AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Jan 2013
Immediate pain response to interlaminar lumbar epidural steroid administration: response characteristics and effects of anesthetic concentration.
Interlaminar LESIs are commonly used to treat LBP or radiculopathy. Most studies focus on the long-term outcomes of LESI. The purpose of this study is to evaluate the immediate effects of fluoroscopically guided LESI on LBP/radiculopathy including low- or high-strength anesthetic response. ⋯ An immediate pain-extinction response is identified after LESI, which appears independent of anesthetic strength. This observation may relate to pain origin and/or pain nociceptor afferent pathway in an individual patient and potentially relate to treatment response.
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AJNR Am J Neuroradiol · Jan 2013
Randomized Controlled Trial Multicenter StudySubsequent fractures post-vertebral augmentation: analysis of a prospective randomized trial in osteoporotic vertebral compression fractures.
Two injectable materials for the treatment of vertebral compression fractures, Cortoss and PMMA, were compared in a prospective, randomized study. Our purpose was to analyze the incidence and nature of subsequent fractures following treatment, one of the secondary outcomes. ⋯ Compared with PMMA, Cortoss use resulted in fewer subsequent fractures, especially in patients with first fractures. In patients without previous fractures, the subsequent fracture rate was also lower in Cortoss-treated versus conservatively treated patients in other studies. This reduced subsequent fracture rate may be due to differences in the material and mechanical properties of Cortoss compared with PMMA. As finite-element analysis modeling demonstrated, Cortoss restores a more physiologic load transfer through the treated vertebra. Patients treated with Cortoss were less likely to be hospitalized for new fractures.
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AJNR Am J Neuroradiol · Jan 2013
Clinical TrialTechnical feasibility and application of mechanical thrombectomy with the Solitaire FR Revascularization Device in acute basilar artery occlusion.
Acute BAO is a devastating neurological condition associated with a poor clinical outcome and a high mortality rate. Recanalization has been identified as a major prognostic factor for good outcome in BAO. Mechanical thrombectomy using retrievable stents is an emerging treatment option for acute stroke. First clinical trials using stent retrievers have shown promising high recanalization rates. However, these studies mainly included large artery occlusions in the anterior circulation with only a few or single cases of BAO. Therefore, the purpose of this study was to evaluate technical feasibility, safety, and efficacy of mechanical thrombectomy using retrievable stent in the treatment of acute BAO. ⋯ A multimodal endovascular approach using retrievable stents in BAO has high recanalization rates, with very low complication rates. Underlying atherothrombotic stenotic lesions of the basilar artery may still necessitate additional permanent stent placement to achieve complete recanalization.
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AJNR Am J Neuroradiol · Jan 2013
Location of the clot and outcome of perfusion defects in acute anterior circulation stroke treated with intravenous thrombolysis.
The location of the clot is a major determinant of ischemic stroke outcome. We studied the impact of the location (ICA, proximal M1 segment of the MCA, distal M1 segment, and M2 segment and more distally) of the clot on the CT perfusion parametric maps, the mismatch ratio, the amount of salvaged brain tissue, and the imaging and clinical outcomes in a retrospective acute (<3 hours) stroke cohort treated with intravenous thrombolysis. ⋯ Admission CBV defects are larger in proximal vessel occlusions. More of the penumbra can be salvaged if the occlusion is located distally. This effect seems to reach a plateau in the distal M1 segment of the MCA.
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AJNR Am J Neuroradiol · Jan 2013
Lateral decubitus positioning for cervical nerve root block using CT image guidance minimizes effective radiation dose and procedural time.
Cervical steroid injections are a minimally invasive means of providing pain relief to patients with cervical radiculopathy. CT guidance offers many potential advantages. We developed a technique with the patient in the lateral position with a lateral needle trajectory to minimize the required needle depth from skin to target and a near-vertical needle trajectory. The aim of this study was to analyze the cohort for complications, procedural time, and effective radiation dose. ⋯ The lateral patient position with CT guidance is safe and allows use of a short needle in a vertical trajectory. This reduces the number of needle adjustments and imaging series to provide a short procedural time with a low effective radiation dose from the procedure.