The Woven EndoBridge Device for the Treatment of Intracranial Aneurysms: Initial Clinical Experience within an Australian Population.

PURPOSE: Advances in endovascular technology have expanded the treatment options for intracranial aneurysms. Intrasaccular flow diversion is a relatively new technique that aims to disrupt blood inflow at the neck of the aneurysm, hence promoting intrasaccular thrombosis. The Woven EndoBridge device (WEB; MicroVention, Aliso Viejo, CA, USA) is an US Food and Drug Administration approved intrasaccular flow diverter for wide-necked aneurysms. We report the early interim clinical and radiological outcomes of patients with both ruptured and unruptured intracranial aneurysms (IAs) treated using the WEB device in an Australian population. MATERIALS AND METHODS: A retrospective analysis was done of patients with ruptured or unruptured IAs who received treatment with WEB across 5 Australian neuroendovascular referral centers between May 2017 and November 2020. Angiographic occlusion was assessed with time-of-flight magnetic resonance angiography. Complications were recorded and clinical outcomes were assessed using the modified Rankin scale at follow-up. RESULTS: In total, 66 aneurysms were treated in 63 patients, with successful deployment of the WEB device in 98.5% (n=65). Eighteen (26.9%) ruptured aneurysms were included. Failure of deployment occurred in a single case. Adjunct coiling and/or stenting was performed in 20.9% (n=14) cases. Sixty-two patients with 65 aneurysms using a WEB device were followed up (mean=9.1 months), and 89.4% of these had complete aneurysm occlusion while 1.5% remained patent. Functional independence was achieved in 93.5% of cases. CONCLUSION: Early results following the use of WEB devices in Australia demonstrate safety and adequate aneurysm occlusion comparable to international literature.

Image-guided spinal injection for pain management.

Radiculopathy and spinal pain are debilitating conditions affecting millions of people worldwide each year. While most cases can be managed conservatively with physiotherapy and nonsteroidal anti-inflammatory medications, minimally invasive corticosteroid injections are the mainstay intervention for those not responsive to conservative treatment. Historically, spinal injections were performed in the absence of imaging guidance; however, imaging modalities, in particular fluoroscopy and computer tomography (CT), have become the standard of care in performing most of these procedures. Under imaging guidance, operators can accurately confirm needle placement and safely target localised pathologies.

The 100 most cited articles in the endovascular management of acute ischemic stroke.

BACKGROUND AND PURPOSE: Endovascular thrombectomy (EVT) has revolutionized the management of acute ischemic stroke. Landmark clinical trials have shown EVT to be one of the most efficacious interventions in clinical medicine over the past 5 years. A method of recognition for an article in the scientific community is to use a citation rank list, in order to identify the seminal works in the academic medical literature. The objective of this study was to characterize the 100 most highly cited articles assessing endovascular management of acute ischemic stroke. METHODS: We conducted a retrospective bibliometric analysis using the Web of Science Citation Index Expanded database for the most cited works in the endovascular management of acute ischemic stroke. Citation count was used to rank the top 100 articles, which were then analyzed for authorship, year of publication, subject, study type, level of evidence, and subject. RESULTS: The mean number of citations was 245 (range 65-1726) and 394 on Google Scholar. The top 100 articles were cited an average of 43.9 times per year and published in 21 journals in the past two decades. The majority of papers (62) were classified as constituting levels 1, 2, or 3 evidence, and included 17 randomized controlled trials. Approximately two-thirds of the top 100 articles originated from the USA. CONCLUSIONS: This study details the most cited articles in the endovascular management of acute ischemic stroke, and furthermore shows that a high proportion of level I evidence exists for this intervention.

Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report.

OBJECTIVE: Uterine arteriovenous malformations (AVM) are unusual causes of vaginal bleeding. Although hysterectomy is the definitive treatment; uterine artery embolization (UAE) provides an alternative therapeutic option. This case presents a technical report of a uterine AVM treated successfully with transcatheter UAE using precipitating hydrophobic injectable liquid (PHIL) embolic agent. CASE REPORT: A 41-year-old female, gravida 6, para 4, miscarriage 2, including a molar pregnancy 15 years prior, presented with massive per vaginal bleeding. Pelvic ultrasound demonstrated an acquired AVM as the underlying aetiology for her presentation. The patient underwent bilateral uterine arterial embolization. Four weeks later, there was nearly complete resolution of the AVM and the patient's menstrual cycle was restored 8 weeks after the procedure. CONCLUSION: Uterine AVM can be treated safely and effectively with UAE using PHIL.