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E-093 Embolic stroke of undetermined source: the role of the nonstenotic carotid plaque
Cryptogenic stroke, or stroke of undetermined cause, presents a remarkably challenging dilemma for the treating physician as there are limited therapeutic options to prevent recurrence. Roughly one third of transient ischemic attacks (TIAs) and ischemic strokes are classified as cryptogenic, with an even greater proportion in young patients.1 While classification systems have been successfully used in trials to refine therapeutic approaches specific to subtype, there has been little progress made in secondary prevention of cryptogenic stroke.2–3 The Cryptogenic Stroke/ESUS International Working Group recently propose...
Source: Journal of NeuroInterventional Surgery - July 23, 2017 Category: Neurosurgery Authors: Bulwa, Z. Tags: Electronic Poster Abstracts Source Type: research

Stentriever thrombectomy with distal protection device for carotid free floating thrombus: a technical case report
We report the clinical details, imaging findings and management of a 45-year-old man who presented with recurrent transient ischemic attacks due to carotid free floating thrombus. Free floating thrombus of the carotid artery is a very rare condition with a high risk of distal embolic shower. The optimal treatment options are debatable and include medical management, surgical thrombectomy and endovascular thrombectomy. We describe the use of a stentriever with filter protection in the management of carotid free floating thrombus as a novel treatment option.
Source: Journal of NeuroInterventional Surgery - July 12, 2017 Category: Neurosurgery Authors: Giragani, S., Balani, A., Agrawal, V. Tags: Ischemic stroke Source Type: research

The natural progression of VGAMs and the need for urgent medical attention: a systematic review and meta-analysis
Conclusions Over time, the rate of preoperative sudden death in patients with VGAM gradually declined and the rate of emergency operations gradually increased. The outcome of patients with early spontaneous thromboses was good. Our study provides a definitive description of the natural progression of VGAMs and the need for urgent medical attention.
Source: Journal of NeuroInterventional Surgery - May 30, 2017 Category: Neurosurgery Authors: Yan, J., Gopaul, R., Wen, J., Li, X.-s., Tang, J.-f. Tags: Hemorrhagic stroke Source Type: research

Mechanical thrombectomy with the ERIC retrieval device: initial experience
Conclusions The ERIC device is an innovative stentriever allowing fast, effective, and safe MET.
Source: Journal of NeuroInterventional Surgery - May 30, 2017 Category: Neurosurgery Authors: Raoult, H., Redjem, H., Bourcier, R., Gaultier-Lintia, A., Daumas-Duport, B., Ferre, J.-C., Eugene, F., Fahed, R., Bartolini, B., Piotin, M., Desal, H., Gauvrit, J.-Y., Blanc, R. Tags: New devices Source Type: research

Where did the clot go? An unusual complication of mechanical thrombectomy caused by malignancy related subclavian steal phenomenon in a patient with acute basilar artery occlusion
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal ...
Source: Journal of NeuroInterventional Surgery - May 30, 2017 Category: Neurosurgery Authors: Randhawa, N., Squires, J. P., Heran, M. K. S., Mann, S. K. Tags: Electronic pages Source Type: research

Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review
Conclusions The hyperdense artery sign is associated with RBC-rich thrombi and improved recanalization rates. However, there was no association between the histopathological characteristics of thrombi and stroke etiology and angiographic outcomes.
Source: Journal of NeuroInterventional Surgery - May 30, 2017 Category: Neurosurgery Authors: Brinjikji, W., Duffy, S., Burrows, A., Hacke, W., Liebeskind, D., Majoie, C. B. L. M., Dippel, D. W. J., Siddiqui, A. H., Khatri, P., Baxter, B., Nogeuira, R., Gounis, M., Jovin, T., Kallmes, D. F. Tags: Editor''s choice, Ischemic stroke Source Type: research

Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients
Conclusions Treatment of non-saccular aneurysms of the posterior fossa is technically possible. Early treatment, particularly of the fusiform and transitional subtypes, is recognized, as is treatment prior to the development of symptoms. A ‘watch and wait’ strategy with regular imaging follow-up could be employed for asymptomatic dolichoectasia.
Source: Journal of NeuroInterventional Surgery - April 13, 2017 Category: Neurosurgery Authors: Bhogal, P., Perez, M. A., Ganslandt, O., Bäzner, H., Henkes, H., Fischer, S. Tags: Open access, Hemorrhagic stroke Source Type: research

'Last known well alone should not determine triage for patients with stroke and symptoms of large vessel occlusion
The term ‘last known well’ (LKW) is ingrained in the culture of stroke treatment. There are good reasons for this. Successful acute thrombolytic trials used LKW as an entry criterion to prove the efficacy of IV thrombolysis.1 2 Based on the results of those trials, treatment of acute stroke with IV thrombolysis is a class 1 recommendation for patients presenting with acute stroke symptoms within 3–4.5 h of LKW.3 Few vascular neurologists will recommend IV thrombolysis for patients outside the time window established by LKW, and hence this term represents a crucial time metric for thrombolytic therapy...
Source: Journal of NeuroInterventional Surgery - March 15, 2017 Category: Neurosurgery Authors: Heck, D. V., Grotta, J. C. Tags: Editorials Source Type: research

Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy
Conclusions A combination of proximal internal carotid artery occlusion using a balloon catheter and distal aspiration through an intermediate catheter represents a safe and efficient adjunct to mechanical thrombectomy with stent retrievers. In our patient cohort, no new thrombembolic complications were detected.
Source: Journal of NeuroInterventional Surgery - March 15, 2017 Category: Neurosurgery Authors: Stampfl, S., Pfaff, J., Herweh, C., Pham, M., Schieber, S., Ringleb, P. A., Bendszus, M., Möhlenbruch, M. A. Tags: Ischemic stroke Source Type: research

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms
Conclusions Ruptured aneurysms <3.5 mm were associated with an increased risk of intraprocedural rupture, and parent vessel angle <60.0°, wider-neck aneurysms, and a history of hypertension were associated with increased risk of thrombus formation during coiling of ruptured ACoA aneurysms.
Source: Journal of NeuroInterventional Surgery - March 15, 2017 Category: Neurosurgery Authors: Fan, L., Lin, B., Xu, T., Xia, N., Shao, X., Tan, X., Zhong, M., Yang, Y., Zhao, B. Tags: Hemorrhagic stroke Source Type: research

Remote aspiration thrombectomy in large vessel acute ischemic stroke
We report a three case series of patients with acute ischemic stroke from supraclinoidal internal carotid artery occlusions treated with remote aspiration thrombectomy through a BGC placed at the cervical internal carotid artery, leading to complete reperfusion without the need for intracranial catheterization. Remote thrombectomy in the setting of intracranial internal carotid artery occlusion may constitute a relatively fast and inexpensive initial thrombectomy maneuver. Further investigation is warranted.
Source: Journal of NeuroInterventional Surgery - February 13, 2017 Category: Neurosurgery Authors: Haussen, D. C., Bouslama, M., Grossberg, J. A., Nogueira, R. G. Tags: Ischemic stroke Source Type: research

Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers
Conclusions The APD technique improves apposition of the tested devices to the vessel wall. The widening effect comes at the cost of minimal shortening of the devices. Our clinical experience shows that using the APD technique to deploy the Trevo device is effective and safe.
Source: Journal of NeuroInterventional Surgery - February 13, 2017 Category: Neurosurgery Authors: Wiesmann, M., Brockmann, M.-A., Heringer, S., Müller, M., Reich, A., Nikoubashman, O. Tags: Ischemic stroke Source Type: research

Experimental evaluation of stent retrievers mechanical properties and effectiveness
Conclusions None of the tested devices were effective in removing white clots of large diameter (≥6 mm). Constant radial force during retrieval allows constant cohesion to the vessel wall and pressure over the clot; such features allow for a higher rate of clot removal.
Source: Journal of NeuroInterventional Surgery - February 13, 2017 Category: Neurosurgery Authors: Machi, P., Jourdan, F., Ambard, D., Reynaud, C., Lobotesis, K., Sanchez, M., Bonafe, A., Costalat, V. Tags: Open access, Ischemic stroke Source Type: research

Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort
Conclusions In our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.
Source: Journal of NeuroInterventional Surgery - December 13, 2016 Category: Neurosurgery Authors: Lee, D. J., Ahmadpour, A., Binyamin, T., Dahlin, B. C., Shahlaie, K., Waldau, B. Tags: Hemorrhagic stroke Source Type: research

Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience
Conclusions Endovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis.
Source: Journal of NeuroInterventional Surgery - December 13, 2016 Category: Neurosurgery Authors: Briganti, F., Leone, G., Ugga, L., Marseglia, M., Macera, A., Manto, A., Delehaye, L., Resta, M., Resta, M., Burdi, N., Nuzzi, N. P., Divenuto, I., Caranci, F., Muto, M., Solari, D., Cappabianca, P., Maiuri, F. Tags: Open access, New devices Source Type: research

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