Five-year results of randomized bioactive versus bare metal coils in the treatment of intracranial aneurysms: the Matrix and Platinum Science (MAPS) Trial.

Background: No randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix coils to BMCs. The primary objective was to compare the rates of target aneurysm recurrence (TAR) at 12 months.

WEAVE Trial: Final Results in 152 On-Label Patients.

Background and Purpose- The WEAVE trial (Wingspan Stent System Post Market Surveillance) is a postmarket surveillance trial mandated by the Food and Drug Administration to assess the periprocedural safety of the Wingspan Stent system in the treatment of symptomatic intracranial atherosclerotic disease. Methods- A total of 152 consecutive patients who met the Food and Drug Administration on-label usage criteria were enrolled at 24 hospitals and underwent angioplasty and stenting with the Wingspan stent. On-label criteria included age 22 to 80 years, symptomatic intracranial atherosclerotic stenosis of 70% to 99%, baseline modified Rankin Scale score ≤3, ≥2 strokes in the vascular territory of the stenotic lesion with at least 1 stroke while on medical therapy, and stenting of the lesion ≥8 days after the last stroke.

In vitro studies for stent-assisted coiling of terminus aneurysms by straight-on intra-aneurysmal stent deployment.

Objective: Deployment of a Neuroform microstent (NFM; Boston Scientific/Target, Freemont, California, USA) within acutely angled geometry may result in substantial deformations. This in vitro study was conducted to validate a novel alternative technique, consisting of intentional deployment of a NFM straight on into a terminus aneurysm, by assessing the mechanics, feasibility, and stability of the coils.

Methods: Silicon models of wide-neck terminus aneurysms were constructed.

Atretic parietal cephalocele associated with sinus pericranii: embryological consideration.

We report a case of atretic parietal cephalocele with a persistent parietal falcine sinus and partial absence of the straight sinus. The direct puncture angiographic study demonstrated that there was a major venous channel through the parietal skull defect. From the embryological point of view, this association may provide us with possible pathoetiologic evidence of congenital sinus pericranii is one of the alternative venous drainage pathways to compensate venous outflow in the cases of intracranial developmental anomalies.

Intracranial angioplasty and/or stent placement in octogenarians is associated with a threefold greater risk of periprocedural stroke or death.

Purpose: To compare the clinical and angiographic outcomes of endovascular treatment of symptomatic intracranial stenosis between octogenarian and younger patients.

Methods: Data for 244 consecutive patients (173 men; mean age 61.6 years) who underwent angioplasty and/or stenting for intracranial atherosclerotic disease at 5 specialized centers were pooled.

Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results.

Introduction: The study's purpose is to report the technical and clinical outcomes of a patient cohort that underwent vertebral artery ostium stent placement for atherosclerotic stenosis.

Methods: We retrospectively analyzed a prospectively collected database of neurointerventional procedures performed at a single center from 1999 to 2005. Outcome measures included recurrent transient neurological deficits (TNDs), stroke, and death.

Comparison of primary angioplasty with stent placement for treating symptomatic intracranial atherosclerotic diseases: a multicenter study.

Background And Purpose: We sought to compare the clinical outcomes between primary angioplasty and stent placement for symptomatic intracranial atherosclerosis.

Methods: We retrospectively analyzed the clinical and angiographic data of 190 patients treated with 95 primary angioplasty procedures and 98 intracranial stent placements (total of 193 procedures) in 3 tertiary care centers. Stroke and combined stroke and/or death were identified as primary clinical end points during the periprocedural and follow-up period of 5 years.

Risk factors for in-stent restenosis after vertebral ostium stenting.

Purpose: To determine whether vascular risk factors, underlying vessel diameter, and/or the type of stent affect restenosis rates for vertebral ostium stents.

Methods: A single-center retrospective analysis was conducted of 44 patients (31 men; mean age 61 years, range 32-81) who underwent stenting of 48 ostial lesions in the vertebral arteries between 1999 and 2005. Only patients who underwent angiographic follow-up were included in the analysis.

Primary bone tumors of the spine in children.

Object: Tumors originating in the vertebrae in children are difficult to treat. In this paper the authors sought to evaluate the decision-making process and outcome of surgical intervention in this population given the complex issues of spinal stability, continued skeletal growth, intraoperative blood loss, and long-term outcome.

Methods: To select patients for this study, the authors retrospectively reviewed medical records and images at the University of Iowa Hospitals and Clinics between 1996 and 2005.

Experimental model evaluation of filter trapping after embolectomy using the Merci system: supplemental technique for Merci retrieval procedure.

Examination of embolectomy using the Merci Retrieval System using experimental stroke models demonstrated that aspiration is not adequate to remove larger clots. The effectiveness of filter trapping was examined using the same models. A silicone model of the carotid artery system with model blood clot was incorporated in a laboratory pulsatile flow system.

Evaluation of Merci Retriever by experimental modeling.

The Merci Retriever is the first device for mechanical embolus removal in patients with cerebral ischemia. Use of the device was evaluated using experimental models. Three stroke model systems were created: silicone embolism model with flow system, pig embolism model, and silicone-pig tortuous artery model.

Simulation of endovascular neurointervention using silicone models: imaging and manipulation.

Silicone models of cerebral aneurysm and stroke pathology were produced by copying the images of clinical cases to evaluate the simulation of endovascular procedures. Conventional silicone models, silicone suture models made from separate aneurysm sac and parent artery sutured together, and animal vascular models made from vessels obtained from pigs were made. The models were incorporated in the training system for simulation of endovascular procedures under digital subtraction angiography control using a portable angiography system.

Tertiary microvascular territories define lacunar infarcts in the basal ganglia.

Lacunar infarcts are commonly found in the basal ganglia, though little is known about the organization of small-scale microvascular territories that presumably subtend lacunae. We investigated microvascular territories of the lenticulostriate arteries, the recurrent artery of Heubner, the anterior choroidal artery, and striate branches of the anterior cerebral and anterior communicating arteries in perfusion-fixed human brains by simultaneous injection of fluorescent dyes and a radio-opaque substance in 5% gelatin. Territories were defined by ultraviolet illumination of dye and high-resolution mammography of radio-opaque substance.

Outcomes for overlapping stents in the extracranial carotid artery.

Various diseases of the carotid artery are treatable by stenting. However, few reports of overlapping carotid stents exist. As a result, the indications, long-term outcomes, and potential complications of this technique remain largely unknown.

Successful treatment of cerebral vasospasm by use of transdermal nitroglycerin ointment (Nitropaste).

To our knowledge, the use of transdermal nitroglycerin ointment (Nitropaste) in the setting of intracranial vasospasm has not been described in the peer-reviewed literature. Five patients with intracranial vasospasm induced by subarachnoid hemorrhage were evaluated angiographically both before and after application of Nitropaste. All cases exhibited mild to moderate improvement in the degree of vasospasm.

Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome.

Background And Purpose: Permanent balloon occlusion (PBO) of the carotid artery has been previously shown to be an effective means to treat carotid blowout syndrome (CBS). However, despite the effectiveness of this endovascular technique, concern remains regarding its potential for producing delayed cerebral ischemic complications in 15% to 20% of patients. This significant limitation of carotid PBO led our group to evaluate an alternative management strategy, consisting of endovascular reconstruction of the carotid artery (ERCA) in patients thought to be at particularly high risk for carotid occlusion (ie, provocative balloon test occlusion, angiographic documented incomplete circle of Willis, or contralateral carotid artery occlusion).

Galenic dural arteriovenous fistula: unusual clinical presentation and successful endovascular therapy. Case report.

The authors report a case in which the clinical and neuroimaging findings were initially considered diagnostic of a brainstem glioma. Angiography revealed a deep venous system (galenic) dural arteriovenous fistula causing brainstem interstitial edema. Successful endovascular surgery resulted in complete clinical recovery of the patient and resolution of the structural abnormalities that had been observed on magnetic resonance images.

Quantitative assessment of polymerization-binding mechanics of cyanoacrylates: model development and validation.

Background And Purpose: Although commonly acknowledged as paramount in significance, the mechanics of cyanoacrylate polymerization remain poorly characterized and quantified for clinical applications. This prompted development of a simplistic model for the systematic study of polymerization and binding behaviors of cyanoacrylates.

Methods: A sliding bed apparatus was constructed that linked a strain gage with a vessel that could be filled with liquid medium, cyanoacrylate, and a microcatheter.

Peripheral aneurysms of the lateral posterior choroidal artery: clinical presentation and endovascular treatment: report of two cases.

Objective And Importance: To describe the clinical presentation and endovascular management of peripheral aneurysms of the lateral posterior choroidal artery. Aneurysms in this location are exceptionally rare and optimal treatment may be difficult.

Clinical Presentation: Two patients with peripheral aneurysms of the distal portion of the lateral posterior choroidal artery presented with headaches from extensive intraventricular hemorrhage.