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An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms
Key point: To compare endovascular coiling with microsurgical clipping among adults with unruptured middle cerebral artery aneurysms (MCAA) by conducting a meta-analysis. The widespread use of neurovascular imaging has increased the amount of intracranial aneurysms eccidentally detected. Although the lifetime risk of aneurysmal rupture in many cases is relatively small (approximately 1% per year), rupture Read more about An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms[…]
DAWN trial: solution or problem?
Key point: To assess the mean score for disability on the utility-weighted modified Rankin scale and the rate of functional independence (mRS≤2) at 90 days. The main results of the “magnificent seven” (MR-CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE, THERAPY) regarding stroke therapy showed that endovascular thrombectomy had a clinical benefit when it was performed within Read more about DAWN trial: solution or problem?[…]
Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis
Key point: To compare outcomes of stroke patients receiving GA and CS/local anesthesia during the procedure. Despite recently published trials showed the sizeable treatment effect of the endovascular mechanical thrombectomy, several studies suggest that the choice of anesthetic management during the endovascular recanalization procedure may have a substantial effect on patient outcomes. Preliminary retrospective observational Read more about Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis[…]
Sex, Smoking, and Risk for Subarachnoid Hemorrhage
Key points: According to prospective cohort studies, smoking is the most important risk factor for unruptured intracranial aneurysms, correlating with their appearance, growth and rupture. In addition, earlier studies report that women are at higher risk for SAH with adjusted hazard ratios (HRs) from 1.4 to 1.9 compared with men. In this paper, published August, 2016, Read more about Sex, Smoking, and Risk for Subarachnoid Hemorrhage[…]
Happy Easter – Smiling Aneurysm
Happy Easter from Neurovascolare Team. Francesco Diana, M.D. Francesco Biraschi, M.D. Simone Peschillo, M.D., Ph.D.
A raised bar for aneurysm surgery in the endovascular era
Key points: Despite microsurgical treatment of cerebral aneurysms has a documented history, the impressive progression of endovascular technology, techniques and skills, and the results of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT) has altered the paradigm for treating intracranial aneurysms. These neurointerventional option have raised the bar for aneurysm surgery, in an era when most Read more about A raised bar for aneurysm surgery in the endovascular era[…]
Collateral leptomeningeal arteries: where are the anastomosis?
Key point: More than 300 years ago, Willis T. characterized the arterial ring at the base of the brain and began debate concerning whether the circle functions primarily as a flow equalizer or as an anastomosis. Heubner O., in 1874, was the first to produce a well-documented study demonstrating the existence of LMA; he was trying to Read more about Collateral leptomeningeal arteries: where are the anastomosis?[…]
The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis
Key points: The role of angiography in the diagnosis of primary central nervous system vasculitis (PCNSV) emerged in the mid-1960, when were recognized recurring but not specific angiographic pattens in the inflammatory conditions of the CNS. However the comprehension of the role of DSA in this cases was made difficult by the lack of a Read more about The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis[…]
Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology
Key points: Conventional techniques for imaging the intracranial arteries can fail to fully characterize disease that resides within the vessel wall. For this reason, there is growing interest in direct visualization of the vessel wall with high-resolution intracranial vessel wall MR imaging (VW-MR imaging). The principal technical requirements for intracranial VW-MR imaging are the following: Clinical Read more about Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology[…]
Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes
Key points: Nowadays there are a number of trials that have shown improved outcomes following endovascular therapy for LVO strokes compared with standard therapies alone, but only a little number of patients is treated without prior IV recombinant tissue plasminogen activator (rt-PA). For this reason the question of whether previous IV rt-PA really help the Read more about Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes[…]