Thromboembolic events associated with Neuroform stent in endovascular treatment of intracranial aneurysms.

Background: The incidence of thromboembolic events associated with Neuroform stent (Boston Scientific Target, Fremont, CA) is known from previous studies but there are uncertainties of scale.

Purpose: To report our rate of ischemic events associated with Neuroform stent.

Methods: Consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled from January 2003 to August 2006.

Prevalence and prediction of left atrial thrombus in patients with a recent cerebral ischemic event, who are in sinus rhythm: a single-center experience.

Background: Left atrial thrombus (LAT) is frequently present in patients with cerebral ischemic events (CIE) who are in atrial fibrillation. The prevalence and predictor of LAT in patients who are in sinus rhythm (SR) is unclear.

Objective: To determine the prevalence and identify predictors of LAT formation in patients with CIE who are in SR.

Complications of Neuroform stent in endovascular treatment of intracranial aneurysms.

Background: The Neuroform stent can help in the treatment of difficult, wide-necked intracranial aneurysms. The objective of our study is to report some of the challenges associated with the Neuroform stent in the treatment of intracranial aneurysms.

Methods: From January 2003 to August 2006, consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled.

Sapphire platinum detachable coil experience in a tertiary-care facility.

Background: The Guglielmi Detachable Coil introduced by the Boston Scientific Corporation has been widely used for endovascular coiling of aneurysm. Recently, Sapphire platinum detachable coils (eV3, Irvine, CA) have been introduced for aneurysm coiling. Herein, we report our clinical experience with the Sapphire coil to evaluate the incidence of coil related complications and the rate of aneurysm occlusion.

The safety and feasibility of continuous intravenous magnesium sulfate for prevention of cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Introduction: Cerebral vasospasm in aneurysmal subarachnoid hemorrhage (SAH) is associated with poor outcome. The safety and feasibility of continuous high-dose intravenous magnesium sulfate (MgSO4) for the prevention of cerebral vasospasm and ischemic cerebral injury has not been well studied.

Methods: Patients presenting to our center within 72 hours of aneurysmalSAH (confirmed by computed tomography [CT] scanning and cerebral angiography) between June 2001 and October 2002 were enrolled in a prospective pilot study in which they received MgSO4 as an adjunct to standard SAH management.

An Update on Myasthenic Crisis.

Myasthenia gravis (MG) is the most common disorder of the neuromuscular junction. Myasthenia crisis, defined as respiratory failure requiring mechanical ventilation in MG, is a common life-threatening complication that occurs in approximately 15% to 20% of patients with MG during their life time. The advent of effective mechanical ventilation, specialized neurointensive care units and the widespread use of immunotherapies have substantially altered the prognosis of myasthenic crisis.

A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage.

The authors performed a multicenter prospective observational study to evaluate the feasibility and safety of intravenous antihypertensive protocol for acute hypertension in patients with intracerebral hemorrhage (ICH). Twenty-seven patients with ICH and acute hypertension (mean age 61.37 +/- 14.

Treatable potential cardiac sources of embolism in patients with cerebral ischemic events: a selective transesophageal echocardiographic study.

Objectives: To characterize cardiac sources of emboli detected by transesophageal echocardiography (TEE) in patients without recognizable cause of transient ischemic attack (TIA) and/or ischemic stroke and TIA.

Methods: We examined a prospective registry that included all patients with TIA and/or stroke evaluated by TEE between July 2000 and August 2001 at our medical center. Ischemic events were classified according to clinical and neuroimaging findings as cortical, lacunar, or vertebrobasilar circulation.

Respiratory failure as a first presentation of myasthenia gravis.

Background: Although respiratory failure commonly occurs during the course of myasthenia gravis (MG), it is rarely described at presentation in patients with previously unrecognized MG.

Material/methods: We determined the prevalence and clinical characteristics of patients with respiratory failure associated with undiagnosed MG by review of the medical records of all patients who were diagnosed with MG related respiratory failure at four University hospitals. Respiratory failure was defined on the basis of a forced vital capacity < or =1 liter, negative inspiratory force < or =20 cm H2O, or requirement of mechanical ventilation.

Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events.

Background: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described.

Objective: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events.

Cardiovascular manifestations of acute intracranial lesions: pathophysiology, manifestations, and treatment.

The objective of this article was to review the effects of acute intracranial lesions on myocardial function. The authors reviewed scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through January 2002. Pertinent literature was referenced, including clinical and laboratory investigations, to demonstrate the effects of acute intracranial lesions on the cardiovascular system.

Characteristics and predictors of aortic plaques in patients with transient ischemic attacks and strokes.

Objective: To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events.

Background: Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described.

Myasthenic Crisis.

Myasthenia gravis is the most common disorder of the neuromuscular junction. Myasthenia crisis, defined as respiratory failure requiring mechanical ventilation in myasthenia gravis, is a common life-threatening complication that occurs in approximately 15% to 20% of patients with myasthenia gravis. The advent of effective mechanical ventilation, specialized neurointensive care units, and the widespread use of immunotherapies have substantially altered the prognosis of myasthenic crisis.

Effect of endovascular treatment on headaches in patients with unruptured intracranial aneurysms.

Background: Patients with unruptured intracranial aneurysms often present with headaches.

Objective: To determine the effect of endovascular treatment on the character and frequency of headaches in patients with unruptured intracranial aneurysms.

Methods: We reviewed the medical records of all patients who underwent endovascular treatment for unruptured intracranial aneurysms within a 9.

Neuroimaging of stroke: a review.

Advances in neuroimaging technology during the past 30 years have resulted in a virtual explosion in the amount of pathologic information that can be obtained in the clinical stroke setting. This neuroimaging revolution has led to a much better understanding of cerebrovascular and tissue pathology, creating a wide array of opportunities for acute treatment and secondary prevention. Advances include early and accurate detection of ischemic and infarcted tissue and the ability to reveal hypoperfused tissue at risk.

Use of intravenous abciximab as adjunctive therapy for carotid angioplasty and stent placement.

The benefit of intravenous abciximab as an adjunctive to percutaneous coronary intervention has been demonstrated in large-scale randomized studies. The role of intravenous abciximab is being defined in carotid angioplasty and stent placement as the procedure is gaining popularity for the treatment of high-grade carotid stenosis in patients considered high-risk for carotid endarterectomy. This paper summarizes the pathophysiological basis and the available data for the use of abciximab as an adjunct to carotid artery stenting.

Intracranial stent placement for the treatment of a carotid-cavernous fistula associated with intracranial angioplasty. Case report.

The authors report a case of an iatrogenic carotid-cavernous fistula (CCF) associated with intracranial angioplasty. Angioplasty was performed using a 3 x 10-mm Open Sail coronary balloon in a patient with high-grade stenosis of the left cavernous internal carotid artery (ICA). After angioplasty, a perforation developed in the cavernous ICA, resulting in a CCF.

Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study.

Objective: We sought to determine the long-term stroke-free survival of patients who present with ischemic events related to intracranial vertebrobasilar stenosis.

Methods: A retrospective cohort of patients diagnosed with symptomatic vertebrobasilar stenosis on the basis of magnetic resonance angiography and/or conventional angiography was identified at four academic medical centers. Patients' clinical and follow-up information was obtained through hospitalization records, clinic visits, and telephone interviews.

Clinical potential of intra-arterial thrombolytic therapy in patients with acute ischaemic stroke.

Acute ischaemic stroke is a leading cause of mortality and morbidity around the world. An arterial occlusive lesion is found in the majority of patients with acute ischaemic stroke, and recanalisation has been shown to result in a better clinical outcome. The only widely approved recanalisation strategy is the use of intravenous alteplase (recombinant tissue-type plasminogen activator; tPA) within 3 hours of stroke onset.

Management of carotid artery stenosis: comparing endarterectomy and stenting.

Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer. It is also the most important cause of disability. Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs.

Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review.

Objective: To determine the time interval between symptom onset and neurologic deterioration related to cerebral edema in patients with massive middle cerebral artery infarction. The time period between onset and neurologic deterioration represents the window for surgical intervention.

Design: Multicenter retrospective chart review.

Third generation thrombolytics for the treatment of ischemic stroke.

The field of intravenous and intra-arterial thrombolysis for the treatment of acute ischemic stroke is rapidly advancing. Limitations of existing thrombolytic agents have prompted the development of new thrombolytic agents over the last decade. These new agents are broadly classified as third generation thrombolytics.

Cerebral blood flow changes associated with intracerebral hemorrhage.

Recent advances have furthered our understanding of changes in CBF after ICH. Recent evidence from experimental and clinical studies has not supported the role of CBF changes in the pathogenesis of neuronal injury. A better understanding of these changes in ICH has modified the basis for formulating treatment strategies and developing innovative therapies.

Ventilatory care in myasthenia gravis crisis: assessing the baseline adverse event rate.

Objective: Myasthenic patients who require mechanical ventilation often develop pneumonia or atelectasis. Although there are differences in the prevalence of these complications among various institutions, there is no evidence that aggressive treatment shortens the course of the myasthenic crisis. We have quantified the severity of lung injury and aggressiveness of respiratory intervention in myasthenic patients admitted to the neuro-critical care unit.

Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agent for ischemic stroke: a prospective study.

Objective: We prospectively evaluated the safety and effectiveness of aggressive mechanical disruption of clot in conjunction with intra-arterial administration of a low-dose third-generation thrombolytic agent (reteplase) to treat ischemic stroke in patients who were considered poor candidates for intravenous alteplase therapy or who failed to improve after intravenous thrombolysis. Mechanical clot disruption was used if low-dose pharmacological thrombolysis was ineffective. This strategy was adopted to increase the recanalization rate without increasing the risk of intracerebral hemorrhage.