The PERFORMANCE II Trial: A Prospective Multicenter Investigation of a Novel Carotid Stent System.

Background: Several randomized clinical trials have shown that the composite endpoint of death, stroke, and myocardial infarction (MI) is equivalent between carotid artery stenting and carotid endarterectomy. However, the risk of minor stroke has been consistently higher with carotid artery stenting.

Objectives: The authors sought to evaluate the safety and effectiveness of a novel carotid stent system comprised of a stent, an adjustable integrated embolic filter and a postdilation balloon, in patients at elevated risk for adverse events from carotid endarterectomy.

Evaluating the effect of noise reduction strategies in CT perfusion imaging for predicting infarct core with deep learning.

This study evaluates the efficacy of deep learning models in identifying infarct tissue on computed tomography perfusion (CTP) scans from patients with acute ischemic stroke due to large vessel occlusion, specifically addressing the potential influence of varying noise reduction techniques implemented by different vendors. We analyzed CTP scans from 60 patients who underwent mechanical thrombectomy achieving a modified thrombolysis in cerebral infarction (mTICI) score of 2c or 3, ensuring minimal changes in the infarct core between the initial CTP and follow-up MR imaging. Noise reduction techniques, including principal component analysis (PCA), wavelet, non-local means (NLM), and a no denoising approach, were employed to create hemodynamic parameter maps.

Availability of Lactation Policies and Facilities for ACGME-Accredited Surgical Residency Training Programs.

Objective: We aimed to investigate availability of lactation policy and facility information among surgical residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Design: Between March 1, 2023 and October 31, 2023, websites of surgical residency training programs on the ACGME Accreditation System List of Programs by Specialty were reviewed for department lactation policies, links to institutional graduate medical education (GME) websites with lactation policies, lists of lactation facilities, and links to institutional GME websites listing lactation facilities. Scatter plots were generated and Pearson correlation coefficients were calculated to assess relationships of the percentages of female residents, fellows, and faculty in each surgical specialty with the percentage of residency program websites with available lactation information.

Differential cardiac impacts of hematological malignancies and solid tumors: a histopathological and biomarker study.

Background: Cancer patients are known to be associated with increased risk of cardiovascular disease. However, no studies have examined the differential impact of hematologic malignancies (HMs) and solid tumors (STs) on cardiac morphology at the tissue level.

Objective: We aimed to examine histopathological features alongside cardiovascular biomarkers in patients with HMs and STs who underwent post-mortem evaluation.

Hybrid Clot Histomic-Transcriptomic Models Predict Functional Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke.

Background And Objectives: Histologic and transcriptomic analyses of retrieved stroke clots have identified features associated with patient outcomes. Previous studies have demonstrated the predictive capacity of histology or expression features in isolation. Few studies, however, have investigated how paired histologic image features and expression patterns from the retrieved clots can improve understanding of clot pathobiology and our ability to predict long-term prognosis.

Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups.

Background And Objectives: The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies.

Fluoroscopic Procedure-Room Scatter-Dose Reduction Using a Region-of-Interest (ROI) Attenuator.

During fluoroscopically-guided interventional (FGI) procedures, dose to the patient as well as the scatter dose to staff can be high. However, a significant dose reduction can be possible by using a region-of-interest (ROI) attenuator that reduces the x-ray intensity in the peripheral x-ray field while providing full field of view imaging. In this work, we investigated the magnitude of scatter dose reduction to staff made possible by using an ROI attenuator composed of 0.

Shining light on neurovascular disease.

Tortuosity and fragility of the intracranial vasculature have precluded the application of novel intravascular imaging modalities during the treatment of cerebrovascular pathologies. In other circulatory beds, these technologies have transformed clinical and therapeutic decision-making. A new report demonstrates the clinical use of high-resolution intravascular imaging in the human cerebrovasculature using neuro optical coherence tomography.

7T-high resolution MRI-derived radiomic analysis for the identification of symptomatic intracranial atherosclerotic plaques.

Introduction: High-resolution magnetic resonance imaging (HR-MRI) allows for detailed visualization of intracranial atherosclerotic plaques. Radiomics can be used as a tool for objective quantification of the plaque's characteristics. We analyzed the radiomics features (RFs) obtained from 7 T HR-MRI of patients with intracranial atherosclerotic disease (ICAD) to determine distinct characteristics of culprit and non-culprit plaques.

Safe and effective use of the Celt ACD vascular closure device for rapid hemostasis following direct carotid puncture thrombectomy.

A man in his early 70s presented to the emergency department about 3.5 hours after acute onset right sided hemiplegia and aphasia. CT angiography confirmed an acute occlusion of the M1 segment of the left middle cerebral artery and severe, but stable, dissection of the aortic arch and a large dissecting aortic aneurysm extending into the innominate artery and beyond into the descending aorta.

Impact of duration of dual anti-platelet therapy on risk of complications after stent-assisted coiling of unruptured aneurysms.

Background: The optimal duration for dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC) of intracranial aneurysms is unclear. Longer-term therapy may reduce thrombotic complications but increase the risk of bleeding complications.

Methods: A retrospective review of prospectively maintained data at 12 institutions was conducted on patients with unruptured intracranial aneurysms who underwent SAC between January 1, 2016 and December 31, 2020, and were followed ≥6 months postprocedure.

Efficacy of intra-arterial carboplatin and bevacizumab in the C6 rat glioma model of glioblastoma multiforme.

Background: Utilizing an endovascular rat glioma model, this study aimed to analyze the efficacy of intra-arterial (IA) carboplatin and bevacizumab delivery with blood-brain barrier breakdown (BBBB) for glioblastoma treatment.

Methods: C6-glioma cells were stereotactically injected into the left frontal lobe of Wistar rats. Tumor growth was confirmed on day 8 via MRI.

First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results.

Background And Objective: Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care.

Methods: We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024.

Obtura: A novel liquid embolic agent with post-embolization radiopacity loss, in endovascular treatment of brain arteriovenous malformations, dural arteriovenous fistulas, and tumors: CLARIDAD trial.

Background: Endovascular embolization is frequently used for vascular lesions of the head and neck. Newer agents may help to enhance visualization and improve treatment outcomes.

Methods: The CLARIDAD clinical trial was a prospective, single center, first-in-man investigation of neurovascular embolization using the novel embolic agent Obtura for a broad indication, covering the need for a liquid embolic agent in head and neck procedures.

An International, Multicenter Feasibility Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis.

Background And Objectives: Cerebral ventriculitis remains a challenging neurosurgical condition because of poor outcomes including mortality rates of nearly 80% and a prolonged course of treatment in survivors. Despite current conventional management, outcomes in some cases remain unsatisfactory, with no definitive therapeutic guidelines. This feasibility study aims to explore the use of a novel active, continuous irrigation and drainage system (IRRAflow [IRRAS AB]) combined with intraventricular drug delivery for patients with cerebral ventriculitis.

Radiomics-Based Predictive Nomogram for Assessing the Risk of Intracranial Aneurysms.

Aneurysm wall enhancement (AWE) has the potential to be used as an imaging biomarker for the risk stratification of intracranial aneurysms (IAs). Radiomics provides a refined approach to quantify and further characterize AWE's textural features. This study examines the performance of AWE quantification combined with clinical information in detecting symptomatic IAs.

Developing a Coordinated Registry Network for devices used for acute ischemic stroke intervention: basilar artery occlusion quality assessment pilot.

Background: Real-world data can be helpful in evaluating endovascular therapy (EVT) in ischemic stroke care. We conducted a pilot study to aggregate data on basilar artery occlusion (BAO) EVT from existing registries in the USA. We evaluated the availability, completeness, quality, and consistency of common data elements (CDEs) across data sources.