Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry.

Background And Objectives: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms.

Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score-matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry.

Objective: Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms.

Methods: The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022.

Training Standards in Neuroendovascular Surgery: Program Accreditation and Practitioner Certification.

Background And Purpose: Neuroendovascular surgery is a medical subspecialty that uses minimally invasive catheter-based technology and radiological imaging to diagnose and treat diseases of the central nervous system, head, neck, spine, and their vasculature. To perform these procedures, the practitioner needs an extensive knowledge of the anatomy of the nervous system, vasculature, and pathological conditions that affect their physiology. A working knowledge of radiation biology and safety is essential.

Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography.

Background: When clinical examination is not reliable for brain death (BD) diagnosis, the preferred confirmatory test at our institution is nuclear medicine perfusion test (NMPT). Computed tomographic angiography (CTA) has been described as an alternative for BD confirmation. This study was designed to quantitatively analyze CTA, assess its accuracy compared with NMPT, and define set parameters for BD confirmation.

Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling.

Background: Stent-assisted coiling of intracranial aneurysms with self-expanding stents has widened the applicability of neuroendovascular therapies to those aneurysms previously considered "uncoilable" because of poor morphology. The Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has demonstrated promising initial short-term results. However, the rates of delayed in-stent stenosis or thrombosis are not known.

Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan.

Introduction: : Brain death is a difficult diagnosis to make, relying primarily on clinical examination. Ancillary tests are used when confounders exist. Nuclear medicine perfusion test (NMPT) is currently the preferred test for confirming brain death.

Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry.

Object: The development of self-expanding stents dedicated to intracranial use has significantly widened the applicability of endovascular therapy to many intracranial aneurysms that would otherwise have been untreatable by endovascular techniques. Recent Food and Drug Administration approval of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has added a new option for self-expanding stent-assisted intracranial aneurysm coiling.

Methods: The authors established a collaborative registry across multiple institutions to rapidly provide largevolume results regarding initial experience in using the Enterprise in real-world practice.

Submaximal angioplasty and staged stenting for severe posterior circulation intracranial stenosis: a technique in evolution.

Introduction: Severe medically refractory intracranial stenosis portends a grave prognosis. Recent advances in stent technology have enabled clinicians to treat these lesions. Evidence in the coronary literature suggests that stenting without predilation angioplasty is as safe and effective as stenting immediately preceded by predilation angioplasty for the treatment of severely stenotic lesions.

Patient selection for revascularization in cervical carotid artery disease: angioplasty and stenting vs. endarterectomy.

Cervical carotid stenosis is a major cause of stroke and disability. Although carotid endarterectomy is an established and effective treatment for some patients with carotid artery stenosis, angioplasty and stenting has emerged in recent years as a viable alternative, particularly for patients who may be less suited for surgery. This article reviews patient selection for the two alternative approaches.

Sirolimus-eluting stents in the canine cerebral vasculature: a prospective, randomized, blinded assessment of safety and vessel response.

Object: Use of the sirolimus-eluting stent has led to a reduction of in-stent stenosis following treatment of coronary atherosclerosis, whereas treatment of intracranial atherosclerosis with bare-metal stents results in excessive restenosis rates of approximately 40%. Neurotoxicity effects and vessel injury are unknown in the cerebral vasculature. To assess the safety profile and vascular effects of sirolimus-coated stents, the authors conducted a prospective comparative study in which drug-eluting and bare-metal stents were implanted in the canine basilar artery (BA).

Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhage.

Object: The goal of this study was to analyze the relationship between cocaine use and outcomes of aneurysmal subarachnoid hemorrhage (SAH).

Methods: A retrospective review was performed of the medical records of patients with intracranial aneurysms treated at a single institution between January 1996 and December 2001. Only patients who presented with SAH were included in the study.

Should interventional cardiologists treat ischemic strokes? A global perspective.

Stroke is the third leading cause of death and the leading cause of severe neurological disability in our nation. The stroke death rate has the potential to reach epidemic proportions as the elderly segment of the population continues to rise. There is an insufficient number of trained physicians to supply the care for this patient population.