Journal of neurointerventional surgery
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The feasibility of rapid cerebral hypothermia induction in humans with intracarotid cold saline infusion (ICSI) was investigated using a hybrid approach of jugular venous bulb temperature (JVBT) sampling and mathematical modeling of transient and steady state brain temperature distribution. This study utilized both forward mathematical modeling, in which brain temperatures were predicted based on input saline temperatures, and inverse modeling, where brain temperatures were inferred based on JVBT. Changes in ipsilateral anterior circulation territory temperature (IACT) were estimated in eight patients as a result of 10 min of a cold saline infusion of 33 ml/min. ⋯ In the inverse model, IACT decreased by 1.9±0.23°C. The results of this study suggest that mild cerebral hypothermia can be induced rapidly and safely with ICSI in the neuroangiographical setting. The JVBT corrected mathematical model can be used as a non-invasive estimate of transient and steady state cerebral temperature changes.
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The first known use of Onyx delivered via a dual lumen balloon catheter is reported. A mandibular arteriovenous malformation was successfully embolized with Onyx via an Ascent balloon catheter. ⋯ Onyx embolization via a dual lumen balloon catheter allows for great penetration without the necessity of the long plug creation process for the usual 'plug and push technique' or the use of detachable tip microcatheters. The technique is limited by the deliverability of the balloon catheter, and is safest in the external carotid circulation.
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Case Reports
Intracranial stenting as monotherapy in subarachnoid hemorrhage and sickle cell disease.
Although there have been a few reports of coiling intracranial aneurysms in patients with sickle cell disease (SCD), there are no reports of intracranial stent placement in this patient population. A patient in whom stent placement was utilized as monotherapy to treat a blister-like aneurysm is described and the implications of SCD and endovascular treatment are discussed. ⋯ This report reviews hypercoagulability in SCD and the treatment options for intracranial aneurysms in patients with SCD. Additionally, the reported case suggests that intracranial stent placement may be a viable option for treating complex intracranial aneurysms in SCD patients.
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The gold standard for the diagnosis of intracranial atherosclerosis remains catheter based digital subtraction angiography (DSA). A symptomatic hemodynamically non-significant intracranial atherosclerotic lesion is described, whose underlying embologenic characteristics were not detectable by either DSA or three-dimensional rotational angiography (3DRA) but fully realized by C-arm cone beam CT (CBCT) angiography. ⋯ The superior spatial resolution and dynamic range characteristics of CBCT angiography provide added clinical utility in disambiguation of questionable intracranial atherosclerotic lesions which may be missed by conventional planar and rotational angiography. The additional information provided by CBCT angiography could be useful in lesion risk stratification and help refine indications for intracranial stent angioplasty given its recent documented shortcomings vis a vis medical management.
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Cerebral angiography is a routine low-risk procedure. Laboratory testing is performed in almost all patients. Some testing may be warranted in selected patients but can also result in delays in performing the procedure. ⋯ The incidence of abnormal testing in patients undergoing outpatient cerebral angiography is very low. These results and evidence in the literature suggest that the majority of patients undergoing cerebral angiography do not require any pre-procedure testing. Assessment of renal function using the estimated glomerular filtration rate in high-risk patients only is, however, warranted.