Journal of neurosurgery
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Journal of neurosurgery · Sep 2013
Randomized Controlled Trial Comparative StudyIncidence of embolism associated with carotid artery stenting: open-cell versus closed-cell stents.
Carotid artery stenting (CAS) can be an alternative option for carotid endarterectomy in the prevention of ischemic stroke caused by carotid artery stenosis. The purpose of this study was to evaluate the influence of stent design on the incidence of procedural and postprocedural embolism associated with CAS treatment. ⋯ Stent design may have an influence on the risk of new embolism, and selecting the appropriate stent may improve outcome.
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Journal of neurosurgery · Sep 2013
Randomized Controlled TrialUse of the intrathoracic pressure regulator to lower intracranial pressure in patients with altered intracranial elastance: a pilot study.
The intrathoracic pressure regulator (ITPR) is a novel noninvasive device designed to increase circulation and blood pressure. By applying negative pressure during the expiratory phase of ventilation it decreases intrathoracic pressure and enhances venous return, which increases cardiac output. It is possible that the ITPR may both decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in brain-injured patients by decreasing cerebral venous blood volume and increasing cardiac output. The authors conducted an open-label, "first-in-humans" study of the ITPR in patients with an ICP monitor or external ventricular drain and altered intracranial elastance. ⋯ This pilot study demonstrates that use of the ITPR in patients with altered intracranial elastance is feasible. Although this study was not powered to demonstrate efficacy, these data strongly suggest that the ITPR may be used to rapidly lower ICP and increase CPP without apparent adverse effects. Additional studies will be needed to assess longitudinal changes in ICP when the device is in use and to delineate treatment parameters.