Journal of neurointerventional surgery
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The artery of Percheron (AOP) is a rare anatomic variant of the paramedian thalamic-mesencephalic arterial supply, arising as a solitary arterial trunk from the P1 segment of the posterior cerebral artery. Its occlusion, commonly caused by cardioembolism, leads to distal bilateral paramedian thalamic ischemia, oftentimes affecting the midbrain and/or the anterior thalamus. AOP occlusion presents with a clinical triad of altered mental status, vertical gaze palsy, and memory impairment, along with other associated symptoms. ⋯ Our extensive literature search sought to determine the best forms of treatment for uncomplicated AOP occlusion, with the inclusion criterion of implementation of medical treatment or other forms of therapy in patient recovery from this condition. We conclude that intravenous heparin and thrombolysis with tissue plasminogen activator are effective firstline treatment options for emergent AOP occlusion followed by a prescription of long term anticoagulants, while non-emergent cases without midbrain involvement could be treated through rehabilitation and continual monitoring by medical staff. Clinical trials of higher power are needed for a more comprehensive analysis of the treatment options for AOP occlusion.
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Meta Analysis
A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke.
A recent randomized controlled trial (RCT), the Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN), demonstrated better outcomes with endovascular treatment compared with medical therapy for acute ischemic stroke (AIS). However, previous trials have provided mixed results regarding the efficacy of endovascular treatment for AIS. A meta-analysis of all available trial data was performed to summarize the available evidence. ⋯ A meta-analysis of prospective RCTs comparing endovascular therapies with medical management demonstrates superior outcomes in patients randomized to endovascular therapy.
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In a swine stroke model we have previously demonstrated a high-intensity fluid attenuated inversion recovery (FLAIR) signal representing the erythrocyte component of the clot. We hypothesized that the intensity of the FLAIR clot signal in patients with acute stroke may predict the efficacy of recanalization by thrombectomy devices. In this study we compared the pretreatment FLAIR signal intensity of the clots in the distal internal carotid artery (ICA) and the degree of angiographic recanalization rate after mechanical thrombectomy. ⋯ High signal intensity on FLAIR clot imaging may predict successful recanalization after endovascular therapy for ICA-T occlusion.
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As the use of the Pipeline Embolization Device (PED) for the treatment of complex intracranial aneurysms rises, knowledge about complications continues to accumulate amidt a paucity of reports on techniques and rescue strategies. We describe the case of a 70-year-old woman who presented with worsening reto-orbital left-sided pain and a large cavernous aneurysm. The patient underwent endovascular treatment with PED, and there was difficulty delivering the device due to significant vascular tortuosity. ⋯ We were finally able to rescue the device and open its proximal end with balloon inflation after using a contralateral trans-anterior communicating artery approach and crossing the PED in a retrograde fashion. Excessive vascular tortuosity poses a genuine risk of PED malfunction and poor deployment. Although we were able to rescue the device and our patient had no permanent morbidity, difficult vascular anatomy rendered the procedure extremely complicated with dreaded complications.