Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke.

Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications.

Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study.

We aimed to evaluate whether virtual non-contrast cerebral computed tomography (VNCCT) reconstructed from intravenous contrast-enhanced dual-energy CT (iv-DECT) could replace non-contrast CT (NCCT) in patients with suspected acute cerebral ischemia. This retrospective study included all consecutive patients in whom NCCT followed by iv-DECT were performed for suspected acute ischemia in our emergency department over a 1-month period. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine signs of acute ischemia in the anterior and posterior circulation, the presence of hemorrhage, and alternative findings, which were randomly evaluated via the consensus reading of NCCT and VNCCT by two readers blinded to the final diagnosis.

Specificity of Quantitative Functional Brain Mapping with Arterial Spin-Labeling for Preoperative Assessment.

Background And Purpose: Arterial spin-labeling is a noninvasive MR imaging technique allowing direct and quantitative measurement of brain perfusion. Arterial spin-labeling is well-established in clinics for investigating the overall cerebral perfusion, but it is still occasionally employed during tasks. The typical contrast for functional MR imaging is blood oxygen level-dependent (BOLD) imaging, whose specificity could be biased in neurologic patients due to altered neurovascular coupling.

Brain functional connectivity alterations associated with neuropsychological performance 6-9 months following SARS-CoV-2 infection.

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging.

Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study.

Background And Purpose: To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort METHODS: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.

Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon: not known vascular malformation of the brain or a posthemorrhagic entity?

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure.

Experimental evaluation of the NeVa™ thrombectomy device a novel stent retriever conceived to improve efficacy of organized clot removal.

Background And Purpose: Stent retrievers are recognized as the most effective devices for intracranial thrombectomy. Although highly effective, such devices fail in clot removal when the brain vessel occlusion is due to organized, firm clots. The mechanism of failure is that during the retrieval, devices remain compressed by the organized clot and slide between it and the vessel wall without any removal effect.

Trans-venous embolization of a basal ganglia ruptured arteriovenous malformation with open surgical arterial control: A hybrid technique.

Treatment of ruptured deep-seated arteriovenous malformations is challenging and associated with elevated risks. This is due to the proximity or involvement of critical brain structures and the specifically fine and delicate angioarchitecture of these lesions, making both endovascular and surgical access technically complicated. We present the advantages of a true combined, open surgical and endovascular transvenous approach in a hybrid operating room.

Hemodynamics of Focal Versus Global Growth of Small Cerebral Aneurysms.

Background And Purpose: Hemodynamics play a driving role in the life cycle of brain aneurysms from initiation through growth until eventual rupture. The specific factors behind aneurysm growth, especially in small aneurysms, are not well elucidated. The goal of this study was to differentiate focal versus general growth and to analyze the hemodynamic microenvironment at the sites of enlargement in small cerebral aneurysms.

The role of unenhanced CT alone for the management of headache in an emergency department. A feasibility study.

Objective: To determine whether unenhanced CT alone could be sufficient for the screening of patients admitted with a suspicion of secondary headache in an emergency center.

Material And Methods: A feasibility study including consecutive patients admitted to our emergency department for acute non-traumatic headache, in whom a brain CT was required by the emergency physician, was conducted over a 3-month period of time. Patients with a suspicion of intracranial pathology, which can only be depicted by i.

Accuracy of a novel risk index combining degree of stenosis of the carotid artery and plaque surface echogenicity.

Background And Purpose: The purpose of this study was to determine the accuracy of a risk index in symptomatic or asymptomatic carotid stenoses.

Methods: Consecutive patients presenting 50% to 99% carotid stenoses were included. A semiautomated gray scale-based color mapping (red, yellow, and green) of the whole plaque and of its surface was achieved.

Principles of classification analyses in mild cognitive impairment (MCI) and Alzheimer disease.

The majority of advanced neuroimaging studies implement group level analyses contrasting a group of patients versus a group of controls, or two groups of patients. Such analyses may identify for example changes in grey matter in specific regions associated with a given disease. Although such group investigations provided key contributions to the understanding of the pathological process surrounding a wide range of diseases, they are of limited utility at an individual level.

Flow-diverting stent for ruptured intracranial dissecting aneurysm of vertebral artery.

Background: The treatment of ruptured dissecting aneurysms of the intracranial vertebral artery (VA) with parent vessel preservation is a challenge for neurosurgeons and interventional neuroradiologists.

Objective: To propose an indication for flow-diverting treatment for reconstruction of a dissecting VA with acute subarachnoid hemorrhage.

Methods: Two male patients transferred after acute subarachnoid hemorrhage and dissecting aneurysm on the V4 segment of the dominant VA.

CT and MR angiography features of traumatic vascular injuries of the neck.

Objective: The objective of this article is to review the CT and MR angiography features of vascular injuries to the neck with special emphasis on the key diagnostic features of common and less common entities.

Conclusion: CT and MR angiography are highly efficient for the diagnosis of most arterial and venous traumatic lesions in the acute setting and when patients develop delayed symptoms. Conventional angiography is recommended only for therapeutic purposes or when the diagnosis remains unclear after performing cross-sectional imaging techniques.

Combined analysis of grey matter voxel-based morphometry and white matter tract-based spatial statistics in late-life bipolar disorder.

Background: Previous magnetic resonance imaging (MRI) studies in young patients with bipolar disorder indicated the presence of grey matter concentration changes as well as microstructural alterations in white matter in various neocortical areas and the corpus callosum. Whether these structural changes are also present in elderly patients with bipolar disorder with long-lasting clinical evolution remains unclear.

Methods: We performed a prospective MRI study of consecutive elderly, euthymic patients with bipolar disorder and healthy, elderly controls.

Magnetic resonance imaging of metabolic diseases of the cerebral white matter.

Metabolic diseases of the brain are a rare occurrence. They may be either occurring as inherited diseases causing a destruction of myelin, or they may be the result of toxicity. Neuroimaging, especially magnetic resonance imaging, plays an important role in the detection and classification of these rare diseases.

Magnetic resonance imaging in multiple sclerosis.

Objectives: multiple sclerosis (MS) is an inflammatory disease of unknown origin affecting the central nervous system. Magnetic resonance imaging (MRI) plays an increasingly important role in its diagnosis and further monitoring of disease progress.

Methods: the typical MRI appearance of MS on conventional MRI sequences and current diagnostic criteria for MS are discussed.

Cerebral microhemorrhage and iron deposition in mild cognitive impairment: susceptibility-weighted MR imaging assessment.

Purpose: To test whether susceptibility-weighted magnetic resonance imaging at baseline may help predict cognitive decline.

Materials And Methods: This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Thirty-five healthy control subjects and 69 patients with mild cognitive impairment were included.

Individual prediction of cognitive decline in mild cognitive impairment using support vector machine-based analysis of diffusion tensor imaging data.

Although cross-sectional diffusion tensor imaging (DTI) studies revealed significant white matter changes in mild cognitive impairment (MCI), the utility of this technique in predicting further cognitive decline is debated. Thirty-five healthy controls (HC) and 67 MCI subjects with DTI baseline data were neuropsychologically assessed at one year. Among them, there were 40 stable (sMCI; 9 single domain amnestic, 7 single domain frontal, 24 multiple domain) and 27 were progressive (pMCI; 7 single domain amnestic, 4 single domain frontal, 16 multiple domain).

Multiple coaxial catheter system for reliable access in interventional stroke therapy.

In some patients with acute cerebral vessel occlusion, navigating mechanical thrombectomy systems is difficult due to tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries. Our purpose was to describe a multiple coaxial catheter system used for mechanical revascularization that helps navigation and manipulations in tortuous vessels. A triple or quadruple coaxial catheter system was built in 28 consecutive cases presenting with acute ischemic stroke.

Percutaneous vertebroplasty: preliminary experiences with rotational acquisitions and 3D reconstructions for therapy control.

Percutaneous vertebroplasty (PVP) is carried out under fluoroscopic control in most centers. The exclusion of implant leakage and the assessment of implant distribution might be difficult to assess based on two-dimensional radiographic projection images only. We evaluated the feasibility of performing a follow-up examination after PVP with rotational acquisitions and volumetric reconstructions in the angio suite.

Rheological changes after stenting of a cerebral aneurysm: a finite element modeling approach.

Hemodynamic changes in intracranial aneurysms after stent placement include the appearance of areas with stagnant flow and low shear rates. We investigated the influence of stent placement on blood flow velocity and wall shear stress of an intracranial aneurysm using a finite element modeling approach. To assess viscosity changes induced by stent placement, the rheology of blood as non-Newtonian fluid was taken into account in this model.

Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results.

Purpose: To describe a new fluoroscopically guided technique for osteoplasty (or cementoplasty) of the superior and inferior pubic rami and ischial tuberosities and to provide information about the access routes and initial results on pain management after this technique.

Materials And Methods: Twenty-three lytic metastases of the superior and inferior pubic rami and ischial tuberosities were treated in 14 consecutive patients. Percutaneous access of the bones was performed under fluoroscopy.