Journal of neurointerventional surgery
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The endovascular treatment of acute ischemic stroke has been revolutionized in the past years by the introduction of new devices for mechanical thrombectomy. Several tools were already available in 2008. The majority allowed the recanalization of acutely occluded intracranial arteries with acceptable levels of safety and efficacy, and with occasional failures. ⋯ The Solitaire stent was initially developed for the endovascular treatment of wide necked intracranial aneurysms but has been demonstrated to be safe and efficacious for intracranial thrombectomy. This was the first successful human clinical use of a Solitaire stent for this purpose and the ignition spark for the development of a whole generation of new devices, now called stent retrievers.
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The use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future. ⋯ Participant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.
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Brain arteriovenous malformations (AVM) account for a significant percentage of brain hemorrhages in pregnant patients. There is general consensus that ruptured AVMs in pregnant women should be managed based on neurosurgical rather than obstetric considerations. Since the risk of re-hemorrhage is significantly higher in the pregnant patient with a ruptured AVM, aggressive treatment during pregnancy must be considered if this can be accomplished with acceptable risk. Recent advances in endovascular technology have increased the potential for successful treatment of previously inoperable high-grade AVMs. ⋯ Extensive endovascular Onyx embolization is feasible in the setting of a ruptured high-grade AVM during pregnancy. The rationale for proceeding with treatment is the perceived higher likelihood of re-hemorrhage from such a lesion.
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Stent assisted coiling of unruptured wide necked intracranial aneurysms require antiplatelets to prevent stent thrombosis. The effect of the loading dose of antiplatelets prior to the stent coiling procedure in an unsecured wide necked ruptured intracranial aneurysm is not known. ⋯ In our series of carefully selected patients, therapeutic dual antiplatelet loading prior to stent assisted coiling of ruptured wide necked intracranial aneurysm was not associated with increased bleeding complications. However, thromboembolic events remain the main challenge. Further study is required to confirm the safety of antiplatelet loading in stent assisted ruptured intracranial aneurysm coiling.