Journal of neurointerventional surgery
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Review Meta Analysis
Seizure control for intracranial arteriovenous malformations is directly related to treatment modality: a meta-analysis.
Seizures are a common presenting sign of intracranial arteriovenous malformations (AVMs). The object of this meta-analysis was to determine if the modality selected to treat AVMs affects the rate of seizure outcomes. ⋯ This is the first meta-analysis designed to study relative rates of seizure outcomes following the currently utilized AVM treatment modalities. In general, MS results in the highest proportion of seizure control. However, if SRS results in successful obliteration of the AVM, then this modality is the most effective in achieving seizure control.
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Outcomes from endovascular therapy for acute stroke are time dependent. Delays in the administration of this therapy have not been extensively studied and no performance benchmarks have been established. There are limited data on the complex factors that can affect these delays. ⋯ Some of these factors are common to intravenous thrombolysis; in addition, there are some that are unique to endovascular therapy. These include the awareness of the first responders, emergency medical services, interhospital transfer and triage systems, activation of the endovascular team, complex imaging decisions, and intraprocedural delays. A thorough understanding of these delays can help identify areas of improvement which may affect clinical outcomes.
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Migration of a coil during endovascular treatment of intracranial aneurysm occurs in 2-6% of cases. The consequences of coil migration vary significantly from minor flow alterations of the parent artery which are asymptomatic to thromboembolic occlusion of major intracranial vessels resulting in large territory infarcts. We performed a comprehensive literature review and identified 37 reported cases of migrated coil retrieval consisting of 10 case reports and six case series. ⋯ The endovascular treatment approaches were coil embolization alone (57%), stent-assisted coiling (26%) and balloon remodeling (17%). Endovascular retrieval was performed with microwires, the Alligator Retrieval device, Merci devices, snares and stentrievers. There was a single report of microsurgical extraction following failed endovascular removal and three cases of coil fracture in which the coil fragments were secured to the vessel walls with stents.
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Treatment of non-saccular vertebrobasilar aneurysms remains highly challenging despite significant recent advances in endovascular techniques. Establishing the natural history of this heterogeneous disease, as best as currently available data allows, is crucial to help guide counseling and management. ⋯ Initial clinical presentation is a strong predictor of subsequent disease course. Although overall prognosis is poor, nearly half of all deaths resulted from non-neurologic causes, underscoring the importance of comprehensive medical management. Aneurysms characterized by expansion, established mass effect, or hemorrhage have a poor natural history, and may be considered for invasive treatment, which is increasingly endovascular in nature. Lesions presenting with ischemia or incidentally are likely best addressed with aggressive neurologic and overall medical management.