Editor’s Choices
Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage • J.P. Cruz, C. O’Kelly, M. Kelly, J.H. Wong, W. Alshaya, A. Martin, J. Spears, and T.R. Marotta
The authors used the Pipeline device to treat 20 patients with acutely ruptured intracranial aneurysms. The most common types of aneurysms treated were blister and dysplastic/dissecting. Procedure-related morbidity/mortality overall was 15%, and 1 death directly related to the procedure occurred. Occlusion rates were 75% and 94% at 6 months and 12 months, respectively. The authors concluded that the Pipeline device offers a feasible treatment option in acute or subacute ruptured aneurysms, especially the blister type. Ruptured giant aneurysms remain challenging for both surgical and endovascular techniques; at this stage, the Pipeline device should be used with caution in this aneurysm subtype.
Evaluating CT Perfusion Using Outcome Measures of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage • P.C. Sanelli, N. Anumula, C.E. Johnson, J.P. Comunale, A.J. Tsiouris, H. Riina, A.Z. Segal, P.E. Stieg, R.D. Zimmerman, and A.I. Mushlin
Ninety-six patients with SAH were evaluated with CT perfusion for cortical deficits and these were correlated with primary (permanent neurologic deficits and infarctions) and secondary (delayed cerebral ischemia manifesting as clinical deterioration) outcome measures. One-third of patients developed permanent neurologic deficits (78% showed CT perfusion defects), infarctions developed in 18% (88% had perfusion defects), and delayed cerebral ischemia was found in 50% (81% had perfusion defects). The most common perfusion abnormalities were reduced CBF and prolonged MTT.
Diffusion Tensor Imaging Correlates with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy and Predicts Outcome following Surgery • J.G.A. Jones, S.Y. Cen, R.M. Lebel, P.C. Hsieh, and M. Law
The relationship between DTI findings and clinical severity of cervical myelopathy due to spondylosis was studied in 30 patients. Low fractional anisotropy correlated with initial clinical assessments and patients with high FA showed better outcome. T2 signal intensity was associated with functional status but did not predict outcome whereas degree of stenosis lacked correlation with all clinical parameters. Thus, DTI may be a useful diagnostic tool for assessing disease severity in these patients and its predictive value regarding postoperative outcome may improve surgical decision making.
Fellows’ Journal Club
Microcatheter to Recanalization (Procedure Time) Predicts Outcomes in Endovascular Treatment in Patients with Acute Ischemic Stroke: When Do We Stop? • A.E. Hassan, S.A. Chaudhry, J.T. Miley, R. Khatri, S.A. Hassan, M.F.K. Suri, and A.I. Qureshi
This study addresses the relationship among procedure time, recanalization, and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment. Demographics, NIHSS scores before and 1 day after the procedure, and modified Rankin Scale scores were assessed in 209 patients. Patients with procedure times ≤30 minutes had lower rates of unfavorable outcome at discharge compared with patients with procedure times ≥30 minutes. Rates of favorable outcomes in endovascularly treated patients after 60 minutes were lower than rates observed with placebo treatment. Unfavorable outcome was positively associated with age, admission NIHSS strata, and longer procedure times.
Prospective Comparison of Angio-Seal versus Manual Compression for Hemostasis after Neurointerventional Procedures under Systemic Heparinization • H.-F. Wong, C.-W. Lee, Y.-L. Chen, Y.-M. Wu, H.-H. Weng, Y.-H. Wang, and H.-M. Liu
This article addresses the utility of Angio-Seal versus manual hemostasis in anticoagulated patients following neurointerventional procedures. In a study of 174 punctures, 104 were closed with Angio-Seal and the rest with manual compression. All patients had activated clotting time values between 250–500 seconds at the time of closure. Mean hemostasis times were significantly longer with manual compression and hematomas 3 times more common. Using Angio-Seal led to arterial occlusion in 1 patient who was successfully revascularized. Thus, Angio-Seal is fast and effective in this setting.
Cervical Spine MR Imaging Findings of Patients with Hirayama Disease in North America: A Multisite Study • V.T. Lehman, P.H. Luetmer, E.J. Sorenson, R.E. Carter, V. Gupta, G.P. Fletcher, L.S. Hu, and A.L. Kotsenas
The authors sought to determine if Hirayama disease in North America has the same imaging findings as it does in Asia. They assessed imaging studies in 21 patients and looked for loss of attachment of posterior dura, lower cord atrophy and high T2 signal, loss of cervical lordosis, and anterior dural shift in flexion. These 4 findings were able to discriminate patients from healthy controls. MR imaging findings in white North American patients with Hirayama disease include loss of attachment on neutral images and forward displacement of the dura with flexion. Findings are often present on neutral MR images and, in the appropriate clinical scenario, should prompt flexion MR imaging to evaluate anterior dural shift.
