Journal of vascular and interventional neurology
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J Vasc Interv Neurol · Oct 2008
Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization.
The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called 'Reversed-Robinhood syndrome'. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease. ⋯ Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive disease of the ICA or MCA is helpful in the identification and quantification of failed vasodilatory reserve. This approach may be useful in selecting patients for possible revascularization procedures.
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J Vasc Interv Neurol · Jul 2008
Mode of arrival to the emergency department of stroke patients in the United States.
The modality of transport to the emergency department has implications for triage, evaluation, and treatment of patients with stroke. We performed this study to determine the national trends in modes of arrival in patients with stroke and its association with emergency department evaluation in a nationally representative sample of United States. ⋯ Although arrival by ambulance was associated with a higher level of care, a prominent proportion of patients with suspected stroke are not arriving by ambulance to the ED.
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J Vasc Interv Neurol · Apr 2008
Treatment of unruptured intracranial aneurysms using internally expanding coils.
The International Subarachnoid Aneurysm Trial (ISAT) showed that patients with intracranial aneurysms treated with coil embolization have better clinical outcomes than those undergoing neurosurgical clipping. However some patients treated endovascularly have recurrence of aneurysms. Low packing density is often cited as a reason for recurrence. Coiling with hydrogel covered coils significantly improves the packing density. We report our initial experience in using a newly introduced design of hydrogel coils. ⋯ The softness of the hydrogel allowed us to deploy coated coils with good packing density. A slight expansion of these coils at the neck can be expected to reduce any neck remnant and potentially inhibit recurrence.
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J Vasc Interv Neurol · Jan 2008
The stroke and neurovascular program at the medical college of wisconsin and froedtert hospital.
The Stroke and Neurovascular Program at the Medical College of Wisconsin and Froedtert Hospital, in Milwaukee, is a comprehensive, interdisciplinary center for stroke medicine. The program encompasses an acute stroke team, a neuro-intensive care unit, a stroke care unit, and a stroke rehabilitation program. ⋯ In addition to clinical service and education, the faculty are actively engaged in research. The program is certified by the Joint Commission as a Primary Stroke Center.