The episode, the PTAC, cost, and the neurointerventionalist
Episodic care forms a payment methodology of increasing relevance to neurointerventional specialists and other providers. Episodic care payment models are currently recognized in both payment paths described by the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA): the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. Understanding the cost of care, as well as how such costs are shaped in the context of episodic care, will be critical to success in both of these paths. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Hirsch, J. A., Rosenkrantz, A. B., Liu, R. W., Manchikanti, L., Nicola, G. N. Tags: Socioeconomics Source Type: research

Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors
Conclusions FDCT PBV mapping is a useful method for evaluating the perfusion of hypervascular brain tumors and the efficacy of embolization. It can be used as a supplement to CT perfusion, MRI, and DSA in the evaluation of tumor embolization. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Wen, L.-L., Zhang, X., Zhang, Q.-R., Wu, Q., Chen, S.-J., Deng, J.-L., Huang, K., Wang, H.-D. Tags: Neuroimaging Source Type: research

Sidewall cerebral aneurysms: effect of an outflow angle-assisted approach on diagnosis
Background The ability to diagnose sidewall cerebral aneurysms (SCAs) on an angle measurement basis may be useful in clinical practice. A study was undertaken to evaluate the effect of an outflow angle (OA)-assisted approach. Methods MR angiography (MRA) images of 438 patients with suspected SCAs and other cerebrovascular diseases were separately evaluated using the subjective approach and the OA approach. The approaches were then exchanged for confirmation of unclear cases. An OA of ≥90° was considered to represent SCA positivity. The accuracy, sensitivity, and specificity of the OA-assisted approach were determin...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Sun, L.-J., Li, Y.-D., Yang, B.-Z., Li, M.-H., Wang, W., Gu, B.-X. Tags: Neuroimaging Source Type: research

Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device
Conclusions Progressive stagnation or occlusion of covered side branches or target aneurysm are early angiographic signs of acute thrombus formation following PED placement and should prompt immediate treatment with a glycoprotein IIb/IIIa inhibitor. Platelet inhibition testing may help identify those patients who are at an increased risk for this complication. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Patel, A., Miller, T. R., Shivashankar, R., Jindal, G., Gandhi, D. Tags: Neuroimaging Source Type: research

Computed tomography interobserver agreement in the assessment of aneurysmal subarachnoid hemorrhage and predictors for clinical outcome
Background The severity of aneurysmal subarachnoid hemorrhage (SAH) is often assessed by the clinical state of the patient on presentation, but radiological evaluation of the extent of hemorrhage has rarely been examined in the literature. Several CT scan based grading systems exist yet only a few studies have investigated interobserver agreement. We evaluated five radiological grading systems and assessed their clinical value for early prognostication. Methodology This was a retrospective study of patients diagnosed with aneurysmal SAH with a CT scan performed within 72 hours of symptom onset. Four independent obser...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Woo, P. Y. M., Tse, T. P. K., Chan, R. S. K., Leung, L. N. Y., Liu, S. K. K., Leung, A. Y. T., Wong, H.-T., Chan, K.-Y. Tags: Neuroimaging Source Type: research

Efficacy and safety of the target puncture technique for treatment of osteoporotic vertebral compression fractures with intravertebral clefts
Conclusions Different puncture techniques were initially effective for all patients with IVCs. However, cement cleft filling by the traditional technique was found to have less stability causing higher VAS/ODI scores and greater loss of correction. Hence, our target puncture technique was recommended in this study. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Yu, W., Liang, D., Jiang, X., Yao, Z., Qiu, T., Ye, L. Tags: Spine Source Type: research

Selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma: fluoroscopic time and radiation dose parameters. A baseline study
Objective To evaluate fluoroscopic time and radiation dose parameters, and factors affecting these parameters, during selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma. Materials and methods Retrospective review from the prospective database of all patients with retinoblastoma treated with SOAC over a 5-year period (September 2009–January 2015) at a single institution after receiving institutional review board approval. Patient demographics, arterial approach, access device, side of treatment, number of SOAC cycles/patient, number of drugs/SOAC, and radiation parameters (outcome variables), includin...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Boddu, S. R., Abramson, D. H., Marr, B. P., Francis, J. H., Gobin, Y. P. Tags: Tumor embolization Source Type: research

Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke
Conclusions Mechanical and aspiration thrombectomy with SOFIA is safe and effective with high revascularization rates. Its trackability, stability, and luminal size make SOFIA suitable for stroke intervention. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Wong, J. H. Y., Do, H. M., Telischak, N. A., Moraff, A. M., Dodd, R. L., Marks, M. P., Ingle, S. M., Heit, J. J. Tags: New devices Source Type: research

Treatment of wide-necked aneurysms with the Low-profile Visualized Intraluminal Support (LVIS Jr) device: a multicenter experience
Conclusions The LVIS Jr is a technically feasible, safe, and effective treatment for wide-necked intracranial aneurysms. Early results are promising but will need to be corroborated with longer-term follow-up. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Grossberg, J. A., Hanel, R. A., Dabus, G., Keigher, K., Haussen, D. C., Sauvageau, E., Linfante, I., Gonsales, D., Aguilar Salinas, P., Bouslama, M., Mayich, M., Nogueira, R. G., Lopes, D. K. Tags: New devices Source Type: research

Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review
Conclusions EMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Ilyas, A., Chen, C.-J., Raper, D. M., Ding, D., Buell, T., Mastorakos, P., Liu, K. C. Tags: Ischemic stroke Source Type: research

Stent-assisted coiling of cerebrovascular aneurysms: experience at a large tertiary care center with a focus on predictors of recurrence
Conclusions Stent-assisted coiling for wide-necked cerebral aneurysms has a high therapeutic success rate with low procedure-related morbidity and mortality. Clinically significant recurrences may occur more frequently with Enterprise stents, in aneurysms with low PD, and with post-procedural dextran use. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Linzey, J. R., Griauzde, J., Guan, Z., Bentley, N., Gemmete, J. J., Chaudhary, N., Thompson, B. G., Pandey, A. S. Tags: Hemorrhagic stroke Source Type: research

Efficacy of endovascular treatment and feasibility of stent-assisted coiling in the presence of severe and symptomatic vasospasm
Conclusions Endovascular treatment of intracranial aneurysms during severe and symptomatic vasospasm is safe and effective. Stent-assisted coiling in the presence of severe vasospasm is also feasible in wide-necked aneurysms with the additional benefits of mechanical vasodilation. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Andic, C., Kardes, O., Durdag, E., Gedikoglu, M., Akin, S. Tags: Hemorrhagic stroke Source Type: research

Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?
Conclusions Single-stage endovascular treatment of multiple aneurysms with combined endovascular techniques is technically feasible and increases the treatment possibility of all detected aneurysms. However, the safety of the procedure is controversial due to relatively high complication rates. In particular, in patients with bilateral internal carotid artery aneurysms, staged therapy may be used instead of simultaneous treatment with flow diverters to avoid thromboembolic events. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Andic, C., Aydemir, F., Kardes, O., Gedikoglu, M., Akin, S. Tags: Hemorrhagic stroke Source Type: research

Flow diverter treatment of intracranial vertebral artery dissecting pseudoaneurysms
Conclusions Our experience suggests that flow diverter stent treatment of intracranial vertebral artery dissecting pseudoaneurysms is safe, and associated with good occlusion rates and favorable clinical outcomes. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Cerejo, R., Bain, M., Moore, N., Hardman, J., Bauer, A., Hussain, M. S., Masaryk, T., Rasmussen, P., Toth, G. Tags: Hemorrhagic stroke Source Type: research

An outcomes-based grading scale for the evaluation of cerebral aneurysms treated with flow diversion
We present an outcomes-based grading scale that considers factors related to failure of flow diversion. Methods The grading scale was developed using the results from consecutive patients at two institutions who were treated with flow diversion for a cerebral aneurysm. The initial treatment results were graded on patient, aneurysm, and treatment characteristics. A 6-point grading scale was developed based on these data. Results One hundred and seventy-one patients were included in the patient cohort. When compared by multivariate analysis with patients without residuals, patients with aneurysm residuals were found to be ...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Park, M. S., Mazur, M. D., Moon, K., Nanaszko, M. J., Kestle, J. R. W., Shah, L. M., Winegar, B., Albuquerque, F. C., Taussky, P., McDougall, C. G. Tags: New devices Source Type: research

Extending the indications for transvenous approach embolization for superficial brain arteriovenous malformations
Conclusions The curative transvenous embolization of superficial intracranial AVMs is feasible and appears safe and effective when strict anatomical selection is respected. This technique extends the current indications for transvenous embolization of intracranial AVMs and may improve cure rates while reducing embolization-related complications. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Viana, D. C., de Castro-Afonso, L. H., Nakiri, G. S., Monsignore, L. M., Trivelato, F. P., Colli, B. O., Abud, D. G. Tags: Hemorrhagic stroke Source Type: research

Successful recanalization in acute basilar artery occlusion treated with endovascular therapy is independent of thrombus length
Conclusions Successful recanalization does not depend on thrombus length in patients with BAO treated with EVT. Recanalization can therefore be achieved despite high clot burden. Additionally, a high density of thrombi was a strong predictor of a favorable outcome. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Shu, L., Riedel, C., Meyne, J., Jansen, O., Jensen-Kondering, U. Tags: Ischemic stroke Source Type: research

Mechanical thrombectomy in patients with medical contraindications for intravenous thrombolysis: a prospective observational study
Conclusions MT is safe in patients with potential comorbidity-derived risks that preclude IVT. MT should be offered, aiming for prompt recanalization, to patients with LVO stroke unsuitable for IVT. Trial registration number NCT02164357; Results. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Alonso de Lecinana, M., Martinez-Sanchez, P., Garcia-Pastor, A., Kawiorski, M. M., Calleja, P., Sanz-Cuesta, B. E., Diaz-Otero, F., Frutos, R., Sierra-Hidalgo, F., Ruiz-Ares, G., Fandino, E., Diez-Tejedor, E., Gil-Nunez, A., Fuentes, B. Tags: Ischemic stroke Source Type: research

Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience
Conclusions Our initial experience shows that use of the Comaneci device is straightforward for the treatment of selected wide-necked aneurysms. Further studies with long-term follow-up data are needed to identify the significance of the presented technique in the neurointerventional armamentarium. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Fischer, S., Weber, A., Carolus, A., Drescher, F., Götz, F., Weber, W. Tags: Open access, New devices Source Type: research

A standardized neurointerventional thrombectomy protocol leads to faster recanalization times
The objective of our study was to detail a standardized IAT protocol, and to assess its influence on time to treatment in ischemic stroke. Methods This was a retrospective observational study over 4 years at a comprehensive stroke center. A standardized IAT protocol was implemented in June 2013 that included pre-notifying the stroke team before hospital arrival, defining clinician roles, processing tasks in parallel, and standardizing IAT procedures. Three time metrics were examined and reported as median (IQR) minutes: arrival to CT imaging, CT to groin puncture, and puncture to recanalization. We compared these met...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Frei, D., McGraw, C., McCarthy, K., Whaley, M., Bellon, R. J., Loy, D., Wagner, J., Orlando, A., Bar-Or, D. Tags: Editor''s choice, Ischemic stroke Source Type: research

Vertebrobasilar atherosclerotic disease: is it time to revisit angioplasty?
Atherosclerotic occlusive disease of the vertebrobasilar (VB) system is an important cause of posterior circulation ischemic stroke, responsible for approximately one-third of cases,1 and associated with high morbidity. Despite medical therapy, the risk of recurrent stroke is significant, particularly for intracranial VB disease, ranging from 10% to 15% per year.2 The role of hemodynamic insufficiency in the etiology of stroke from VB stenosis/occlusion has long been purported, but until recently, there have been few data to directly support this mechanism. Traditional tissue-based imaging techniques for evaluation of hemo...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Amin-Hanjani, S., Siddiqui, A. H., Turan, T. N., Woo, H., Prabhakaran, S., Derdeyn, C. P., Charbel, F. T. Tags: Commentary Source Type: research

Varied terrain
This issue of the Journal of Neurointerventional Surgery (JNIS) delivers manuscripts on a wide-range of subjects relevant to contemporary endovascular practice. Topics include: managing vertebro-basilar ischemic disease, reducing treatment times in emergency large vessel occlusion (ELVO) patients, expanding embolization modalities for arteriovenous malformations (AVMs), treating complex aneurysms through existing and novel technology, embolizing tumors as stand-alone treatment and in preparation for surgery, and exploring socioeconomic issues that impact the neurointerventionalist. These articles reflect the JNIS commitmen...
Source: Journal of NeuroInterventional Surgery - October 13, 2017 Category: Neurosurgery Authors: Albuquerque, F. C. Tags: Editor ' s column Source Type: research

E-091 Progressive oclusion of incompletely occluded small saccular aneurysms after stent-assisted coil embolization: analysis of related factors and long-term follow-up
Introduction Although aneurysms incompletely occluded after coil embolization are subject to recanalization, complete occlusion may evolve in some aneurysms during follow-up in clinical practice, even though the sac fills with contrast immediately after coiling. Stent usage may augment the progressive thrombosis within coiled aneurysms. We evaluated outcomes of small aneurysms (
Source: Journal of NeuroInterventional Surgery - October 6, 2017 Category: Neurosurgery Authors: Lim, J., Cho, Y., Kang, H., Han, M. Tags: Electronic Poster Abstracts Source Type: research

Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review
We present a case of cervical fracture-dislocation injury and compression/occlusion of the right vertebral artery, which spontaneously resolved following surgical reduction and fusion. Postoperative cerebral angiography showed no evidence of vertebral artery stenosis, and systemic anticoagulation was discontinued. This case shows that vertebral artery occlusion can resolve spontaneously after fracture reduction, and cerebral angiography should play a role in assessing these complicated traumatic injuries. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Yaeger, K., Mascitelli, J., Kellner, C., Hickman, Z., Mocco, J., Margetis, K. Tags: Spine Source Type: research

Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population
Conclusions In this series of LM cases treated at Stanford, we found that doxycycline, OK-432, and ethanolamine oleate sclerotherapy appear to have a similar safety and efficacy profile in the treatment of macrocystic and mixed LMs of the head and neck in the pediatric population. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Tu, J. H., Do, H. M., Patel, V., Yeom, K. W., Teng, J. M. C. Tags: Head and neck Source Type: research

High prevalence of intracranial aneurysms in patients with aortic dissection or aneurysm: feasibility of extended aorta CT angiography with involvement of intracranial arteries
Introduction Previous studies have suggested a higher prevalence of intracranial aneurysms (IAs) in patients with aortic aneurysms (AAs). Objective To carry out a preliminary study to evaluate the prevalence of IAs in these patients and the diagnostic feasibility of extended aorta CT angiography (CTA), including intracranial arteries as well as the aorta. Materials and methods We retrospectively reviewed all patients with a clinical diagnosis of AA or aortic dissection (AD) who had undergone aorta CTA as well as MR angiography, CTA, and/or DSA of the brain between 2009 and 2014. Since 2012, the extended aorta CTA protoco...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Lee, D., Ahn, S. J., Cho, E.-S., Kim, Y. B., Song, S.-W., Jung, W. S., Suh, S. H. Tags: Neuroimaging Source Type: research

Utility of perfusion imaging in acute stroke treatment: a systematic review and meta-analysis
The objective of our study was to evaluate the available scientific evidence regarding the utility of perfusion imaging in determining treatment eligibility in patients with acute stroke and in predicting their clinical outcome. Methods We performed a systematic review of the literature using PubMed, Web of Science, and Cochrane Library focusing on themes of medical imaging, stroke, treatment, and outcome (CRD42016037817). We included randomized controlled trials, cohort studies, and case-controlled studies published from 2011 to 2016. Two independent reviewers conducted the study appraisal, data abstraction, and quality ...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Ryu, W. H. A., Avery, M. B., Dharampal, N., Allen, I. E., Hetts, S. W. Tags: Neuroimaging Source Type: research

Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification
Conclusions In this preclinical model, we have shown that the Shield Technology phosphorylcholine modification reduces the platelet-specific thrombogenicity of a flow diverter under physiologically relevant flow with and without DAPT. We have further identified increased fibrin-driven thrombogenicity associated with FRED relative to PED. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Hagen, M. W., Girdhar, G., Wainwright, J., Hinds, M. T. Tags: Open access, Basic science Source Type: research

Selection of helical braided flow diverter stents based on hemodynamic performance and mechanical properties
Conclusions The combination of CFD and structural analysis can provide promising solutions for an optimized stent. Stents exhibiting different mechanical properties but the same flow reduction effects could be designed by varying both the weave angle and wire thickness. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Suzuki, T., Takao, H., Fujimura, S., Dahmani, C., Ishibashi, T., Mamori, H., Fukushima, N., Yamamoto, M., Murayama, Y. Tags: Open access, Basic science Source Type: research

In situ tissue engineering: endothelial growth patterns as a function of flow diverter design
Conclusions This study gives preliminary evidence that temporal and spatial endothelialization is dependent on FD design. Circulating CD34+ progenitor cells contribute to endothelialization throughout the healing process. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Marosfoi, M., Langan, E. T., Strittmatter, L., van der Marel, K., Vedantham, S., Arends, J., Lylyk, I. R., Loganathan, S., Hendricks, G. M., Szikora, I., Puri, A. S., Wakhloo, A. K., Gounis, M. J. Tags: Basic science Source Type: research

Comparison of venous sinus manometry gradients obtained while awake and under general anesthesia before venous sinus stenting
Conclusions Calculated pressure gradients were markedly affected by anesthesia. These findings suggest that candidacy for stenting should be determined with venous manometry while patients are awake owing to the unpredictable and highly variable effect of general anesthesia on pressure measurements and an apparent tendency to underestimate the degree of venous outflow obstruction. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Fargen, K. M., Spiotta, A. M., Hyer, M., Lena, J., Turner, R. D., Turk, A. S., Chaudry, I. Tags: Clinical neurology Source Type: research

Intracranial venous pressures under conscious sedation and general anesthesia
Introduction Venous outflow obstruction has been implicated in the pathophysiology of a subset of patients with idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as an effective treatment. However, the effect of anesthesia on venous sinus pressure measurements is unpredictable. A more thorough understanding of the effect of the level of anesthesia on intracranial venous pressures might help to better define patients who might benefit most from stent placement. Objective To compare, in a retrospective cohort study, intracranial venous pressures measured under conscious (CS) sedation ve...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Raper, D. M. S., Buell, T. J., Chen, C.-J., Ding, D., Starke, R. M., Liu, K. C. Tags: Clinical neurology Source Type: research

Off-label use of the Angioseal vascular closure device for femoral arteriotomy: retrospective analysis of safety and efficacy
Background Angioseal, an arteriotomy closure device (ACD), functions as a collagen plug that physically closes arteriotomy sites and can simultaneously induce platelet activation and aggregation. When used ‘on-label’, the safety and efficacy profile of Angioseal is superior compared with those of other ACDs. However, Angioseal is sometimes deployed in less than ideal situations. Therefore, we sought to assess the safety and efficacy of ‘off-label’ Angioseal use in patients undergoing femoral arteriotomies. Methods We performed a retrospective review of all femoral arterial angiograms executed at ou...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Shah, S. S., Perez, G., Snelling, B. M., Haussen, D. C., Sur, S., Sharma, I., Yavagal, D. R., Elhammady, M. S., Peterson, E. C. Tags: Clinical neurology Source Type: research

P2Y12 hyporesponse (PRU>200) is not associated with increased thromboembolic complications in anterior circulation Pipeline
Conclusions P2Y12 hyporesponse (PRU>200) is not associated with increased periprocedural complications in a contemporary series of patients undergoing anterior circulation PED placement. Titration of antiplatelet medications to P2Y12>200 remains unindicated and may increase the risk of hemorrhagic complications. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Bender, M. T., Lin, L.-M., Colby, G. P., Lubelski, D., Huang, J., Tamargo, R. J., Coon, A. L. Tags: Clinical neurology Source Type: research

Contribution of whole platelet aggregometry to the endovascular management of unruptured aneurysms: an institutional experience
Conclusions Preoperative platelet inhibition testing using WBA can be useful to assess and correct antiaggregant non-responsiveness, and may reduce postoperative mortality and permanent morbidity. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Aoun, S. G., Welch, B. G., Pride, L. G., White, J., Novakovic, R., Hoes, K., Sarode, R. Tags: Clinical neurology Source Type: research

Deployment technique that takes advantage of the characteristics of Enterprise VRD2: an in vitro study
Conclusions Enterprise VRD2 is superior to Enterprise VRD in reducing ISA in curved vessels and can alter ISA according to the deployment technique used. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Chihara, H., Ishii, A., Kikuchi, T., Ikeda, H., Arai, D., Miyamoto, S. Tags: New devices Source Type: research

Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent
Conclusions Willis covered stent implementation may be safe and feasible for BBAs. This strategy might be a promising option for this high-risk type of aneurysm. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Fang, C., Tan, H.-Q., Han, H.-J., Feng, H., Xu, J.-C., Yan, S., Nie, Z.-Y., Jin, L.-J., Teng, F. Tags: Hemorrhagic stroke Source Type: research

Influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling
Conclusions CYP2C19 genetic polymorphisms had significant influence on the antiplatelet effect of clopidogrel, and could be considered as risk factors of ischemic or bleeding events and even clinical outcomes of patients with intracranial aneurysms treated with stent-assisted coiling. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Ge, H., Lv, X., Ren, H., Jin, H., Jiang, Y., He, H., Liu, P., Li, Y. Tags: Hemorrhagic stroke Source Type: research

Stroke prevention by endovascular treatment of carotid and vertebral artery dissections
Introduction Endovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances. Objective To review our institutional experience with endovascular treatment of cervical dissections over the past 20 years to examine indications for treatment, interventional methods, and outcomes. Methods Retrospective review of a prospectively maintained database to identify patients with extracranial dissection who underwent endovascular intervention between January 1996 and January 2016. Demographic data and details of procedures, outcomes, and co...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Moon, K., Albuquerque, F. C., Cole, T., Gross, B. A., McDougall, C. G. Tags: Ischemic stroke Source Type: research

Endovascular treatment for AIS with underlying ICAD
Conclusions Despite AIS with underlying ICAD requiring a more complex, technically demanding recanalization strategy than traditional thromboembolic AIS, it appears safe, and good outcomes are obtainable. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Al Kasab, S., Almadidy, Z., Spiotta, A. M., Turk, A. S., Chaudry, M. I., Hungerford, J. P., Turner, R. D. Tags: Ischemic stroke Source Type: research

Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters
Conclusion When using SRs for intracranial stroke thrombectomy, the concurrent use of IACs is associated with a decrease in procedural time and thrombectomy attempts compared with use of SRs alone. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Jindal, G., Serulle, Y., Miller, T., Le, E., Wozniak, M., Phipps, M., Iyoha, M., Gupta, V., Shivashankar, R., Gandhi, D. Tags: Ischemic stroke Source Type: research

CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke
Background Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy. Methods Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized i...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Sallustio, F., Motta, C., Pizzuto, S., Diomedi, M., Giordano, A., D'Agostino, V. C., Sama, D., Mangiafico, S., Saia, V., Legramante, J. M., Konda, D., Pampana, E., Floris, R., Stanzione, P., Gandini, R., Koch, G. Tags: Ischemic stroke Source Type: research

Impact of thrombus length on recanalization and clinical outcome following mechanical thrombectomy in acute ischemic stroke
Conclusions In this study, thrombus length had no relevant impact on recanalization, neurological outcome, or intraprocedural complications following mechanical thrombectomy of middle cerebral artery occlusions. Therefore, mechanical thrombectomy with stent retrievers can be attempted with large clots. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Seker, F., Pfaff, J., Wolf, M., Schönenberger, S., Nagel, S., Herweh, C., Pham, M., Bendszus, M., Möhlenbruch, M. A. Tags: Ischemic stroke Source Type: research

Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques
Conclusions We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Aytac, E., Gürkas, E., Akpinar, C. K., Saleem, M. A., Qureshi, A. I. Tags: Ischemic stroke Source Type: research

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial
Background The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. Objective To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial. Methods CBS was calculated for the endovascular arm (IV tissue plasminogen activator ...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Mokin, M., Levy, E. I., Siddiqui, A. H., Goyal, M., Nogueira, R. G., Yavagal, D. R., M Pereira, V., Saver, J. L. Tags: Ischemic stroke Source Type: research

Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes
Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable. (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Mokin, M., Fargen, K. M., Primiani, C. T., Ren, Z., Dumont, T. M., Brasiliense, L. B. C., Dabus, G., Linfante, I., Kan, P., Srinivasan, V. M., Binning, M. J., Gupta, R., Turk, A. S., Elijovich, L., Arthur, A., Shallwani, H., Levy, E. I., Siddiqui, A. H. Tags: Ischemic stroke Source Type: research

Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis
Introduction The minimal stroke severity justifying endovascular intervention remains elusive; however, a significant proportion of patients presenting with large vessel occlusion (LVO) and mild symptoms subsequently decline and face poor outcomes. Objective To evaluate our experience with these patients by comparing best medical therapy with thrombectomy in an intention-to-treat analysis. Methods Analysis of prospectively collected data of all consecutive patients with National Institutes of Health Stroke Scale (NIHSS) score ≤5, LVO on CT angiography, and baseline modified Rankin Scale (mRS) score 0–2 from Nove...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Haussen, D. C., Bouslama, M., Grossberg, J. A., Anderson, A., Belagage, S., Frankel, M., Bianchi, N., Rebello, L. C., Nogueira, R. G. Tags: Editor''s choice, Ischemic stroke Source Type: research

Denominator fallacy revisited
We have previously written about ‘denominator fallacy’ and its importance in the way that we report and interpret results, especially for endovascular treatment of acute stroke.1 In most studies, the number of patients going for endovascular thrombectomy (EVT) is taken as the denominator and the number of these patients achieving a modified Rankin Scale (mRS) of 0–2 as the numerator. The number of patients taken for EVT is dependent on the overall set-up, the view of the interventionalists, economic considerations (in some jurisdictions), imaging criteria, and clinical criteria. Of these, imaging criteria...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Goyal, M., Jadhav, A. P. Tags: Commentary Source Type: research

Social media and JNIS: expanding the digital clique
Social media have developed into popular platforms for promoting online content for individuals, businesses, and news media sites. Many peer-reviewed medical journals have followed suit to advertise recent publications.1 2 A randomized controlled trial of Journal of the American College of Radiology publications showed significantly increased page visits in those advertised with an organized social media strategy from editorial board members compared with a control arm.3 It is therefore not surprising that the impact indicated by social media traffic shortly after publication may be highly predictive of future ci...
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: Fargen, K. M., Wilson, T. A., de Leacy, R., Jadhav, A. P., Ducruet, A. F. Tags: Editor ' s column Source Type: research

Segmental upper mid-basilar artery sacrifice in a child using a Micro Vascular Plug device for treatment of a basilar arteriovenous fistula compressing the brainstem
We present... (Source: Journal of NeuroInterventional Surgery)
Source: Journal of NeuroInterventional Surgery - September 12, 2017 Category: Neurosurgery Authors: See, A. P., Kochis, M. A., Orbach, D. B. Tags: Neuroimaging Source Type: research