Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study.

Background: Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.

Initial Technical Experience with the SMART Coil for the Embolization of Intracranial Aneurysms.

Background/objective: Traditional platinum coils used for cerebral aneurysm embolization have a uniform degree of softness throughout an individual coil's length. Recently, SMART Coils (Penumbra Inc., Alameda, California, USA) have been developed, which transition in softness along the length of their coils.

Aneurysm Study of Pipeline in an Observational Registry (ASPIRe).

Background And Objective: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms.

Materials And Methods: We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED.

The SPEED study: initial clinical evaluation of the Penumbra novel 054 Reperfusion Catheter.

Background And Purpose: Revascularization of acute ischemic stroke from a large vessel occlusion continues to be a challenge with current thrombectomy devices. The purpose of the SPEED study was to report the safety and effectiveness of the Penumbra 054 Reperfusion Catheter System in revascularizing large vessel occlusions.

Methods: In this retrospective multicenter study, data were collected from patients with angiographic evidence of large vessel occlusion treated with the Penumbra 054 device as the intended primary therapy.

CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study.

Background: The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke.

Methods: Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥ 8, regardless of time from symptom onset.

Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial.

Background And Purpose: Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates.

Intraoperative endovascular treatment as an adjunct to microsurgical clipping of paraclinoid aneurysms.

Object: The endovascular procedure can provide proximal control, suction decompression, and prompt intraoperative angiography during microsurgical clipping of aneurysms of the paraclinoid segment of the internal carotid artery (ICA). The authors assess the safety and feasibility of this method in 24 consecutive cases.

Methods: Frontotemporal craniotomy and radical pterionectomy were performed with the patient's head immobilized in a radiolucent frame while femoral artery catheterization was achieved.

Early clinical experience with a dedicated portable computed tomography scanner in a biplane neuroangiography suite: assessment of feasibility and utility in neurointerventional practice.

The ability to have on-site access to cross-sectional imaging in a biplane neuroangiography suite has tremendous potential for enhancing current neurointerventional practice.Although a few prototypical multimodality suites have been created, several problems/limitations have prevented widespread implementation. Recently, a portable CT scanner has been developed, which may overcome previous shortcomings.

Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms.

Objectives: The use of percutaneous, direct puncture therapeutic embolization (DPTE) of hypervascular head and neck neoplasms is a relatively new modality that may be used to supplement or supplant conventional endovascular transarterial embolization. Although the preliminary clinical experience reported by a single group has been favorable, extensive case series experience is lacking. This prompted us to review our recent clinical experience with these techniques to determine safety, efficacy, and emerging role in the overall neurointerventional therapeutic armamentarium.

Clinically aggressive diffuse capillary telangiectasia of the brain stem: a clinical radiologic-pathologic case study.

Capillary malformations or telangiectasias of the brain usually exhibit a benign clinical course, although occassionally they may be associated with mild to moderate symptomatology of uncertain origin. We report a case of an exceptionally aggressive capillary telangiectasia in a child, which was associated with progressive neurologic deterioration resulting in death.

Use of mechanical thrombolysis via microballoon percutaneous transluminal angioplasty for the treatment of acute dural sinus thrombosis: case presentation and technical report.

Objective And Importance: Although conventional superselective chemical thrombolysis is frequently successful for the treatment of severe acute dural sinus thrombosis, the technique has limitations and risks. This prompted us to develop a supplemental technique for achieving more rapid recanalization, using coronary microballoon percutaneous transluminal angioplasty catheters. We describe a successful application of this technique and technology that has not been previously reported.

A reexamination of the angiotoxicity of superselective injection of DMSO in the swine rete embolization model.

Background And Purpose: There are a variety of embolization applications for non-adhesive, liquid agents. We reevaluated the potential microvascular angiotoxicity of superselective infusions of dimethyl sulfoxide (DMSO) using very long infusion rates in a previously described animal model.

Methods: Twenty-six swine underwent percutaneous femoral puncture for superselective catheterization of the artery of the rete while being continuously monitored for ECG and intraarterial pressure.

Accentuated Vasospasm during Treatment of an Acutely Ruptured Aneurysm with Electrolytically Detachable Coils: Coincidence or Causation?

We report an unusual case of precipitous worsening of vasospasm associated with subarachnoid haemorrhage that developed during endosaccular coil embolisation of a ruptured posterior communicating aneurysm. The acutely worsening vasospasm occurred in the distal ipsilateral anterior circulation remote from the site of microcatheter manipulation, resulting in transient occlusion. Despite successful endovascular treatment of both the aneurysm and vasospasm, the patient continued to clinically decline and eventually died.

Repositioning of displaced guglielmi detachable coils after endosaccular embolisation using a modification of the neck plastic technique. A technical note.

After undergoing prior partial surgical clipping of an acutely ruptured internal carotid aneurysm, a 29-year-old woman was referred for endovascular treatment of the gradually enlarging aneurysm remnant. The aneurysm had a somewhat peculiar ellipsoid configuration due to placement of the clip, with the largest dimension measuring less than 4 mm, and the neck measuring approximately 2 mm. Using the conventional endosaccular coil embolisation technique, two small electrolytically detachable coils were carefully folded into the aneurysm sac to produce excellent tight packing.

Classification of vascular malformations of the central nervous system.

The ability to systematically and meaningfully classify a disease is in many ways a reflection of our overall understanding of it. Over time, nosologic schemes applied to any disease typically undergo a characteristic evolution from purely descriptive, to pathoanatomic and/or embryologic, to finally biological definitions. With the recent developments in further elucidating the pathophysiology, histopathology, natural history, and cellular biology of various vascular malformations occurring within the central nervous system, it is time to derive a more comprehensive and "universal" classification system that integrates classic pathoanatomic schemes with a biologically defined scheme previously developed for systematic vascular malformations.

The net national costs of illegal immigration into the United States.

"This article examines the major economic pros and cons of illegal immigration and answers the question: what, if any, are the public and private costs of illegal immigration in the United States? In brief, the article finds that between four and 5.4 million illegal immigrants reside here..

The magnetization transfer effect in cerebral infarction.

Purpose: To estimate the age of cerebral infarcts using magnetization transfer.

Methods: Twelve patients with radiographically and clinically documented cortical and subcortical cerebral infarctions underwent MR imaging on a 0.1T magnet.