Journal of neurointerventional surgery
-
Comparative Study
Comparison of CT and fluoroscopic guidance for lumbar puncture in an obese population with prior failed unguided attempt.
In the past 50 years, fluoroscopic guidance has been used to improve upon lumbar puncture (LP) technique that was unchanged for over a century. Recently, CT has seen increasing use as a guidance modality due to its ability to demonstrate soft tissue contrast and provide millimeter accuracy with needle targeting. This study compared procedure time and radiation dosages for fluoroscopic and CT guided LP. ⋯ Both fluoroscopic and CT guidance may be used to perform an LP in an obese population with a short procedure time and low radiation dose.
-
Comparative Study
Dexmedetomidine: a safe alternative to general anesthesia for endovascular stroke treatment.
There have been reports that general anesthesia (GA) is associated with worse clinical outcomes during intra-arterial treatment (IAT) for stroke. Since traditional sedatives carry the risk of respiratory depression, this retrospective study was designed to compare sedation with the α2 adrenergic agonist dexmedetomidine (DEX) and with GA for IAT procedures. ⋯ DEX can be safely administered in patients undergoing endovascular reperfusion therapies. Further study is required to determine if outcomes are different among sedatives used during such procedures.
-
Transarterial infusion of Onyx is now widely used in the treatment of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). Transvenous Onyx embolization is rarely performed, and usually in cases of carotid cavernous fistulas. We describe a novel technique of transvenous Onyx embolization in the treatment of three high risk DAVFs and one vein of Galen (VOG) AVM. ⋯ Transvenous Onyx infusion into a single arterial feeder can produce retrograde embolization of numerous other arterial feeders supplying high risk DAVFs and complex cerebral AVMs. This technique appears to be safe and potentially curative in select cases.
-
Successful neuroendovascular treatments rely on microcatheter stability from guide catheter support. We present our experience using a new large-bore 0.058 inch or 0.072 inch inner diameter (ID) hyperflexible access catheter placed deep within the intracranial circulation during the neurointervention. ⋯ The Navien is the newest hyperflexible access catheter that is highly trackable into ultra-distal intracranial positions. It maneuvers atraumatically, providing improved distal intracranial support for a variety of complex cerebrovascular interventions and preserves necessary ID for quality intraprocedural roadmaps and angiography.