Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access.

Background: The transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.

Transradial versus transfemoral approaches for diagnostic cerebral angiography: a prospective, single-center, non-inferiority comparative effectiveness study.

Background: Interventional cardiology produced level 1 evidence recommending radial artery-first for coronary angiography given lower vascular complications. Neuroendovascular surgeons have not widely adopted the transradial approach. This prospective, single center, non-inferiority comparative effectiveness study aims to compare the transradial and transfemoral approaches for diagnostic cerebral angiography with respect to efficacy, safety and patient satisfaction.

Republished: Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis.

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation.

Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis.

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation.

Middle Meningeal Artery Embolization for the Treatment of an Expanding Epidural Hematoma.

Introduction: Epidural hematomas (EHs) usually originate from traumatic injury to the middle meningeal artery (MMA). Although large EHs may need to be emergently evacuated, the management of smaller EHs is less clear, especially in the absence of significant mass effect or neurologic deficits. Endovascular treatment via MMA embolization for epidural hematomas has only been recently reported.

Maturing institutional experience with the transradial approach for diagnostic cerebral arteriography: overcoming the learning curve.

Background: Despite growing interest in the transradial approach for neurovascular procedures, prospective data about the learning curve for neurointerventionalists adopting this approach are limited.

Methods: A subsequent prospective series of 50 consecutive right transradial diagnostic cerebral arteriograms was compared with our initial institutional experience using a procedural staging system. The primary outcome was the ability to achieve the predefined procedural goals using the radial approach.

Stentriever salvage after failed manual aspiration thrombectomy.

Introduction: Manual aspiration thrombectomy (MAT) and stent retriever mediated aspiration thrombectomy (SMAT) are well described reperfusion strategies for large vessel occlusions. This study aims to identify predictors of successful crossover to SMAT after failed first pass MAT.

Methods: Prospectively collected data for patients with acute large vessel occlusions undergoing thrombectomy over a 23 month period at a comprehensive stroke center were reviewed.

A prospective study of the transradial approach for diagnostic cerebral arteriography.

Background: The transradial approach for cardiac catheterization is associated with improved patient safety and satisfaction in comparison with the transfemoral approach. Prospective data for the transradial approach for cerebral arteriography are lacking.

Objective: To carry out a prospective study of consecutive patients undergoing transradial cerebral arteriography at our institution to evaluate the safety, feasibility, and limitations of this approach.

Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy.

Introduction: Various large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored.

Methods: Prospectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries.

Seeing Is Believing: Headway27 as a Highly Visible and Versatile Microcatheter with Ideal Dimensions for Stroke Thrombectomy.

Introduction: Microcatheter selection is an infrequent focus of stroke thrombectomy technique evaluation. The Headway27 microcatheter strikes an excellent balance of microcatheter dimensions (156 cm length, 2.6 Fr distal OD, ID 0.

Intravenous Drug Use Is Novel Predictor of Infectious Intracranial Aneurysms in Patients with Infective Endocarditis.

Introduction: Infectious intracranial aneurysms (IIAs) are a rare but potentially devastating complication of infective endocarditis. The clinical and radiographic findings that predispose patients to IIA remain poorly understood.

Methods: We performed a retrospective review of a prospectively maintained database of consecutive endocarditis patients undergoing catheter-based angiography at a single tertiary-level academic center during the period of July 2013-December 2017.

Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents.

Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections.

Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents.

Use of Omnipaque Intraoperative Dye in the Surgical Treatment of Pan-Spinal Epidural Abscesses: Technical Case Report.

Background And Importance: Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions.

Clinical Presentation: A 57-year-old man presented with lower back pain, which progressed to include urinary retention and evidence of lumbar discitis/osteomyelitis on magnetic resonance imaging.

Cervical instability presenting as thoracic pain: case report and literature review.

Study Design: Case report.

Objective: To report a case of cervical instability from an os odontoideum that presented as posterior thoracic pain and to present a review of the literature.

Background: Thoracic posterior paraspinal spasms and pain are common chief complaints in individuals with spinal abnormalities.

Anterograde revision of cervical spinal cord stimulator paddle electrode: a case report.

Objectives:   To illustrate a new surgical revision strategy for malfunctioning spinal cord stimulation (SCS) paddle electrodes.

Background:   SCS is a treatment for chronic neuropathic pain that delivers therapeutic doses of electric current to the dorsal columns resulting in dermatomal paresthesia and pain reduction. Reasons for SCS failure include hardware malfunction or breakage and medical complications.