World Neurosurg
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To test the hypothesis that the level of clinical efficacy reported in the investigational device exemption (IDE) study of the X-STOP device that led to its approval by the U.S. Food and Drug Administration could also be achieved in patients who are representative of the population approved for treatment, irrespective of whether they met all the stringent requirements of the IDE study. ⋯ The success level in the controlled IDE study that established the safety and efficacy of the X-STOP device was achieved in a representative patient cohort that did not necessarily meet all the strict requirements of the IDE plan. Nevertheless, the overall results were not good, suggesting that the ZCQ definition of success might not have captured the true outcome of surgical treatment with the X-STOP device.
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Deployment of a Neuroform microstent (NFM; Boston Scientific/Target, Freemont, California, USA) within acutely angled geometry may result in substantial deformations. This in vitro study was conducted to validate a novel alternative technique, consisting of intentional deployment of a NFM straight on into a terminus aneurysm, by assessing the mechanics, feasibility, and stability of the coils. ⋯ Stent-assisted coiling of wide-neck terminus aneurysms with straight-on deployment of NFM consistently achieved a stable NFM-coil complex. The NFM also had a better supporting force in a straight position. Some technical difficulties may be encountered during subsequent coiling. This alternative technique to conventional cross-neck bridging appears to be another strategy for wide-neck terminus aneurysm coiling.
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A therapeutic dilemma exists when patients with symptomatic carotid stenosis and concomitant heparin-induced thrombocytopenia (HIT) are advised to urgently undergo carotid endarterectomy (CEA) with heparin therapy. ⋯ We now recommend systemic intravenous and local argatroban irrigation to prevent thromboembolic complications in CEA cases with HIT and renal insufficiency. Bivalirudin for both systemic intravenous use and local irrigation may be safer in patients without renal insufficiency because of its shorter half-life.
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Review Historical Article
A perspective on radiosurgery: creativity, elegance, simplicity, and flexibility to change.
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To determine if tubular microdiskectomy is associated with differences in hospital charges compared with open microdiskectomy. ⋯ This analysis revealed significantly lower acute hospital charges associated with tubular microdiskectomy versus open microdiskectomy at an academic tertiary care hospital. These differences appear to the related to decreased use of postoperative resources in the tubular group.