1,721,093 research outputs found
Response by Behme to Letter Regarding Article, “Emergent Carotid Stenting After Thrombectomy in Patients With Tandem Lesions”
No full textWoven EndoBridge intrasaccular flow disrupter for the treatment of ruptured and unruptured wide-neck cerebral aneurysms: report of 55 cases
No full textBACKGROUND AND PURPOSE: The safety and efficacy of the Woven EndoBridge (WEB) device for the treatment of cerebral aneurysms have been investigated in several studies. Most of these studies focused on specific aneurysms or a certain WEB device. Our objective was to report the experience of 2 German centers with the WEB device, including technical feasibility, safety, and short-term angiographic outcome. MATERIALS AND METHODS: We performed a retrospective study of all ruptured and unruptured aneurysms that were treated with a WEB device (WEB Double-Layer, Single-Layer, and Single-Layer Sphere) between April 2012 and August 2014. Primary outcome measures included the feasibility of the implantation and the angiographic outcome at 3-month follow-up. Secondary outcome measures included the clinical outcome at discharge and procedural complications. RESULTS: Fifty-five aneurysms in 52 patients, including 14 ruptured aneurysms, underwent treatment with the WEB device. The median age of patients was 55 years (range, 30-75 years); 19/55 (37%) were men. The device could be deployed in all patients and was implanted in 51/55 (93%) cases. Procedural complications occurred in 6/51 (12%), comprising 2 thromboembolic events, 2 thrombus formations, 1 high-grade posterior cerebral artery stenosis, and 1 aneurysm rupture. None of these had clinical sequelae. Angiographic follow-up at 3 months was available for 44/51 (86%) aneurysms. A favorable angiographic result at 3 months was achieved in 29/44 (66%) cases, whereas the percentage of good anatomic results increased from 40% in 2012 to 75% in 2014. CONCLUSIONS: The WEB device proved to be safe. Acceptable occlusion rates can be achieved but seem to require wide experience with the device.Sequent Medical; MicroVention; Covidie
Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center
No full textIntroduction Over the past decade, endovascular techniques for the treatment of acute ischemic stroke have emerged significantly. However, revascularization rates are limited at approximately 80%, and mechanical thrombectomy procedures still last about 1h. Therefore, we investigated the novel direct aspiration first pass technique for its efficacy and safety. Methods Our neurointerventional database was screened for patients who received mechanical thrombectomy for acute ischemic stroke using the Penumbra 5MAX ACE aspiration catheter on an intention to treat basis between November 2013 and June 2014. Procedural data, including modified Thrombolysis in Cerebral Infarction (mTICI) score, procedural timings, and complications, as well as clinical data at admission and discharge, were analyzed. Results 54 patients received mechanical thrombectomy using the 5MAX ACE. Median age was 69 (39-94) years (54% were men). Baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (2-27) and 44/54 (81%) patients received intravenous thrombolysis. Vessel occlusion sites were 91% anterior circulation and 9% posterior circulation. A successful revascularization result (mTICI 2b) was achieved in 93% of cases whereas direct aspiration alone was successful in 30/54 (56%) cases; among these, median time from groin puncture to revascularization was 30min (9-113). Symptomatic intracranial hemorrhage occurred in 2/54 (4%) patients, and embolization to new territories in 3/54 (6%). Median NIHSS at discharge was 6 (0-24); 46% of patients were independent at discharge. Conclusions The direct aspiration first pass technique proofed to be fast, effective, and safe. Promising revascularization results can be achieved quickly in more than 50% of patients using this technique as the firstline option. Nevertheless, stent retrievers are still warranted in approximately 40% of cases to achieve a favorable revascularization result.Penumbr
Complications Associated with Cerebral Aneurysm Morphology in Balloon-Assisted Coil Embolization of Ruptured and Unruptured Aneurysms-a Single-Center Analysis of 116 Consecutive Cases
No full textBACKGROUND: We investigated the complication rates of balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms dependent on their morphologic characteristics in angiography. METHODS: The study was a single-center retrospective analysis of all consecutive endovascular balloon-assisted coiling interventions performed between April 2008 and December 2013. Data were extracted from a prospective database on an intention-to-treat basis. We described the clinical (Hunt & Hess score, modified Rankin scale) and technical results (Raymond Roy aneurysm occlusion scale) and analyzed the rate of periprocedural complications with regard to aneurysm subgroups of bifurcation aneurysms versus sidewall aneurysms. RESULTS: There were 116 interventions performed on 108 patients (mean age: 51.7 +/- 11.1 years), with 70/116 emergency procedures (60%), 36/116 elective procedures (31%), and 10/116 elective procedures on recurrent aneurysms (9%). The balloon was used in 108/116 cases (93%). Among the cases, 76/116 were bifurcation aneurysms and 40/116 were sidewall aneurysms. Periprocedural complications, such as rerupture, thrombus formation, distal embolism, coil-loop protrusion, and coil migration, occurred in 26/116 cases (22%). Complications occurred significantly more often in ruptured than unruptured bifurcation aneurysms (23 vs. 3 events, P < 0.05). There was a significantly higher rate of complications in bifurcation aneurysms compared with sidewall aneurysms (17% vs. 3%, P = 0.03). Six periprocedural complications were associated with a permanent neurologic deficit (6% of cases), all of which occurred in the subgroup of acutely ruptured aneurysms. CONCLUSION: The risk of periprocedural complications in balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms is linked to the morphologic presentation of the aneurysm; the complication rate was significantly higher in bifurcation aneurysms
Alternative Transcarotid Approach for Endovascular Treatment of Acute Ischemic Stroke Patients: A Case Series
No full textIntravenous thrombolysis and thrombus length are predictive factors for successful recanalization in acute ischemic stroke treated by mechanical thrombectomy
No full textIntravenous thrombolysis and thrombus length are predictive factors for successful recanalization in acute ischemic stroke treated by mechanical thrombectomy
No full textEvaluation of an Acute Stroke Patient with Flat Detector CT Prior to Mechanical Thrombectomy
No full textFlat panel detectors have revolutionized tomographic imaging in the angio suite. Recent developments in hardware and software have improved soft tissue resolution and acquisition time even further, enabling soft-tissue and perfusion imaging within the angio suite. The so called “one-stop-shop” stroke imaging with flat panel detector computed tomography (FDCT) will significantly improve door to groin times and probably have an impact on patient outcome. In the presented case a patient underwent multidetector CT (MDCT) to exclude hemorrhage, then MDCT angiography (MDCTA) to identify the occluded vessel, and MDCT perfusion (MDCTP) for penumbra imaging. Patient’s symptoms significantly improved during transport to the angiography suite. Thus, prior to intervention, multimodal FDCT with vessel and perfusion imaging was acquired and ultimately led to cancelation of the interventional therapy. In this clinical scenario, multimodal FDCT imaging can provide quick answers and eliminate the risk of an invasive angiography in cases of reperfusion prior to mechanical thrombectomy.Open-Access-Publikationsfonds 201
Unenhanced Time-of-Flight MR Angiography versus Gadolinium-Enhanced Time-of-Flight MR Angiography in the Follow-Up of Coil-Embolized Aneurysms
No full textBackground and Purpose Coil embolization of ruptured and unruptured aneurysms has emerged as a widely accepted alternative to clipping. Unfortunately, coil-embolized aneurysms need a long-term imaging follow-up to confirm the stability of the occlusion status. We investigated whether contrast-enhanced time-of-flight (ToF) magnetic resonance angiography (MRA) (gadolinium [Gdi-ToF) provides any diagnostic benefit over conventional ToF MRA (nonenhanced [NE]-ToF) in this context. Material and Methods From October 2013 to January 2015, all patients who were regularly scheduled for their follow-up after coil embolization were examined with GdToF and NE-ToF angiography. The general visibility of the occlusion result was compared between the two MRAs as well as with the last digital subtraction angiography (DSA) available. Subgroups of interest (follow-up after stent-assisted coil embolization, cases with already known aneurysm remnants) were also analyzed. Results A total of 70 patients (44 female) harboring 74 treated aneurysms were examined. The reproducibility of the DSA result in terms of therapeutic relevance was 100%. In 10 of 74 cases (14%), the aneurysm status was more difficult to judge in the NE-ToF images (p = 0.02), and the visualization of small vessels was significantly better in the Gd-ToF (p = 0.003). NE-ToF did not fail to show any aneurysm remnants but were more difficult to depict in 35% of the cases (p = 0.09). Regarding the aneurysms that were coiled with stent assistance, there was no significant difference in terms of the visualization (p = 0.1). Conclusion Gd-ToF angiography is in general not superior to NE-ToF for the follow-up of coil-embolized aneurysms
Evaluation of an Acute Stroke Patient with Flat Detector CT Prior to Mechanical Thrombectomy
No full textFlat panel detectors have revolutionized tomographic imaging in the angio suite. Recent developments in hardware and software have improved soft tissue resolution and acquisition time even further, enabling soft-tissue and perfusion imaging within the angio suite. The so called “one-stop-shop” stroke imaging with flat panel detector computed tomography (FDCT) will significantly improve door to groin times and probably have an impact on patient outcome. In the presented case a patient underwent multidetector CT (MDCT) to exclude hemorrhage, then MDCT angiography (MDCTA) to identify the occluded vessel, and MDCT perfusion (MDCTP) for penumbra imaging. Patient’s symptoms significantly improved during transport to the angiography suite. Thus, prior to intervention, multimodal FDCT with vessel and perfusion imaging was acquired and ultimately led to cancelation of the interventional therapy. In this clinical scenario, multimodal FDCT imaging can provide quick answers and eliminate the risk of an invasive angiography in cases of reperfusion prior to mechanical thrombectomy.Open-Access-Publikationsfonds 201
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