Bioresorbable Vascular Scaffolds in Interventional Neuroradiology.

PURPOSE: Bioresorbable vascular scaffolds (BVS) have changed practice patterns in cardiology. These resorbable stents have not yet been utilized in the cerebrovascular circulation. We report the initial experiences with these devices in interventional neuroradiology. METHODS: A retrospective review of clinical presentations, imaging findings and follow-up results of all patients treated using a BVS by our neurovascular team was carried out using hospital electronic charts and the hospital radiographic archive system. Treatment was performed only if patients had a non-tortuous cerebrovascular anatomy suitable for navigation by the bulky BVS. RESULTS: In this study 9 patients (5 women, mean age 51.3 years) were treated with Absorb or DeSolve scaffolds without permanent morbidity or mortality, 5 had intracranial or vertebral artery stenosis and in 4 patients with cerebral aneurysms scaffold-assisted coiling was performed. At a mean follow-up of 22.3 months, 1 parent artery in the aneurysm group was occluded and the remaining BVSs showed no significant restenosis. Fusiform luminal enlargement was demonstrated in one aneurysm patient. In two patients treated for stenosis, transient intra-arterial filling defects resembling BVS struts (scaffold silhouette) was demonstrated on early follow-up angiograms. In the patient with parent artery occlusion (who was judged to have unjailed the internal carotid bifurcation) and in the patient with luminal remodeling, we were able to discontinue all antiplatelet medications at 3 years without any consequences. CONCLUSION: Absorbable stent technology has potential applications in interventional neuroradiology. We suggest that BVS should be optimized for cerebral circulation if prospective studies are to be undertaken for cerebrovascular applications of BVS.

Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients.

BACKGROUND AND PURPOSE: The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the prognostic performance of the ABCD(2) score and brain infarction on imaging to determine the optimal weighting of infarction in the score (ABCD(2)I). METHODS: Twelve centers provided unpublished data on ABCD(2) scores, presence of brain infarction on either diffusion-weighted imaging or CT, and follow-up in cohorts of patients with transient ischemic attack diagnosed by World Health Organization criteria. Optimal weighting of infarction in the ABCD(2)I score was determined using area under the receiver operating characteristic curve analyses and random effects meta-analysis. RESULTS: Among 4574 patients with TIA, acute infarction was present in 884 (27.6%) of 3206 imaged with diffusion-weighted imaging and new or old infarction was present in 327 (23.9%) of 1368 imaged with CT. ABCD(2) score and presence of infarction on diffusion-weighted imaging or CT were both independently predictive of stroke (n=145) at 7 days (after adjustment for ABCD(2) score, OR for infarction=6.2, 95% CI=4.2 to 9.0, overall; 14.9, 7.4 to 30.2, for diffusion-weighted imaging; 4.2, 2.6 to 6.9, for CT; all P<0.001). Incorporation of infarction in the ABCD(2)I score improved predictive power with an optimal weighting of 3 points for infarction on CT or diffusion-weighted imaging. Pooled areas under the curve increased from 0.66 (0.53 to 0.78) for the ABCD(2) score to 0.78 (0.72 to 0.85) for the ABCD(2)I score. CONCLUSIONS: In secondary care, incorporation of brain infarction into the ABCD system (ABCD(2)I score) improves prediction of stroke in the acute phase after transient ischemic attack.

Obsessive compulsive symptoms associated with quetiapine treatment in a schizophrenic patient: a case report.

PURPOSE: Atypical antipsychotics (AAPs) are used as adjunct therapy in the treatment of resistant obsessive-compulsive symptoms (OCSs). Paradoxically other reports suggest that AAPs, particularly clozapine, risperidone, and olanzapine can induce de novo emergence or exacerbation of OCSs in psychotic patients. The authors present here the first report suggesting an association between de novo appearance of OCSs and quetiapine treatment in a schizophrenic patient. CASE: The patient was a 33-year-old woman with the diagnosis of paranoid schizophrenia, who displayed OCSs for the first time during treatment with quetiapine. The symptoms reduced remarkably when fluoxetine was added to her treatment regimen while keeping the quetiapine dosage unchanged. CONCLUSION: AAP-induced OCSs merit consideration and early identification, as these drugs are now widely in use in clinical practice. This rare but disabling side effect should also be monitored in quetiapine treated schizophrenic patients.

A novel finding in thoracic outlet syndrome: tachycardia.

In this case report, we rendered a 22 year old woman with the diagnosis of neurogenic thoracic outlet syndrome. We have evaluated her symptoms of palpitation with Holter monitorization during Roos test before and after surgery where transaxillary first rib resection and scalenectomy were performed. Postoperatively she improved and the tachycardia resolved. We propose that stellate ganglion or postganglionic efferent sympathetic fibers forming the cardiac plexus are exposed to compression while Roos test is being performed. Due to this irritation, there can be an increase in the cardiac sympathetic activity.