44 mm2) produced smaller artifacts than cobalt alloy clips (2,797.4 +/- 3,121.98 mm2) by CTA (p=0.006), but the mean size of titanium clip induced artifacts was smaller for 64-row (544.0 +/- 68.77 mm2) than for 16-row (953.3 +/- 279.95 mm2) multislice CTA (p=0.026). On the other hand, cobalt alloy clip related artifacts were similarly sized (64-row, 2,191.5 +/- 2,072.86 mm2 versus 16-row, 3,857.6 +/- 4,386.56 mm2, p=0.246). CONCLUSION: Titanium clips produce smaller artifacts than cobalt-alloy clips and 64-row multislice CTA reduced titanium clip-induced artifacts as compared with 16-row multislice CTA. However, cobalt-alloy clip artifacts were huge and were not reduced by the higher row CTA unit.

Comparison of Aneurysmal Clip-induced Artifacts in 64- and 16-row Multislice Computed Tomography Angiograms / 대한뇌혈관외과학회지

OBJECTIVE: The aim of this study was to compare titanium and cobalt alloy clip induced artifacts in 16- and 64-row multislice computed tomography angiograms. METHODS: A total of 40 intracranial aneurysms in 37 patients treated using titanium or cobalt-alloy clips were enrolled in this study. Computed tomography angiography (CTA) was performed using a 16-row (12 aneurysms; cobalt-alloy clips in 8 and titanium clips in 4) or 64-row (28 aneurysms; cobalt-alloy clips in 14 and titanium clips in 14) multislice CT machine after surgical clipping. Clip-induced artifacts were divided into white and black components, and artifact sizes were quantified by measuring the areas of these components. RESULTS: The titanium clips (634.9 +/- 308.44 mm2) produced smaller artifacts than cobalt alloy clips (2,797.4 +/- 3,121.98 mm2) by CTA (p=0.006), but the mean size of titanium clip induced artifacts was smaller for 64-row (544.0 +/- 68.77 mm2) than for 16-row (953.3 +/- 279.95 mm2) multislice CTA (p=0.026). On the other hand, cobalt alloy clip related artifacts were similarly sized (64-row, 2,191.5 +/- 2,072.86 mm2 versus 16-row, 3,857.6 +/- 4,386.56 mm2, p=0.246). CONCLUSION: Titanium clips produce smaller artifacts than cobalt-alloy clips and 64-row multislice CTA reduced titanium clip-induced artifacts as compared with 16-row multislice CTA. However, cobalt-alloy clip artifacts were huge and were not reduced by the higher row CTA unit.