Proper ophthalmic artery aneurysms.

Background: The ophthalmic segment of the internal carotid artery (ICA) represents a common site for cerebral aneurysms. However, aneurysms of the ophthalmic artery (OphA) itself represent rare lesions and have been associated with trauma and flow-related lesions such as arteriovenous fistulas or malformations. Here, we explore clinical and radiological features of four patients managed for five proper ophthalmic artery aneurysms (POAAs).

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic.

Background: Tenecteplase (TNK) is a genetically modified variant of alteplase (TPA) and has been established as a non-inferior alternative to TPA in acute ischemic stroke (AIS). Whether TNK exerts distinct benefits in large vessel occlusion (LVO) AIS is still being investigated.

Objective: To describe our first-year experience after a healthcare system-wide transition from TPA to TNK as the primary thrombolytic.

In-hospital mortality rates, complication rates, length of stay, and total costs of >14,000 chronic subdural hematomas treated in the U.S. between 2016 and 2020: Query of the premier health-care database.

Background: With the drastically aging population in the U.S., chronic subdural hematomas (cSDHs) are projected to represent the most common neurosurgical diagnosis requiring treatment within the next two decades.

Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience.

Introduction: The Walrus balloon guide catheter (BGC) is a new generation of BGC, designed to eliminate conventional limitations during mechanical thrombectomy.

Objective: To report a multi-institutional experience using this BGC for proximal flow control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS).

Methods: Prospectively maintained databases at 8 North American centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with a Walrus BGC.

Perioperative Continuous Noninvasive Arterial Pressure Monitoring for Neuroendovascular Interventions: Prospective Study for Evaluation of the Vascular Unloading Technique.

Background: Blood pressure monitoring is crucial during neuroendovascular procedures. Intraoperative hemodynamic instability is associated with complications, which underscores the importance of continuous monitoring. Although direct measurement with an intra-arterial catheter is the gold standard for determining arterial pressure, it is costly, time-consuming, and associated with complications.

Utility of P2Y Reactive Unit Assessment on Ticagrelor in Cerebral Aneurysms Treated with Intracranial Stenting and Flow Diversion: Cohort Study and Case Report From Two Neurovascular Centers.

Background: Dual antiplatelet therapy consisting of aspirin and clopidogrel is the standard of care for neurointerventional stenting and flow diversion. Platelet function testing has been increasingly performed to identify patients with a hypo- or hyper-response to clopidogrel. Ticagrelor has been a popular alternative antiplatelet agent for such patients.

Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study.

Background: The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series.

Objective: To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration.

Intraoperative 3-Dimensional Rotational Angiography in Cerebrovascular Surgery: A Case Series.

Objective: Intraoperative imaging is critical in cerebrovascular surgery to assess the technical success of the operation. This case series aimed to evaluate the safety and efficacy of 3-dimensional rotational angiogram (3D-RA) in addition to 2-dimensional intraoperative angiography (2D-IOA) during cerebrovascular surgery in the hybrid operating room.

Methods: All consecutive patients who underwent open cerebrovascular surgery and intraoperative 2D-IOA with 3D-RA in a hybrid operating room at 2 academic centers between August 2018 and December 2019 were identified from a prospectively maintained institutional database.

Lower complication rates associated with transradial versus transfemoral flow diverting stent placement.

Background: Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.

Methods: We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019.

The Utility of a Diagnostic Angiogram Following Mechanical Thrombectomy for Treatment of Acute Ischemic Stroke.

Objective: Digital subtraction angiography is the gold standard for diagnosis of vascular pathology. The value of angiography of non-target vessels following mechanical thrombectomy for the treatment of acute ischemic stroke (AIS) is unknown.

Patients And Methods: Consecutive patients treated with mechanical thrombectomy for AIS due to large vessel occlusion (LVO) at an academic institution between February 2016 and December 2018 were retrospectively reviewed.

Predictor of 90-day functional outcome after mechanical thrombectomy for large vessel occlusion stroke: NIHSS score of 10 or less at 24 hours.

Objective: Mechanical thrombectomy is the established treatment for acute ischemic stroke due to large vessel occlusion (LVO). The authors sought to identify early predictors of a favorable outcome in stroke patients treated with mechanical thrombectomy.

Methods: Consecutive patients with ischemic stroke due to LVO who underwent mechanical thrombectomy at a Comprehensive Stroke Center in the US between 2016 and 2018 were retrospectively reviewed.

Utility of platelet function testing in stent-assisted coiling of cerebral aneurysms.

Background: Thromboembolic complications are the primary risks of stent-coiling of cerebral aneurysms. The utility of platelet function testing in stent-assisted aneurysm coiling remains controversial. This study aimed to assess a pharmacy-mediated antiplatelet management protocol for stent-assisted coiling.

Modern Training and Credentialing in Neuroendovascular Acute Ischemic Stroke Therapy.

Background: Acute ischemic stroke (AIS) remains a significant source of morbidity and mortality worldwide. Multiple recent randomized clinical trials for AIS patients presenting with large vessel occlusion have demonstrated radical improvement in outcomes with mechanical thrombectomy (MT), which is now recognized as the new standard of care for patients presenting up to 24 hr.

Objective: To provide a perspective on training and credentialing requirements for practitioners in this field.

Acute Development and Rupture of a Basilar Tip Mycotic Aneurysm.

Background: Infectious intracranial aneurysms are rare but encountered when associated with rupture or detected on screening of high-risk patients. The time course of the development of these aneurysms is unknown. Ultimately, the data published on mycotic aneurysms are in the form of case series, retrospective studies, with one recent systematic review, all of which have difficulty defining specifics regarding aneurysmal formation in these patients.

Pipeline Embolization Device with Shield Technology for Intracranial Aneurysms: An Initial U.S. Experience.

Background: Thromboembolic complications remain a major reason for morbidity and mortality after flow diversion, in addition to hemorrhagic complications not limited to the brain predicated on the prolonged need for dual antiplatelet therapy. Surface modification to decrease thrombogenicity and accelerate aneurysm occlusion is a promising alteration to mitigate those risks. The Pipeline embolization device with Shield Technology possesses such characteristics; however, it has not yet been approved in the United States.

Pharmacy-Mediated Antiplatelet Management Protocol Compared to One-time Platelet Function Testing Prior to Pipeline Embolization of Cerebral Aneurysms: A Propensity Score-Matched Cohort Study.

Background: There is ongoing controversy regarding the optimal antiplatelet regimen, and extent or even need for platelet function testing surrounding Pipeline flow diverter (Medtronic Inc, Dublin, Ireland) embolization of cerebral aneurysms.

Objective: To compare a unique pharmacy-mediated antiplatelet medication management protocol to a 1-time platelet function testing strategy prior to Pipeline placement.

Methods: A retrospective review of patients with cerebral aneurysms who underwent Pipeline embolization at 2 academic institutions was performed.

Lateral Medullary Ischemic Infarct Caused by Posterior Inferior Cerebellar Artery Aneurysm.

Posterior inferior cerebellar artery (PICA) aneurysms are rare. The most common complication of intracranial aneurysms is rupture causing subarachnoid hemorrhage. Ischemic infarct, although more common in giant thrombosed aneurysms, is a very rare manifestation of small intracranial aneurysms.