Continuous infusion of low-dose unfractionated heparin after aneurysmal subarachnoid hemorrhage: a preliminary study of cognitive outcomes.

Objective: Cognitive dysfunction occurs in up to 70% of aneurysmal subarachnoid hemorrhage (aSAH) survivors. Low-dose intravenous heparin (LDIVH) infusion using the Maryland protocol was recently shown to reduce clinical vasospasm and vasospasm-related infarction. In this study, the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive changes in aSAH patients treated with the Maryland LDIVH protocol compared with controls.

Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies.

Background: The pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself.

Clinical efficacy of 2-phase versus 4-phase computed tomography for localization in primary hyperparathyroidism.

Background: Four-dimensional computed tomography is being used increasingly for localization of abnormal glands in primary hyperparathyroidism. We hypothesized that compared with traditional 4-phase imaging, 2-phase imaging would halve the radiation dose without compromising parathyroid localization and clinical outcomes.

Methods: A transition from 4-phase to 2-phase imaging was instituted between 2009 and 2010.

An overview of antithrombotics in ischemic stroke.

The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke.

Strategic and Technical Considerations for the Endovascular Embolization of Intracranial Meningiomas.

Endovascular embolization is a frequently used adjunct to operative resection of meningiomas. Embolization may decrease intraoperative blood loss, operative time, and surgical difficulty associated with resection. The specific clinical applications of this treatment have not been defined clearly.

Prevalence of dural venous sinus stenosis and hypoplasia in a generalized population.

Background And Purpose: While recent literature has described the prevalence of transverse sinus stenosis in patients with idiopathic intracranial hypertension, tinnitus, and refractory headaches, it is unclear what the prevalence is in the general population. This study evaluates the prevalence of venous sinus stenosis and hypoplasia in the general patient population.

Materials And Methods: 355 of 600 consecutive patients who underwent CT angiography of the head met the inclusion criteria.

Endovascular treatment of ophthalmic artery aneurysms: ophthalmic artery patency following flow diversion versus coil embolization.

Background And Purpose: The Pipeline Embolization Device (PED) has been shown to effectively treat complex internal carotid artery aneurysms while maintaining patency of covered side branches. The purpose of this retrospective matched cohort study is to evaluate the effect of flow diversion on the patency of the ophthalmic artery when treating ophthalmic artery aneurysms.

Methods: A retrospective review of our prospectively collected institutional database identified 19 ophthalmic artery aneurysms treated with a PED.

Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.

Background: We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures.

Methods: Patients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0-10 scale) and disability assessed using the Roland-Morris Disability Questionnaire (RMDQ).

A method for complete angiographic obliteration of a brain arteriovenous malformation in a single session through a single pedicle.

Historically, the endovascular treatment of arteriovenous malformations (AVM) has largely been relegated to an adjunctive role to open surgical and radiosurgical methods. In this article, we describe a novel endovascular approach to the treatment of brain AVM using Onyx (ev3 Endovascular, Plymouth, MN, USA), which may allow for a complete angiographic obliteration in a single treatment session. Twelve patients underwent Onyx embolization of an AVM using a novel "reverse plug and push" technique in which a plug is formed around the treatment catheter prior to injecting Onyx into the AVM.

Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms.

Object: The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique.

Methods: The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported.

DynaCT imaging for intraprocedural evaluation of flow-diverting stent apposition during endovascular treatment of intracranial aneurysms.

The treatment of large, complex intracranial aneurysms is being increasingly performed using flow-diverting stents (FDS) such as the Pipeline Embolization Device (PED; ev3, Irvine, CA, USA). Malapposition of a FDS to the parent artery wall decreases the likelihood of aneurysm obliteration and increases the risk of both immediate and delayed complications. DynaCT scanning (Siemens Medical Solutions, Erlangen, Germany) is a novel imaging modality which uses a flat plane detector to generate CT images using the same C-arm employed for digital subtraction angiography.

Stenting of symptomatic intracranial stenosis using balloon mounted coronary stents: a single center experience.

Objective: Intracranial atherosclerotic disease is the cause of up to 10% of ischemic strokes and transient ischemic attacks. Intracranial stenting with off-label balloon mounted coronary stents (BMCS) may be a viable alternative for patients with symptomatic intracranial stenosis who fail best medical therapy.

Design: Between December 2005 and June 2012, 42 symptomatic intracranial stenoses were treated with a BMCS after failing medical management.

Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction.

We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction.

Solitaire Flow Restoration thrombectomy for acute ischemic stroke: retrospective multicenter analysis of early postmarket experience after FDA approval.

Background: The promising results of the Solitaire Flow Restoration (FR) With the Intention for Thrombectomy (SWIFT) trial recently led to Food and Drug Administration (FDA) approval of the Solitaire FR stent retriever device for recanalization of cerebral vessels in patients with acute ischemic stroke.

Objective: To report the early postmarket experience with this device since its FDA approval in the United States, which has not been previously described.

Methods: We conducted a retrospective analysis of consecutive acute ischemic strokes cases treated between March 2012 and July 2012 at 10 United States centers where the Solitaire FR was used as a single device or in conjunction with other intraarterial endovascular approaches.

Early postmarket results after treatment of intracranial aneurysms with the pipeline embolization device: a U.S. multicenter experience.

Background: The pipeline embolization device (PED) is the latest technology available for intracranial aneurysm treatment.

Objective: To report early postmarket results with the PED.

Methods: This study was a prospective registry of patients treated with PEDs at 7 American neurosurgical centers subsequent to Food and Drug Administration approval of this device.

Telehealth stroke education for rural elderly Virginians.

Objective: Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person stroke prevention education methods.

Symptomatic Wingspan stent stenosis and occlusion: stent-in-stent rescue.

The use of the Wingspan stent in severe intracranial stenosis is associated with a relatively high in-stent re-stenosis rate. Reported management strategies for re-stenosis have included angioplasty alone or angioplasty with placement of a second Wingspan stent. A case is presented in which thrombosis within a Wingspan stent was treated with a balloon expandable cobalt-chromium stent within the Wingspan stent.

Magnetic resonance angiography of the extracranial carotid system.

Objectives: To discuss the role of magnetic resonance angiography (MRA) in the evaluation of the extracranial carotid system with an emphasis on atherosclerosis and to briefly address the role of magnetic resonance imaging in imaging of carotid atherosclerotic plaque.

Methods: Literature and institutional review.

Discussion: The North American Symptomatic Carotid Endarterectomy Trial and European Carotid Surgery Trial studies have emphasized the importance of recognition and treatment of carotid stenosis in the prevention of ischemic stroke.

Imaging diagnosis of acute pulmonary embolism.

Pulmonary embolism represents a major public healthcare problem and it also imposes frequent clinical diagnostic issues. Despite the availability of the D-dimer tests, imaging remains the mainstay for its diagnosis. Computed tomography pulmonary angiography (CTPA) is now the most widely used diagnostic test and its utility has been well validated in a large number of trials.

Soft tissue calcifications in the lower extremities of severely diabetic patients simulating venous stasis or collagen vascular disease.

The purpose of this work is to report soft tissue calcifications in severely diabetic patients that simulate venous stasis or scleroderma, without other stigmata of these diseases. Findings from lower extremity radiographs were reviewed on two patients with severe diabetes mellitus and abnormal soft tissue calcifications. Findings were correlated with clinical history, physical exam findings, and laboratory values.

Surgical revascularization in the presence of a preserved primitive carotid-basilar communication.

Anomalous arteries that connect the anterior and posterior cranial arterial systems are unusual variants that can severely alter normal patterns of cerebral blood flow. Persistent trigeminal, hypoglossal, otic, and proatlantal arteries have been described. This report illustrates the technical aspects of carotid endarterectomy with an ipsilateral preserved primitive carotid-basilar communication.

Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty.

Purpose: Some operators use the lack of point tenderness over compression fractures to exclude patients from undergoing percutaneous vertebroplasty procedures. The purpose of this study was to determine whether this lack of tenderness portends a poorer clinical outcome after vertebroplasty than is achieved in patients with such tenderness.

Materials And Methods: The authors conducted a retrospective review of consecutive percutaneous vertebroplasty procedures performed at their institution to define two populations.

The therapeutic benefit of repeat percutaneous vertebroplasty at previously treated vertebral levels.

Background And Purpose: Recurrent pain after vertebroplasty is relatively common, usually representing a new fracture at a different vertebral level. In a small cohort described herein, clinical and imaging findings indicated that recurrent pain arose from abnormality of the previously treated level. Our purpose was to demonstrate that repeat percutaneous vertebroplasty performed within the same fractured vertebra can offer therapeutic benefit for patients with recurrent pain after initial treatment.

Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures.

Background And Purpose: Controversy exists regarding the utility of antecedent venography in percutaneous vertebroplasty. Our purpose was to determine whether antecedent venography improves clinical outcomes and/or decreases extravertebral cement extravasation in these procedures.

Methods: We retrospective reviewed outcomes of consecutive percutaneous vertebroplasty procedures performed at our institution to define two populations, each consisting of 24 patients treated at 42 vertebral levels.