Kooperativer Bibliotheksverbund

Berlin Brandenburg


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  • 1
    Language: English
    In: Journal of Clinical Neuroscience, September 2013, Vol.20(9), pp.1303-1305
    Description: The Solitaire-FR (eV3/Covidien, Irvine, CA, USA) retrievable stent (SFR), designed for mechanical thrombectomy in acute ischemic stroke, recently received Food and Drug Administration approval in the USA. Clot retrieval is performed by deploying the SFR through a microcatheter directly into the thrombus, to capture the clot and restore perfusion. In order to perform this maneuver, a balloon guide catheter must be used to apply negative suction and reverse flow within the cervical arteries, thus minimizing the chance of antegrade blood flow dislodging the thrombus from the stent. This technique requires at least an 8-French system that can increase the risk of arterial injury at the access site particularly in older patients with smaller or highly atherosclerotic peripheral arteries, and may provide inadequate aspiration in the vertebrobasilar system where only one vertebral artery is accessed and aspirated. The author describes a technique whereby a 6-French tri-axial system is used to deliver the SFR through a Penumbra Aspiration Microcatheter (Penumbra, Inc., Alameda, CA, USA) to provide intracranial aspiration in close proximity to the stent.
    Keywords: Brain ; Mechanical Thrombectomy ; Penumbra ; Solitaire-Fr ; Stroke ; Medicine
    ISSN: 0967-5868
    E-ISSN: 1532-2653
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  • 2
    In: Circulation, 2018, Vol.138(Suppl_1 Suppl 1), pp.A11577-A11577
    Description: Introduction: Questions remain about the risks of mechanical thrombectomy (MT) in octogenarians. We hypothesized the odds of mortality at discharge and ninety days are significantly greater for patients age eighty and older.Methods: Patients who underwent MT at Crouse Hospital for a primary diagnosis of ischemic stroke located in the internal carotid or middle cerebral arteries were reviewed.Results: A total of 90 patients were treated between Oct 2015 and Dec 2017 (n=56 age 〈80, n=34 age ≥80). There were nosignificant differences between the two age groups in NIHSS at admission (12.1±1.0 vs 12.8±1.4, p=0.67, n=82), mean time to groin puncture for MT (3.0±0.6 vs 3.1±0.7 h, p=0.87, n=90,proportion of patients receiving thrombolysis (53.6% vs. 47.1%, χ2=0.4, p=0.55), or proportion of patients with Thrombolysis in Cerebral Infarction (TICI) score ≥ 2B (82.2% vs 85.2%, p=0.74,χ2=0.1 n=72). There were significantly greater odds of mortalityat discharge (OR=11.8; 95% CI =1.4, 102.7, p=0.026) and at ninety days post-discharge (OR=4.4; 95% CI 1.6, 12.4, p=0.005)for patients eighty and older. Both the mean modified Rankin Score at discharge (2.9±0.3 vs. 3.9±0.4, p = 0.018, n=89) and the proportion of atrial fibrillation (19.6% vs 44.1%, p=0.002, χ2=9.0, n=90) were significantly greater in patients age eighty and older.Conclusion: Despite similarities in stroke severity, time to treatment, use of thrombolysis, and recanalization, octogenarians had a significantly greater risk of mortality when undergoing MT for ischemic stroke in our single center review, which may represent real world experience. These differences in mortality are partially explained by prior strokes, atrial fibrillation, and previously undiagnosed cardiovascular and pulmonary comorbidities, suggesting that patient selection is particularly important in the older population.
    ISSN: 0009-7322
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  • 3
    Language: English
    In: Clinical Neurology and Neurosurgery, March 2013, Vol.115(3), pp.252-259
    Description: Pseudotumor cerebri, or benign intracranial hypertension, is characterized by intracranial hypertension of unknown etiology typically in obese women 〈45 years of age, and can be disabling secondary to headaches and visual disturbances. Medical management includes pharmaceuticals that reduce cerebrospinal fluid (CSF) production and lumbar punctures that reduce the CSF volume, both aimed at reducing intracranial pressure. When medical management fails, surgical CSF diverting procedures are indicated. Recently it has been demonstrated that dural sinus stenosis or thrombosis can be responsible for this disease and treated with endovascular venous stent placement. The intent of this educational manuscript is to review the clinical presentation of pseudotumor cerebri patients and discuss the medical, surgical, and endovascular treatment options for this disease. After reading this paper, the reader should be able to: (1) understand the pathophysiological basis of pseudotumor cerebri, (2) describe its presenting signs and symptoms, and (3) discuss the medical, surgical, and endovascular treatment options.
    Keywords: Benign Intracranial Hypertension ; Dural Sinus Stenosis ; Endovascular Venous Stent ; Pseudotumor Cerebri ; Thrombosis ; Medicine
    ISSN: 0303-8467
    E-ISSN: 1872-6968
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  • 4
    In: The Journal of Trauma: Injury, Infection, and Critical Care, 2010, Vol.68(4), pp.E99-E103
    Keywords: Atlanto-Occipital Joint -- Injuries ; Foreign Bodies -- Surgery ; Head Injuries, Penetrating -- Surgery ; Wounds, Gunshot -- Surgery;
    ISSN: 0022-5282
    E-ISSN: 15298809
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  • 5
    Language: English
    In: Acta Neurochirurgica, 2013, Vol.155(2), p.231(6)
    Description: Byline: Amit Singla (1), Mark R. Villwock (1), Walter Jacobsen (2), Eric M. Deshaies (1,3,4,5,6) Keywords: Aneurysm; Coils; Embolization; Occlusion; Recurrence Abstract: Background Coil embolization has gained importance in the management of intracranial aneurysms over the past decade. However, the recurrence risk after embolization mandates closer follow-up than surgical clip ligation. Currently, there is no reliable system for predicting aneurysm sac thrombosis. An aneurysm embolization grade (AEG) reported previously by the senior author (EMD) has been proposed as a tool for predicting the durability of aneurysm occlusion based on hemodynamic characteristics. Here, we present our internal validity results. Methods AEG and Raymond--Roy Occlusion Classification (RROC) scores were prospectively assigned to all aneurysms coiled from June 2008 to June 2011. The prospectively assigned AEG and RROC scores from the cerebral angiograms were collected for data analysis and validity assessment of the AEG system. 110 consecutive patients who had aneurysm coil embolization were included in this study. Results The post-coiling AEG significantly predicted follow-up angiographic filling characteristics. Pairwise comparisons revealed that the follow-up AEG for those initially scored 'A' (complete obliteration) was significantly better than the contrast-flow groups. Significant differences were also noted between contrast-stasis and contrast-flow groups. A pairwise comparison between RROC scores demonstrated that only the RROC Type 1 could be used to predict follow-up occlusion durability. Stent placement in wide-neck aneurysms had no effect on initial AEG, RROC, or long-term occlusion durability. Packing density significantly predicted initial AEG and RROC, but had no effect on long-term occlusion. Conclusions The AEG system is uniquely based on angiographic filling characteristics of the aneurysm, and this study demonstrated its high predictive value for determining aneurysm sac thrombosis. Assigning an AEG to the aneurysm can guide the neurointerventionalist in discussions with the patient regarding the probability of aneurysm recurrence and potential need for retreatment. Author Affiliation: (1) Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA (2) Department of Neurosurgery, Albany Medical Center, Albany, NY, USA (3) SUNY Upstate Neurovascular Institute, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA (4) Cerebrovascular, Endovascular, and Skull Base Neurosurgery, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA (5) Neuroendovascular Fellowship Program, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA (6) Neurosurgery, Neuroscience & Physiology, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA Article History: Registration Date: 02/11/2012 Received Date: 17/09/2012 Accepted Date: 02/11/2012 Online Date: 15/11/2012 Article note: The Aneurysm Embolization Grade was discussed in a presentation by the senior author (EMD) titled "Controversies in Aneurysm Therapy" at the Second Annual International Congress of Interventional Neurology, September 6--8 2012, Minneapolis, Minnesota, USA.
    Keywords: Medical Schools ; Neurosciences ; Aneurysm
    ISSN: 0001-6268
    E-ISSN: 09420940
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  • 6
    Language: English
    In: Journal of Stroke and Cerebrovascular Diseases, May 2014, Vol.23(5), pp.1069-1072
    Description: The timing of tracheostomy in stroke patients unable to protect their airway has become a topic of debate. Proponents for early tracheostomy (ET) cite benefits including less ventilation–associated pneumonia, less sedative drug use, shorter length of stay, and reduced mortality in comparison with late tracheostomy (LT). We examined the timing of tracheostomy on stroke patient outcomes across the United States using the Nationwide Inpatient Sample (2008-2010). Independent samples tests and chi-squared tests were used to make comparisons between early (≤10 days) and late (11-25 days) tracheostomy. Multivariable models, adjusted for confounding factors, investigated outcome measures. In total, 13,165 stroke cases were included in the study (5591 in the ET group and 7574 in the LT group). Patients receiving an ET had a significant reduction in the odds of ventilator-associated pneumonia in comparison with the LT group (OR: .688,  = .026). The length of stay for patients receiving an ET was significantly lower in comparison with the LT group (  〈 .001) and was associated with an 18% reduction in total hospital costs (  〈 .001). Early tracheostomy for stroke patients may reduce the incidence of ventilator-associated pneumonia, thereby shortening the hospital stay and lowering total hospital costs. These relationships warrant further investigation in a large prospective multicenter trial.
    Keywords: Tracheostomy ; Stroke ; Neurocritical Care ; Outcome ; Tracheostomy Timing ; Medicine
    ISSN: 1052-3057
    E-ISSN: 1532-8511
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  • 7
    Language: English
    In: World Journal of Neuroscience, 2011-11-01, 1卷3期 (Vol.1, Issue 3), pp.45-48
    Description: Objective and Importance-Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular techniques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perforating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation-A 47 year old female presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent technique was used to divert flow away from the aneurysm neck to induce aneurysm thrombosis. Intervention (or Technique)-Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to deliver coils for endovascular embolization; this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclusion—Stent-within-stent technique should be considered as a possible endovascular treatment option for small side-wall and perforator artery aneurysms that can’t be safely treated with coils or embolic agents.
    Keywords: Aneurysm ; Basilar, Enterprise ; Stent ; Subarachnoid Hemorrhage
    ISSN: 2162-2000
    E-ISSN: 21622019
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  • 8
    Language: English
    In: Journal of NeuroInterventional Surgery, 23 May 2016, Vol.8(5), p.457
    Description: Mechanical thrombectomy (MT) for the treatment of acute ischemic stroke has been growing in popularity while the therapeutic benefit of MT has been increasingly debated. Our objective was to examine national trends in mortality following MT.
    Keywords: Stroke ; Thrombectomy ; Intervention ; Economics
    ISSN: 1759-8478
    ISSN: 17598478
    E-ISSN: 1759-8486
    E-ISSN: 17598486
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  • 9
    Language: English
    In: Global Spine Journal, February 2016, Vol.6(1), pp.11-14
    Description: Study Design Case report. Objective Temporary external ventricular drainage for refractory thoracolumbar cerebrospinal fluid (CSF) leak is not reported in the literature. We describe a recent case that utilized this technique. Methods...
    Keywords: External Ventricular Drain ; Cerebrospinal Fluid Leak ; Ependymoma ; Dural Defect
    ISSN: 2192-5682
    E-ISSN: 2192-5690
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  • 10
    Language: English
    In: Journal of neurosurgery, March 2012, Vol.116(3), pp.665-71
    Description: Rapid revascularization of tandem extracranial and intracranial acute thromboembolic occlusions can be challenging and can delay restoration of blood flow to the cerebral circulation. Taking advantage of collateral pathways in the circle of Willis for thrombectomy can reduce the occlusion-to-revascularization time significantly, thereby protecting brain tissue from ischemic injury. The authors report using the trans-anterior communicating artery (ACoA) approach by using the Penumbra microcatheter to rapidly restore blood flow to the middle cerebral artery (MCA) territory prior to treating the ipsilateral internal carotid artery (ICA) occlusion. Two patients with acute onset of tandem ipsilateral ICA and MCA occlusions and a competent ACoA underwent rapid revascularization of the MCA using a trans-ACoA approach for pharmaceutical and mechanical thrombolysis with the 0.026-in Penumbra microcatheter. Subsequently, once blood flow was reestablished in the MCA territory via cross-filling from the contralateral ICA, the proximally occluded ICA dissection was revascularized with a stent. Both patients had rapid revascularization of the MCA territory (both Thrombolysis in Myocardial Infarction Grade 3) with the trans-ACoA approach (19 and 36 minutes) followed by treatment of the ipsilateral proximal ICA occlusion. This prevented prolonged MCA ischemia time (72 and 47 minutes for ICA revascularization time saved) that would have otherwise occurred if the dissections were treated prior to revascularization of the MCA. Both patients had improved NIH Stroke Scale scores after the procedure. No adverse events from crossing the ACoA with the Penumbra microcatheter were encountered during the revascularization procedure. The trans-ACoA approach with the Penumbra microcatheter for rapid revascularization of an acutely thrombosed MCA in the setting of a simultaneous ipsilateral proximal ICA occlusion is feasible in patients with a competent ACoA. This technique can significantly minimize ischemic injury by reducing the occlusion-to-revascularization time and allow for MCA perfusion via collateral circulation while treating a proximal occlusion. To the best of the authors' knowledge, this is the first reported trans-ACoA approach with the Penumbra microcatheter and the first to report the utilization of the collateral intracranial circulation to reduce occlusion-to-revascularization time.
    Keywords: Anterior Cerebral Artery -- Surgery ; Carotid Artery Diseases -- Surgery ; Carotid Artery, Internal -- Surgery ; Cerebral Revascularization -- Instrumentation ; Infarction, Middle Cerebral Artery -- Surgery ; Middle Cerebral Artery -- Surgery
    ISSN: 00223085
    E-ISSN: 1933-0693
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