| 1. |
- Bhogal, P, et al.
(författare)
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Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept
- 2017
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 9:1, s. 52-59
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Tidskriftsartikel (refereegranskat)abstract
- To report our preliminary experience with the use of stent retrievers to cause vasodilation in patients with delayed cerebral vasospasm secondary to subarachnoid hemorrhage.MethodsFour patients from two different high volume neurointerventional centers developed cerebral vasospasm following subarachnoid hemorrhage. In addition to standard techniques for the treatment of cerebral vasospasm, we used commercially available stent retrievers (Solitaire and Capture stent retrievers) to treat the vasospastic segment including M2, M1, A2, and A1. We evaluated the safety of this technique, degree of vasodilation, and longevity of the effect.ResultsStent retrievers can be used to safely achieve cerebral vasodilation in the setting of delayed cerebral vasospasm. The effect is long-lasting (>24 hours) and, in our initial experience, carries a low morbidity. We have not experienced any complications using this technique although we have noted that the radial force was not sufficient to cause vasodilation in some instances. The vasospasm did not return in the vessel segments treated with stent angioplasty in any of these cases. In two of our cases stent angioplasty resulted in the reversal of focal neurological symptoms.ConclusionsStent retrievers can provide long-lasting cerebral vasodilation in patients with delayed cerebral vasospasm.
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| 2. |
- Falk Delgado, Alberto, et al.
(författare)
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Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms : a pragmatic meta- analysis of randomized and non- randomized trials with short- and long- term follow- up
- 2017
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Ingår i: JOURNAL OF NEUROINTERVENTIONAL SURGERY. - : BMJ PUBLISHING GROUP. - 1759-8478 .- 1759-8486. ; 9:3, s. 264-
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Tidskriftsartikel (refereegranskat)abstract
- Background Two randomized trials have evaluated clipping and coiling in patients with ruptured aneurysms. Aggregated evidence for management of ruptured and unruptured aneurysms is missing. Objective To conduct a meta- analysis evaluating clinical outcome after aneurysm treatment. Methods PubMed, Cochrane Central Register of Controlled Trials, and Clinicaltrials. gov were searched for studies evaluating aneurysm treatment. The primary outcome measure was an independent clinical outcome ( modified Rankin scale 0- 2, Glasgow Outcome Scale 4- 5, or equivalent). Secondary outcomes were poor outcome and mortality. ORs were calculated on an intention- to- treat basis with 95% Cls. Outcome heterogeneity was evaluated with Cochrane's Q test ( significance level cut- off value at < 0.10) and l(2) ( significance cut- off value > 50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value < 0.05 was regarded as statistically significant. Results Searches yielded 18 802 articles. All titles were assessed, 403 abstracts were evaluated, and 183 full-text articles were read. One- hundred and fifty articles were qualitatively assessed and 85 articles were included in the meta- analysis. Patients treated with coiling ( randomized controlled trials ( RCTs)) had higher independent outcome at short- term follow- up ( OR= 0.67, 95% Cl 0.57 to 0.79). Independent outcome was favored for coiling at intermediate and long- term follow-up ( RCTs and observational studies combined-OR= 0.80, 0.68 to 0.94 and OR= 0.81, 0.71 to 0.93, respectively). Independent outcome and lower mortality was favored after coiling in unruptured aneurysms ( database registry studies) at short- term follow- up ( OR= 0.34, 0.29 to 0.41 and OR= 1.74, 1.52 to 1.98, respectively). Conclusions This meta- analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiling.
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| 3. |
- Maus, V, et al.
(författare)
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Endovascular treatment of posterior condylar canal dural arteriovenous fistula
- 2017
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 9:2, s. E7-U11
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Tidskriftsartikel (refereegranskat)abstract
- Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even dementia. Diagnosis and endovascular treatment require a profound knowledge of the vascular anatomy of the craniocervical junction and comprehensive neurovascular imaging. We describe the clinical presentation, angiographic imaging and endovascular treatment of a PCC DAVF in a female patient with pulse-synchronous bruit as the presenting symptom. The fistula drained almost exclusively into the sigmoid sinus and internal jugular vein. There was no intracranial reflux. The PCC DAVF was treated with transvenous coil occlusion of the fistulous pouch in the condylar canal. Symptoms resolved immediately after intervention and the patient recovered quickly without any neurological deficits. MR angiography confirmed occlusion of the DAVF. The dural sinus was patent with normal blood flow.
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| 4. |
- Soderqvist, AK, et al.
(författare)
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Thrombectomy in acute ischemic stroke: estimations of increasing demands
- 2017
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 9:9, s. 830-833
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Tidskriftsartikel (refereegranskat)abstract
- New recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.MethodsThe new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009–2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0–5, 6–11, 12–19, and 20–35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.ResultsThe number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).ConclusionsWhen the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.
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