Journal of neurointerventional surgery
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Comparative Study
A technical comparison of thrombectomy vacuum aspiration systems.
Improved functional outcomes after mechanical thrombectomy for emergent large vessel occlusion depend on expedient reperfusion after clinical presentation. Device technology has improved substantially over the years, and several commercial options exist for both large-bore aspiration catheters and suction pump systems. ⋯ The Penumbra Jet Engine pump generates significantly higher vacuum pressures and tip forces than the other commercially available aspiration pump systems. Furthermore, catheters with a larger inner diameter generate higher tip suction forces on aspiration. Whether these mechanical features lead to improved clinical outcomes is yet to be determined.
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In ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy. ⋯ HbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.
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Spetzler-Martin (SM) grade I-II (low-grade) arteriovenous malformations (AVMs) are often considered safe for microsurgery or radiosurgery. The adjunctive use of preoperative embolization to reduce surgical risk in these AVMs remains controversial. ⋯ Curative treatment of SM I-II AVMs can be performed using endovascular embolization with microsurgical resection or radiosurgery in selected cases, with very low morbidity and high cure rates. Compared with other published series, these outcomes suggest that preoperative embolization is a safe and effective adjunct to definitive surgical treatment. Long-term follow-up showed that patients with low-grade AVMs undergoing surgical resection or radiosurgery have good functional outcomes.
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Self-expandable stents have broadened the spectrum of endovascular treatment of intracranial aneurysms. However, procedures involving double stenting in Y/X configurations carry a relatively high risk of procedural complications. The Neuroform ATLAS, the evolution of Neuroform EZ, is a nitinol self-expanding hybrid/open cell stent which can be delivered through a low profile 0.017 inch catheter. We present our experience in the treatment of intracranial aneurysms with this stent in Y and X configurations. ⋯ The Neuroform ATLAS is an effective device for treatment of bifurcation aneurysms, allowing good conformability, a high level of navigability, and easy mesh crossing to perform Y/X stenting procedures. The rate of procedural complications remains non-negligible, and an indication for a double stenting procedure should be carefully discussed in a multidisciplinary meeting.
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Randomized Controlled Trial Comparative Study
Safety and quality of endovascular therapy under general anesthesia and conscious sedation are comparable: results from the GOLIATH trial.
The "General or Local Anesthesia in Intra-Arterial Therapy" (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm. ⋯ Safety and quality of EVT under either GA and CS are comparable.