AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Oct 2013
Multicenter StudySpinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers.
Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity with progressive spinal cord symptoms. The aim of this study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas that were primarily treated with endovascular embolization. ⋯ We conclude that endovascular treatment of spinal dural arteriovenous fistulas can result in good clinical outcomes. Surgery remains the treatment of choice when safe embolization of the proximal radicular draining vein cannot be obtained or because the shunting artery of the spinal dural arteriovenous fistula also supplies the anterior spinal, posterior spinal, or a radiculomedullary artery.
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AJNR Am J Neuroradiol · Oct 2013
Clinical TrialIntracranial 4D flow MRI: toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes.
Arteriovenous malformations are an important etiology of hemorrhagic stroke. However, current imaging modalities and risk do not provide insights into individual AVM hemodynamics and its role in pathophysiology. The aims of this study are to determine whether intracranial 4D flow MR imaging can provide insights into arteriovenous malformation hemodynamics independent of the Spetzler-Martin grade and to report the changes in flow observed during staged embolization. ⋯ Spetzler-Martin grade does not reflect differences in 3D AVM arterial and venous hemodynamics, and an individual assessment of AVM hemodynamics may be needed for improved lesion characterization. Four-dimensional flow MR imaging may have the potential to monitor and guide embolization treatment planning.
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AJNR Am J Neuroradiol · Oct 2013
Case ReportsStent retriever use for retrieval of displaced microcoils: a consecutive case series.
Coil displacement during endovascular coiling procedures may require coil retrieval in the context of flow limitation or thromboembolic risk. No standard recommended method of coil retrieval exists. ⋯ Two illustrative cases from the 14 are described, and technical notes are detailed regarding use of the technique. The use of stent retrievers presents a simple, safe, and effective choice for removal of prolapsed coils during aneurysm coiling.
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AJNR Am J Neuroradiol · Oct 2013
Radiation dose for 345 CT-guided interlaminar lumbar epidural steroid injections.
CT guidance is increasingly being used to localize the epidural space during epidural steroid injections. A common concern is that CT may be associated with significantly higher radiation doses compared with conventional fluoroscopy. The goal of this retrospective study was to determine the average dose-length product and effective dose delivered while interlaminar epidural steroid injections are performed and allow comparison with other modalities. ⋯ The use of a stationary table and an intermittent scanning technique allow for short procedures and doses that are significantly lower than those of conventional diagnostic CT scans. Furthermore, because CT dose index overestimates radiation dose in stationary table procedures, the actual radiation dose may be even lower than stated here.
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AJNR Am J Neuroradiol · Oct 2013
Comparative StudyStent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes.
Stent-assisted coiling and balloon-assisted coiling are 2 well-established techniques for treatment of wide-neck intracranial aneurysms. A direct comparative analysis of angiographic outcomes with the 2 techniques has not been available. We compare the angiographic outcomes of wide-neck aneurysms treated with stent-assisted coiling versus balloon-assisted coiling. ⋯ Stent-assisted coiling may yield lower rates of retreatment and higher rates of aneurysm obliteration and progression of occlusion at follow-up than balloon-assisted coiling with a similar morbidity rate.