Showing papers by "David Fiorella published in 2012"
Stony Brook University1, Washington University in St. Louis2, Emory University3, Oregon Health & Science University4, University of Florida5, University at Buffalo6, University of Alabama at Birmingham7, Houston Methodist Hospital8, St. Joseph's Hospital and Medical Center9, University of Texas Southwestern Medical Center10, Medical College of Wisconsin11, Medical University of South Carolina12, Mayo Clinic13, National Institutes of Health14
TL;DR: Periprocedural strokes in SAMMPRIS had multiple causes with the most common being perforator occlusion, and excluding patients with these features from undergoing percutaneous transluminal angioplasty and stenting to lower the procedural risk would limit per cutaneous translumsinal angio-stenting and stent selection to a small subset of patients.
Abstract: Background and Purpose—Enrollment in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was halted due to the high risk of stroke or death within 30 days of enrollment in the percutaneous transluminal angioplasty and stenting arm relative to the medical arm. This analysis focuses on the patient and procedural factors that may have been associated with periprocedural cerebrovascular events in the trial. Methods—Bivariate and multivariate analyses were performed to evaluate whether patient and procedural variables were associated with cerebral ischemic or hemorrhagic events occurring within 30 days of enrollment (termed periprocedural) in the percutaneous transluminal angioplasty and stenting arm. Results—Of 224 patients randomized to percutaneous transluminal angioplasty and stenting, 213 underwent angioplasty alone (n=5) or with stenting (n=208). Of these, 13 had hemorrhagic strokes (7 parenchymal, 6 subarachnoid), 19 had ischemic strok...
155 citations
TL;DR: In this paper, the authors reported 4 cases of delayed ipsilateral IPH following the successful treatment of anterior circulation aneurysms with the PED, all of which occurred within the cerebral hemisphere.
Abstract: BACKGROUND AND PURPOSE: The PED is a flow-diverting stent designed for the treatment of cerebral aneurysms. We report 4 cases of delayed ipsilateral IPH following the technically successful treatment of anterior circulation aneurysms with the PED. MATERIALS AND METHODS: Clinical and imaging data from all patients undergoing aneurysm treatment with the PED at 2 institutions were analyzed to assess the incidence of delayed IPH after treatment with the PED. RESULTS: A total of 66 patients (47 anterior circulation) with cerebral aneurysms underwent treatment with a PED between January 2008 and November 2010. Four patients experienced delayed periprocedural IPH, all after the treatment of anterior circulation aneurysms (8.5%, 4/47). The aneurysm size ranged from 5 to 21 mm. All IPHs occurred within the cerebral hemisphere, ipsilateral to the treated aneurysm, and were anatomically remote from the treated aneurysms. All procedures were uncomplicated, and patients emerged from general anesthesia at neurologic baseline. The hemorrhages became clinically evident between 1 and 6 days after the procedure. Two patients had unfavorable outcomes (mRS scores, 4 and 6). CONCLUSIONS: Delayed IPH may occur after the treatment of anterior circulation aneurysms with flow diverters. This complication does not seem to be restricted to a specific aneurysm subtype and does not seem to be related to an intraprocedural complication or solely attributable to DAT.
149 citations
01 Jan 2012
TL;DR: Delayed IPH may occur after the treatment of anterior circulation aneurysms with flow diverters, and does not seem to be related to an intraprocedural complication or solely attributable to DAT.
Abstract: BACKGROUND AND PURPOSE: The PED is a flow-diverting stent designed for the treatment of cerebral aneurysms. We report 4 cases of delayed ipsilateral IPH following the technically successful treatment of anterior circulation aneurysms with the PED. MATERIALS AND METHODS: Clinical and imaging data from all patients undergoing aneurysm treatment with the PED at 2 institutions were analyzed to assess the incidence of delayed IPH after treatment with the PED.
140 citations
TL;DR: A case report is presented which describes a novel complication of delayed intraparenchymal hemorrhage following deployment of a pipeline embolization device for the treatment of a previously ruptured partially thrombosed ophthalmic segment aneurysm.
Abstract: The pipeline embolization device has demonstrated clinical success in the management of complex intracranial aneurysms arising along the anterior intracranial circulation with a relatively low complication profile. A case report is presented which describes a novel complication of delayed intraparenchymal hemorrhage following deployment of a pipeline embolization device for the treatment of a previously ruptured partially thrombosed ophthalmic segment aneurysm.
74 citations
TL;DR: A rare case of severe in-stent stenosis occurring as a delayed complication of Neuroform stent-assisted coil embolization of an unruptured intracranial aneurysm is presented.
Abstract: The intracranial stent functions primarily to prevent protrusion of coils into the parent vessel during the embolization of wide-necked cerebral aneurysms and might also reduce aneurysm recanalization rate. In spite of these advantages, little is known about the long-term interaction of the stent with the parent vessel wall. We present a rare case of severe in-stent stenosis occurring as a delayed complication of Neuroform stent-assisted coil embolization of an unruptured intracranial aneurysm.
70 citations
TL;DR: The fatal spontaneous delayed rupture of a previously unruptured large PICA aneurysm following treatment with the PED is presented and aneurysms with an anatomic arrangement that promote continued flow into the neck may not be optimal candidates for the flow-diversion treatment strategy.
Abstract: In this report, we present the fatal spontaneous delayed rupture of a previously unruptured large PICA aneurysm following treatment with the PED. Pathology at postmortem examination has supported the theory that intra-aneurysmal thrombus may acutely destabilize the aneurysm wall. Aneurysms with an anatomic arrangement that promote continued flow into the neck may not be optimal candidates for the flow-diversion treatment strategy.
69 citations
TL;DR: Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base, which is important to recognize because primary stenting not only is ineffective but also may actually exacerbate the outflow obstruction.
Abstract: BACKGROUND AND IMPORTANCE:Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.CLINICAL PRESENTATION:We report 2 patients presenting with central venous
61 citations
TL;DR: It is suggested that the supply of neurointerventionists (NIs) physicians is not only sufficient, but has exceeded the present need for services, and Fellowship training is ingrained into the fabric of academic practices and currently seems to be perpetuated more by inertia than a dynamic evaluation of the present workforce needs.
Abstract: > To bring about destruction by overcrowding, mass starvation, anarchy, the destruction of our most cherished values—there is no need to do anything. We need only do nothing except what comes naturally—and breed. And how easy it is to do nothing. Isaac Asimov
The purpose of any training program is to provide a supply of skilled workers to address an unmet demand for their services. With respect to medical training, new physicians are required either to take the place of retiring physicians or to address an unmet demand for patient care. Evolving data strongly suggest that the supply of neurointerventional (NI) physicians is not only sufficient, but has exceeded the present need for services. Despite this, we continue to train new neurointerventionists (NIs) in unprecedented and increasing numbers every year. These new NI physicians are finding it progressively more difficult to secure employment and, once hired, face considerable challenges in building a practice and developing/maintaining their skills. Fellowship training is ingrained into the fabric of our academic practices and currently seems to be perpetuated more by inertia than a dynamic evaluation of the present workforce needs. It is the position of the authors that, if we do not re-evaluate this process, we are potentially doing a tremendous disservice to the people we are training, to patients in need of treatment (and maybe more importantly to those patients with lesions who are not in need of treatment), and finally to ourselves.
One of the more difficult aspects of evaluating the NI workforce is obtaining accurate data to characterize the status of current supply and demand—such as the number of practicing NI physicians, the number and growth rate of neuroendovascular cases and the number of new graduates entering the market each year. These statistics must be triangulated using several available sources, the most …
53 citations
TL;DR: Evidence supporting the endovascular treatment of acute ischemic stroke was evaluated based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM).
Abstract: Objective To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. Methods Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.
53 citations
TL;DR: A multimodal approach to prevention has not previously been tested in patients with atherosclerotic stroke, and several trials have studied the effects of specific risk factor medications but no stroke prevention trials have used a mutimodal aggressive risk factor approach.
Abstract: The value of comprehensive intensive atherosclerotic risk factor control in patients with coronary artery disease is well established. In 2007, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial demonstrated that among patients with stable coronary disease, intensive management of vascular risk factors was as good as endovascular intervention plus intensive medical management for preventing cardiac ischemic events.1 Yet, despite the fact that atherosclerotic risk factor control in patients with stroke or transient ischemic attack is recommended by guidelines,2 a multimodal approach to prevention has not previously been tested in patients with atherosclerotic stroke. Older atherosclerotic stroke prevention trials comparing carotid revascularization with medical therapy, such as North American Symptomatic Carotid Endarterectomy Trial (NASCET)3 and Asymptomatic Carotid Atherosclerosis Study (ACAS),4 were performed in an era before statins and angiotensin converting enzyme inhibitors became standard of care, and therefore risk factor control was not adequate by today’s standards. Even recent trials comparing carotid revascularization procedures5,6 had little emphasis on risk factor control in their design and therefore had little impact on blood pressure and cholesterol measures at 1 year.7,8 Among stroke prevention trials in patients with heterogeneous causes of stroke, several trials have studied the effects of specific risk factor medications9–11 or of intensive control of a particular risk factor, such as blood pressure,12 but no stroke prevention trials have used a mutimodal aggressive risk factor approach.
Among patients with intracranial atherosclerosis, which may be the most common cause of stroke worldwide,13 risk factor control is also believed to be important for stroke prevention. The Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial, in which patients with symptomatic intracranial stenosis were managed with either warfarin or aspirin and usual risk factor management,14 showed that …
46 citations
Journal Article•
TL;DR: Patients with impaired collateral flow associated with severe intracranial stenosis had the highest risk for stroke within 30 days, both with intensive medical therapy and as a complication of angioplasty and stenting.
Abstract: Background: The degree of collateral circulation is a powerful risk factor for recurrent stroke in the setting of medical therapy for symptomatic intracranial atherosclerosis. The impact of collaterals on the short-term risk for stroke in patients treated by stenting or intensive medical therapies is not known. We systematically evaluated baseline angiographic features of collateral circulation and antegrade flow across intracranial stenoses in randomized subjects of the multicenter SAMMPRIS trial and correlated these to their 30-day risk of ischemic stroke. Methods: Digital review of baseline angiograms in SAMMPRIS was conducted to score ASITN/SIR collateral grade and TICI antegrade flow, blind to other data. Dichotomized collateral and TICI scores (none/partial versus complete) were analyzed independently and in combinations with trial endpoints of territorial ischemic stroke or stroke in territory (SIT) and intracranial hemorrhage (ICH) within 30 days in the intensive medical and stenting arms of the study. Log-rank tests with follow-up time censored at 30 days were used in the analysis. Results: Collaterals could be assessed on 376/424 baseline angiography studies available for digital imaging review for the 451 randomized subjects in SAMMPRIS (186 medical, 190 stenting). Early territorial stroke (SIT) occurred in 6/186 (3.2%) subjects in the medical arm and 20/190 (10.5%) after stenting. SIT was not associated with TICI in either arm, whereas collaterals exerted a potent protective influence in medical (p=0.067) and stented (p=0.004) cases, with 0/66 (0%) SIT in the medical arm and 0/51 (0%) SIT in the stented arm when collaterals were complete. SIT in medical cases was associated with partial TICI/partial collaterals (5/25 (20.0%)) versus complete TICI/partial collaterals (1/95 (1.1%)) and partial TICI/complete collaterals (0/66 (0%)), p Conclusions: Patients with impaired collateral flow associated with severe intracranial stenosis had the highest risk for stroke within 30 days, both with intensive medical therapy and as a complication of angioplasty and stenting.
TL;DR: The purpose of this article is to correct the deficiencies and errors in the critique of SAMMPRIS by Abou-Chebl and Steinmetz, which contains inaccurate references to the study data and protocol, incorrect derivations of event rates in the trial, and selective use of unpublished SAMM PRIS data presented at a scientific meeting.
Abstract: See related article, p 2682.
Even before the early results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial were published,1 commentaries that were critical of the trial or that attempted to explain the poor outcome of patients treated with stenting in the trial were published or being submitted for publication.2–4 Subsequent to the publication of the SAMMPRIS results, other commentaries soon followed.5–12 As the lead investigators of SAMMPRIS, we welcome the scientific debate on possible limitations of the trial and the implications of the results on management of patients with intracranial stenosis and the design of future trials of this high-risk disease. However, these opinions should be based on an accurate representation of the published data from the trial.
The recent critique of SAMMPRIS in Stroke by Abou Chebl and Steinmetz12 fails in this regard. Their critique contains inaccurate references to the study data and protocol, incorrect derivations of event rates in the trial, and selective use of unpublished SAMMPRIS data presented at a scientific meeting. These unpublished data were used to support the authors' viewpoint, whereas other data from the same presentation that contradicted that viewpoint were omitted. The purpose of this article is to correct the deficiencies and errors in the critique of SAMMPRIS by Abou-Chebl and Steinmetz.
### Incorrect References
In their critique, Abou-Chebl and Steinmetz claim that relationships between specific lesion and procedural variables and periprocedural complications were misrepresented in the SAMMPRIS primary article in the New England Journal of Medicine ( NEJM ). They write “Although in the publication of the SAMMPRIS trial the authors write that vessel size was not related to the risk of complications, there was a greater risk of ICH (10% versus 0%) if the prestent lesion diameter was …
Patent•
05 Jun 2012TL;DR: In this article, a system, method, computer-readable medium, apparatus, and device for simulating placement of an expandable device in a cavity is provided, where a 3D image of a tubular cavity geometry is acquired and a centerline of the cavity, and a perimeter of a cavity based on the centerline and the three-dimensional image of cavity geometry, is determined.
Abstract: A system, method, computer-readable medium, apparatus, and device for simulating placement of an expandable device in a cavity is provided. For example, a three or more dimensional image of a cavity, e.g., a tubular cavity, geometry is acquired. A centerline of the cavity, and a perimeter of the cavity based on the centerline of the cavity and the three-dimensional image of the cavity geometry, are determined. The length of a wire of the expandable device as the wire rotates along the perimeter of the cavity in a deployment direction is determined. A pitch of the rotation of the wire based on a local diameter at the centerline site of rotation and in-air parameters of the expandable device is determined. A deployed device length of the expandable device along the centerline of the cavity is determined. A processor is usable to determine and/or calculate each of the above.
DOI•
15 Dec 2012
TL;DR: Familiarity, ease of access, trust, and awareness will be important for the future.
Abstract: 目的总结采用血管内技术治疗急性缺血性卒中的有关证据并等级分类。方法对美国心脏协会（American Heart Association，AHA）以前发表的推荐意见进行审查并作为当前流程的基础。在此这基础上，进行系统的文献回顾以评估支持急性缺血性卒中血管内治疗的证据。根据AHA卒中委员会和牛津大学循证医学中心提出的循证医学证据分级指南进行评估。对操作安全性、技术效果以及对临床转归的影响进行特别审核。
Patent•
09 May 2012
TL;DR: In this article, an expandable member is inserted into the blood vessel to bring at least a portion of the member body into contact with the obstruction, and an outward radial force is exerted on the obstruction to dislodge at least one fragment from the obstruction.
Abstract: A method of increasing blood flow through an obstructed blood vessel includes providing an expandable member substantially made of a mesh having a plurality of interstices. The expandable member has a proximal member end and a distal member end spaced longitudinally apart by a tubular member body. The expandable member is substantially closed at the distal member end. The expandable member is inserted into the blood vessel. The expandable member is positioned within the blood vessel with the proximal member end upstream of the distal member end and the member body located radially adjacent atleast a portion of an obstruction. The expandable member is expanded to bring at least a portion of the member body into contact with the obstruction. An outward radial force is exerted on the obstruction to dislodge at least one fragment from the obstruction and to enhance blood flow through the blood vessel past the obstruction. The at least one fragment is passed through at least one interstice of the member body in the radial direction. The at least one fragment is selectively retained within the expandable member. An apparatus for increasing blood flow through an obstructed blood vessel is also provided.
TL;DR: A “real world” series of over 100 aneurysms and intracranial dissections treated with the Pipeline embolization device (PED) is presented.
Abstract: Henkes and his team present a “real world” series of over 100 aneurysms and intracranial dissections treated with the Pipeline embolization device (PED). These data provide
Journal Article•
TL;DR: These relationships of collaterals with hemodynamic impairment and other baseline variables were established across all anatomical distributions of intracranial stenosis.
Abstract: Background: Severe intracranial atherosclerosis, in excess of 70% luminal stenosis, is an established cause of recurrent stroke. Collateral circulation and the hemodynamic effects of such stenoses,...
TL;DR: Higher pre-treatment ASPECTS on CTA source images are associated with better outcomes following EVT, and Comparative studies with NCCT ASPECts are required to evaluate relative accuracy for patient selection.
Abstract: Introduction/purpose There is no standard imaging approach for EVT patient selection. CT remains the most widely used modality for stroke evaluation. Ischemic change on non-contrast CT (NCCT) quantified using ASPECTS has been demonstrated to predict clinical response to EVT. To date, definitive studies evaluating the impact of CTA source image (CTA-SI) pre-treatment ASPECTS (pre-ASPECTS) on outcomes following EVT are lacking. START was a prospective, multicenter study to evaluate the influence of pre-treatment core infarct size in patients undergoing endovascular stroke therapy using the Penumbra System. Materials and Methods The imaging method was at each center9s discretion and included NCCT, CTA-SI, CT perfusion, or MRI diffusion imaging. This study focused on the preliminary CTA-SI results. Results are reported from an interim analysis of the START trial data as adjudicated by a central Core Laboratory. Graded in a blinded fashion, ASPECTS was analyzed according to the a priori classification (0–4, 5–7, 8–10), as well as using the entire scale. Clinical outcomes were dichotomized as 90-day modified Rankin Scale scores of 0–2 (good) vs 3–6. Univariate and multivariate analyses were performed to determine predictors of outcome. Results Of the 147 patients enrolled, 77 met study criteria for this interim analysis. The mean age was 66.0±14.1 years; median NIHSS was 19 (14–24). Target vessel occlusions were in the ICA (22.1%), MCA (75.3%), and other (2.6%). The median pre-ASPECTS on CTA-SI was 6 (4–7). There were 20 (26%) patients with scores of 0–4, 43 (55.8%) with 5–7, 14 (18.2%) with 8–10. The rate of TIMI 2–3 revascularization was 85.3% (64/75). The median time from groin puncture to aspiration discontinuation was 71.5 (40–108) min. 37 (48.1%) patients achieved a good 90-day outcome. 22 (28.6%) died. Four (5.2%) patients suffered from symptomatic hemorrhage, and 11 (14.3%) suffered from asymptomatic hemorrhage. Higher pre-ASPECTS on CTA-SI was significantly associated with good outcomes (median 6 (IQR 5–7) vs 5 (IQR 3–7), p 4 was the optimal threshold for identifying good outcomes (89% sensitivity, 38% specificity). Other univariate predictors of good outcome were lower age (p=0.01), lower NIHSS (p=0.04), revascularization time (p Conclusion Higher pre-treatment ASPECTS on CTA source images are associated with better outcomes following EVT. Comparative studies with NCCT ASPECTS are required to evaluate relative accuracy for patient selection. Competing interests D Frei: None. A Yoo: None. D Heck: None. F Hellinger II: None. V McCollom: None. D Fiorella: None. A Turk III: None. T Malisch: None. O Zaidat: None. M Alexander: None. T Devlin: None. E Levy: None. Q Shah: None. F Hui: None. M Goyal: None. B Ghodke: None. A Shaibani: None. M Harrigan: None. T Jovin: None. M Madison: None. Z Chaudhry: None. R Gonzalez: None. L Barraza: Penumbra, Inc. S Sit: Penumbra, Inc. A Bose: Penumbra, Inc.
TL;DR: The introduction of permanent and then temporary stenting over the past decade has advanced the ability to revascularize occluded intracranial vessels efficiently in the setting of acute ischemic stroke and the existing data indicate that this stent-based approach to cerebral revascularization is superior to predicate devices.
Abstract: The introduction of permanent and then temporary stenting over the past decade has advanced our ability to revascularize occluded intracranial vessels efficiently in the setting of acute ischemic stroke. The existing data indicate that this stent-based approach to cerebral revascularization is superior to predicate devices.
The implantation of stents for the revascularization of large vessel occlusions in the setting of acute ischemic stroke was first described and advocated by Hopkins and Levy at the State University of New York at Buffalo.1–3 Their initial case reports and case series described the immediate and reliable revascularization of otherwise refractory intracranial occlusions with balloon-expandable coronary stents. This approach represented the beginning of a paradigm shift in the intra-arterial treatment of acute ischemic stroke.
As self-expanding intracranial aneurysm stents (Neuroform, Stryker Neurovascular, Kalamazoo, MI, USA; Enterprise, Codman & Shurtleff, Raynham, MA, USA) and the Wingspan stent (Stryker Neurovascular) became available in the USA in the early 2000s, the Buffalo group as well as Nelson and colleagues at NYU began to report individual cases of the application of these devices for the revascularization of refractory intracranial occlusions on an emergency basis.4–6 The more flexible and low profile self-expanding intracranial microstents provided a technically easier and less traumatic approach to stent revascularization and, for the most part, these devices supplanted the more rigid balloon-mounted stents for this purpose. Ultimately, larger case series were reported documenting the feasibility of this approach as well as relatively impressive outcomes despite its application as a bailout procedure employed as a last resort.6–8
While these microstents provided an efficient means of emergency revascularization, the approach also presented some significant practical and theoretical drawbacks:
1. Requirement for immediate peri-procedural as well as post-procedural antithrombotic medications. Approaches to stent-supported revascularization typically required intra-procedural IIb/IIIa inhibitors followed by post-procedural oral dual antiplatelet …
Journal Article•
TL;DR: The 30-day events in the SAMMPRIS trial were multi-factorial, with no single factor accounting for the majority of events and will need to address several different mechanisms for this procedure to be proven effective.
Abstract: Background: Enrollment in first multicenter, randomized trial of Stenting and Aggressive Medical Management for Prevention of Recurrent Ischemic Stroke (SAMMPRIS) was stopped early owing to an excess 30-day event rate in the stenting group relative to the medical arm and a futility analysis. The purpose of this study was to carefully examine the peri-procedural events that occurred in the trial and to correlate them with any baseline or procedural factors that might be associated with an increased risk for an adverse outcome. Methods: 224 of 451 patients were randomized to the stent arm. 33 suffered an independently-adjudicated endpoint event (stroke or death) within 30 days. The present analysis was limited to patients that underwent the complete per-protocol stenting procedure (n=209). 30 total endpoint events occurred in these 209 patients. Two asymptomatic hemorrhages also occurred and were included in the analysis of peri-procedural complications. Study records, including case report forms, procedural reports, and baseline and procedural imaging for these 32 patients were reviewed. 30-day events were further categorized as wire perforation, reperfusion hemorrhage, and thrombo-embolic ischemic stroke. The ischemic strokes were further categorized as perforator or embolic, based on imaging findings. Baseline and procedural factors in these patients were compared to the remaining 177 patients for predictors of the 30-day events. Results: There were seven wire perforations, six resulting in an endpoint. Five were subarachnoid hemorrhages (SAH). One was treated with nBCA and resulted in an ischemic stroke. One additional asymptomatic SAH occurred as a result of a wire perforation. Six intra-parenchymal hemorrhages (IPH) occurred. Five of the six were definitely delayed hours or days after a successful revascularization procedure, likely representing reperfusion hemorrhage. One was asymptomatic. The remaining 19 30-day endpoints were ischemic strokes. 12 were perforator strokes and seven were distal embolic. Two of these were related to delayed stent thrombosis days after the procedure. No correlation between operator experience or volume in the trial and 30-day events was found. Baseline risk factors and procedural factors were also not correlated with the risk for a procedural complication. Conclusions: The 30-day events in the SAMMPRIS trial were multi-factorial, with no single factor accounting for the majority of events. Further research on angioplasty and stenting for intracranial stenosis will need to address several different mechanisms for this procedure to be proven effective.
TL;DR: JNIS is the official journal of the Society of NeuroInterventional Surgery as well as the Neurointerventional Section of the Australian and New Zealand Society of Neuroradiology and boasts an article that has already been downloaded close to 6000 times (full text).
Abstract: In this environment of information overload, establishing a journal that represents the most current advances in a fast growing field can be quite difficult. Clinicians and researchers have a veritable plethora of options, as demonstrated by the rise in national and international journals available in print or electronic version. The decision to submit a manuscript to a specific journal is met usually with two simple questions of ‘Is it indexed?’ and ‘What is the impact factor?’ Although very valid questions, one might suggest that the TRUE reason for publication is to inform as many of your colleagues as possible about what you deem to be important in an honest, concise, and effective format, thereby contributing to the repository of knowledge such that it moves the field forward.
In 2009, the Society of NeuroInterventional Surgery (SNIS) launched its flagship journal. SNIS chose the BMJ Group as its publisher, which meant that the journal had a readymade audience beyond SNIS membership as it is packaged as part of the subscription to Journal of Neurology, Neurosurgery and Psychiatry . It also provided a streamlined author submission system and a sophisticated online publication platform. The response and subsequent development has been exceptional. Three short years later, JNIS has evolved from a semi-annual publication in its first year to a quarterly in its second year. In January of 2012, JNIS moved to its current bimonthly publication schedule. JNIS is also the official journal of the Society of Vascular Interventional Neurology as well as the Neurointerventional Section of the Australian and New Zealand Society of Neuroradiology.
The journal boasts an article that has already been downloaded close to 6000 times (full text) as well as an …
Journal Article•
TL;DR: The SAMMPRIS protocol resulted in major improvements in controlling most risk factors within 30 days of enrollment, which may have contributed to the lower than expected 30 day stroke rate in the medical group.
Abstract: Purpose: SAMMPRIS is the first stroke prevention trial to include protocol-driven aggressive management of multiple vascular risk factors. We sought to determine the impact of this protocol on early risk factor control in the trial. Materials and Methods: SAMMPRIS randomized 451 patients with symptomatic 70%-99% intracranial stenosis to aggressive medical management or stenting plus aggressive medical management at 50 USA sites. For the primary risk factor targets (SBP Results: The differences in risk factor measures between baseline and 30 days are shown in Table 1. Conclusions: The SAMMPRIS protocol resulted in major improvements in controlling most risk factors within 30 days of enrollment, which may have contributed to the lower than expected 30 day stroke rate in the medical group (5.8%). However, the durability of this approach over time will be determined by additional follow-up.
TL;DR: The initial preclinical experience with the Pulsar Vascular Aneurysm Neck Reconstruction Device (PVANRD) in a canine bifurcation model is described and it is shown that the PVANRD is a novel b ifurcation stent that facilitates treatment of wide necked bifURcation aneurysms compared with currently available adjunctive devices.
Abstract: Introduction Treatment of wide necked bifurcation aneurysms often poses procedural and long-term outcome challenges. We describe the initial preclinical experience with the Pulsar Vascular Aneurysm Neck Reconstruction Device (PVANRD) in a canine bifurcation model. Methods Experimental bifurcation vein pouch aneurysms were surgically created in the carotid arteries of eight canines. Endovascular coiling of the aneurysms with assistance of the PVANRD was performed in all cases with acute performance compared to Y-stenting. Results 12 devices were deployed in the eight cases. Device deployment was straightforward and successfully protected the parent artery and maintained patency of the bifurcation in all cases, despite the use of oversized coils. Conclusion The PVANRD is a novel bifurcation stent that facilitates treatment of wide necked bifurcation aneurysms compared with currently available adjunctive devices. Competing interests A Turk: Pulsar Vascular. S Tateshima: None. M Chaudry: None. D Fiorella: None. R Turner: None. M Kelly: None.Abstract E-019 Figure 1
TL;DR: This paper was a highly-focused empirical exercise to determine, based on morphology alone, the potential for endoluminal implants for treatment of aneurysms.
Abstract: We greatly appreciate the input by Dr Hirsch and colleagues.1 Our paper was a highly-focused empirical exercise to determine, based on morphology alone, the potential for endoluminal implants for treatment of aneurysms. There are myriad additional factors that, without question, will affect the appropriateness of …