Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device.

Aneurysms that involve the internal carotid artery and posterior communicating artery junction and incorporate a fetal posterior cerebral artery are known as fetal posterior communicating artery aneurysms. We report the outcomes of four patients with fetal posterior communicating artery aneurysms who underwent treatment with the pipeline embolization device with or without adjunctive coil embolization. In our study, all four patients failed to achieve aneurysm occlusion at the last follow-up evaluation.

Surgical outcomes for moyamoya angiopathy at barrow neurological institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery-to-middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres.

Background: Untreated, moyamoya angiopathy is a progressive vaso-occlusive process that can lead to ischemic or hemorrhagic stroke.

Objective: To review 1 institution's surgical experience with both direct and indirect bypass (encephaloduroarteriosynangiosis) in adult and pediatric groups.

Methods: A retrospective review was conducted of a consecutive series of patients treated for moyamoya angiopathy between 1995 and 2009.

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.

Enhanced staff communication and reduced near-miss errors with a neurointerventional procedural checklist.

Introduction: Over the past several decades, checklists have emerged in a variety of different patient care settings to help reduce medical errors and ensure patient safety. To date, there have been no published accounts demonstrating the effectiveness of checklists designed specifically for the unique demands of neurointerventional procedures.

Methods: A three-part, 20-item checklist was developed specific to neurointerventional procedures using the WHO surgical checklist as a template.

Direct radial artery access with the 070 neuron guide catheter for aneurysm coiling: a novel application of the neuron catheter for cerebral interventions.

Background And Importance: Most neuroendovascular interventions rely on a transfemoral approach to the intracranial circulation; however, this is sometimes not possible because of complex aortic arch anatomy or femoral arterial disease. Transradial arteriography and intervention are well established in interventional cardiology, and there have been some reports of successful neurointervention using this technique. The incidence of radial artery occlusion or other access site complications after transradial access is directly related to the outer diameter of the sheath used to access the artery.

Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis.

Background: There is a growing body of literature supporting venous sinus stenosis as a causative etiology for many patients diagnosed with idiopathic intracranial hypertension. Recent series have documented improvement in the pre- and post-stenosis venous pressure gradient as well as clinical symptoms after stenting. Concomitant real time intracranial pressure (ICP) monitoring has not been previously described during venous sinus stenting.

Flow failure from intracranial atherosclerotic disease: a rationale for endovascular intervention in a population with recurrent symptoms despite maximal medical therapy.

The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial, the first randomized trial to compare best medical therapies with angioplasty and stenting, was halted prematurely owing to a 30-day stroke rate of 14.7% in the angioplasty and stenting arm compared with 5.8% in the medical management arm.

The stent anchor technique for distal access through a large or giant aneurysm.

Large and giant aneurysms pose significant challenges to the endovascular techniques of coil embolization or parent vessel reconstruction. Many large aneurysms are wide-necked with bulbous domes and frequently require stent-assisted coiling or flow diversion to reconstruct and preserve flow through the parent artery. Often the wire must be looped in the dome before catheterization of the exiting portion of the parent vessel is possible.

Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article.

Object: Intramedullary, or glomus, spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to resection with or without adjuvant embolization. The authors retrospectively reviewed the senior author's (R.F.

Surgical management of giant posterior communicating artery aneurysms.

Background: Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality.

Objective: To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances.

Methods: All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database.

Occurrence of angiographic femoral artery complications after vascular closure with Mynx and AngioSeal.

Introduction: There have been recent reports of high vascular complication rates after the use of the Mynx vascular closure device (VCD). At our institution, vascular complications due to these devices have rarely been encountered. A study was undertaken to retrospectively compare angiographic abnormalities seen after femoral artery closure by both the Mynx and AngioSeal VCDs to provide further insight into the risks associated with VCDs.

Intracranial stents for treatment of acute ischemic stroke: evolution and current status.

Background: Intravascular stents have been applied to treat a variety of pathophysiologic conditions. With advances in stent design and delivery, stenting has become a viable treatment option in neurovascular disease. Recently, intracranial arterial stenting has received increasing interest as a modality to rapidly and effectively recanalize affected vessels in the setting of acute ischemic stroke.

Delayed complication from a percutaneous vascular closure device following a neuro-interventional procedure.

Percutaneous vascular closure devices are being increasingly used as alternatives to manual compression for the closure of femoral arteriotomy after endovascular procedures as they appear to reduce time to ambulate, improve patient's comfort, and are implicated with cost saving. However, vascular closure devices have been associated with an increased risk of complications including hematoma formation, local bleeding, arteriovenous fistula formation, pseudoaneurysm and arterial leg ischemia. To our knowledge, if the above complications occur it is usually within the first 30 days after the procedure.

Vasospasm after aneurysmal subarachnoid hemorrhage: review of randomized controlled trials and meta-analyses in the literature.

Objective: Cerebral vasospasm is a major source of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). A variety of therapies have been utilized to prevent or treat vasospasm. Despite the large number of clinical trials, few randomized controlled trials (RCTs) of sufficient quality have been published.

Direct thrombectomy using the Penumbra thromboaspiration catheter for the treatment of cerebral venous sinus thrombosis.

Objective: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke. A 21 year-old female presented to our institution in a rapidly deteriorating neurological state following failed systemic heparin therapy for treatment of superior sagittal sinus (SSS) thrombosis.

Methods: The patient underwent emergent mechanical thrombectomy of the thrombosed SSS using the 0.

Vertebral brown tumors causing neurologic compromise.

Objective: Brown tumors are nonneoplastic lesions that occur only in the setting of hyperparathyroidism. Although vertebral brown tumors are relatively rare pathologic entities, their incidence seems to be on the rise, as evidenced by multiple case reports published during the past four decades. An extensive review of these lesions is lacking in the literature.

Delayed intraparenchymal hemorrhage following pipeline embolization device treatment for a giant recanalized ophthalmic aneurysm.

The pipeline embolization device has demonstrated clinical success in the management of complex intracranial aneurysms arising along the anterior intracranial circulation with a relatively low complication profile. A case report is presented which describes a novel complication of delayed intraparenchymal hemorrhage following deployment of a pipeline embolization device for the treatment of a previously ruptured partially thrombosed ophthalmic segment aneurysm.

Interventional neurovascular disease: avoidance and management of complications and review of the current literature.

There has been a substantial increase in the number of neuroendovascular procedures performed over the last 15 years. Although rare, complications of cerebral angiography and neuroendovascular procedures have the potential to be devastating. Fortunately, dedication to careful patient selection, meticulous attention to technical detail, and standardization of endovascular treatment protocols results in an acceptably low complication rate.

Critical care guidelines on the endovascular management of cerebral vasospasm.

Cerebral vasospasm and delayed cerebral ischemia account for significant morbidity and mortality after aneurysmal subarachnoid hemorrhage. While most patients are managed with triple-H therapy, endovascular treatments have been used when triple-H treatment cannot be used or is ineffective. An electronic literature search was conducted to identify English language articles published through October 2010 that addressed endovascular management of vasospasm.

Aggressive intervention to treat a young woman with intracranial hemorrhage following unsuccessful intravenous thrombolysis for left middle cerebral artery occlusion. Case report.

Stroke patients whose condition does not improve after intravenous administration of tissue plasminogen activator (tPA) may be candidates for endovascular intervention. Patients with new intracerebral hemorrhage noted during such interventions pose a difficult challenge to neurointerventionists and are often sequestered as treatment failures and deemed inappropriate for intraarterial recanalization efforts. The authors present a case in which aggressive intervention was performed despite evidence of contrast extravasation on preintervention angiography.

Timing of aneurysm surgery: the International Cooperative Study revisited in the era of endovascular coiling.

Objective: The International Cooperative Study on the Timing of Aneurysm Surgery demonstrated that subarachnoid hemorrhage (SAH) patients who underwent surgery on post-hemorrhage days 4-10 had worse outcomes than patients treated on days 0-3 and days 11-14. Based on these findings, it was concluded that patients who present with SAH on days 4-10 should have aneurysm surgery delayed until after day 10. Since the study, coiling has become a treatment option and it is unclear whether these results apply to this new treatment modality.

Novel application of an intermediate sized bridging catheter as an adjunct to aneurysm coiling in patients with tortuous vasculature.

Selective microcatheterization of intracranial aneurysms during coiling can be limited by tortuous vasculature. Stabilization of the microcatheter via distal placement of the guide catheter in the intracranial vasculature may cause vessel dissection or vasospasm. We describe the application of an intermediate sized bridging catheter in four patients with tortuous vasculature who underwent successful coiling of ruptured aneurysms.