Journal ArticleTransl Stroke Res · October 2024
Maladaptive inflammation underlies the formation and rupture of human intracranial aneurysms. There is a growing body of evidence that anti-inflammatory pharmaceuticals may beneficially modulate this process. Clopidogrel (Plavix) is a commonly used irrever ...
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Journal ArticleJ Stroke Cerebrovasc Dis · May 2024
BACKGROUND: Intracranial artery atherosclerotic stenosis (ICAS) is a major cause of stroke, especially in Asian countries. Current treatment options, including balloon-mounted stent (BMS) and balloon angioplasty (BA), lack sufficient evidence to determine ...
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Journal ArticleTransl Stroke Res · April 2024
Serum interleukin-1 (IL-1) are possibly indicative of the inflammation in the intracranial aneurysm (IA) wall. This study aimed to investigate whether IL-1 could discriminate the unstable IAs (ruptured intracranial aneurysms (RIAs) and symptomatic unruptur ...
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Journal ArticleJ Am Heart Assoc · March 19, 2024
BACKGROUND: Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient g ...
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Journal ArticleJ Neurol Neurosurg Psychiatry · February 14, 2024
BACKGROUND: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya ...
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Journal ArticleTransl Stroke Res · December 2023
Near-infrared laser therapy, a special form of transcranial light therapy, has been tested as an acute stroke therapy in three large clinical trials. While the NEST trials failed to show the efficacy of light therapy in human stroke patients, there are man ...
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Journal ArticleJ Neurointerv Surg · November 24, 2023
BACKGROUND: Carotid artery intraluminal thrombus (ILT), or free-floating thrombus, is an uncommon cerebrovascular entity with considerable equipoise regarding its clinical management. Likewise, in patients treated with medical management (MM), distal embol ...
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Journal ArticleTransl Stroke Res · October 19, 2023
Cerebral cavernous malformation (CCM), either sporadic or familial, is a devastating vascular malformation affecting the central nervous system that can present with intracerebral hemorrhage, seizure, and new focal neurologic deficits resulting in substant ...
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Journal ArticleNeurosurg Rev · October 3, 2023
Chronic subdural hematoma (cSDH) is common among the elderly, with surgical evacuation as a prevalent treatment, facing recurrence rates up to 30%. Recently, middle meningeal artery embolization (MMAE) has emerged as a promising approach, offering reduced ...
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Journal ArticleInterv Neuroradiol · October 2023
INTRODUCTION: Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic r ...
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Journal ArticleJ Neurointerv Surg · August 2023
BACKGROUND: Aneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively. OBJECTIVE: To use a new quantitative tool ...
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Journal ArticleStroke · July 2023
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke frequently affecting young to middle-aged adults, with an unmet need to improve outcome. This special report focusses on the development of intrathecal haptoglobin supplementation as ...
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Journal ArticleRedox Biol · June 2023
Ferumoxytol (FMX) is an FDA-approved magnetite (Fe3O4) nanoparticle used to treat iron deficiency anemia that can also be used as an MR imaging agent in patients that can't receive gadolinium. Pharmacological ascorbate (P-AscH-; IV delivery; plasma levels ...
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Journal ArticleJ Neurosurg · March 1, 2023
OBJECTIVE: Endovascular electroencephalography (evEEG) uses the cerebrovascular system to record electrical activity from adjacent neural structures. The safety, feasibility, and efficacy of using the Woven EndoBridge Aneurysm Embolization System (WEB) for ...
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Journal ArticleActa Neurochir (Wien) · February 2023
OBJECTIVE: Brain aneurysms comprise different compartments that undergo unique biological processes. A detailed multimodal analysis incorporating 3D aneurysm wall enhancement (AWE), computational fluid dynamics (CFD), and finite element analysis (FEA) data ...
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Journal ArticleInterv Neuroradiol · August 2022
OBJECTIVE: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic manage ...
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Journal ArticleTransl Stroke Res · August 2022
Current MR-vessel wall imaging (VWI) of unruptured intracranial aneurysms (UIAs) permits the visualization of wall structures. Aneurysm wall enhancement (AWE) was associated with atherosclerotic remodeling of the aneurysm wall accompanied by infiltration o ...
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Journal ArticleTransl Stroke Res · October 2024
Maladaptive inflammation underlies the formation and rupture of human intracranial aneurysms. There is a growing body of evidence that anti-inflammatory pharmaceuticals may beneficially modulate this process. Clopidogrel (Plavix) is a commonly used irrever ...
Full textLink to itemCite
Journal ArticleJ Stroke Cerebrovasc Dis · May 2024
BACKGROUND: Intracranial artery atherosclerotic stenosis (ICAS) is a major cause of stroke, especially in Asian countries. Current treatment options, including balloon-mounted stent (BMS) and balloon angioplasty (BA), lack sufficient evidence to determine ...
Full textLink to itemCite
Journal ArticleTransl Stroke Res · April 2024
Serum interleukin-1 (IL-1) are possibly indicative of the inflammation in the intracranial aneurysm (IA) wall. This study aimed to investigate whether IL-1 could discriminate the unstable IAs (ruptured intracranial aneurysms (RIAs) and symptomatic unruptur ...
Full textLink to itemCite
Journal ArticleJ Am Heart Assoc · March 19, 2024
BACKGROUND: Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient g ...
Full textLink to itemCite
Journal ArticleJ Neurol Neurosurg Psychiatry · February 14, 2024
BACKGROUND: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya ...
Full textLink to itemCite
Journal ArticleTransl Stroke Res · December 2023
Near-infrared laser therapy, a special form of transcranial light therapy, has been tested as an acute stroke therapy in three large clinical trials. While the NEST trials failed to show the efficacy of light therapy in human stroke patients, there are man ...
Full textLink to itemCite
Journal ArticleJ Neurointerv Surg · November 24, 2023
BACKGROUND: Carotid artery intraluminal thrombus (ILT), or free-floating thrombus, is an uncommon cerebrovascular entity with considerable equipoise regarding its clinical management. Likewise, in patients treated with medical management (MM), distal embol ...
Full textLink to itemCite
Journal ArticleTransl Stroke Res · October 19, 2023
Cerebral cavernous malformation (CCM), either sporadic or familial, is a devastating vascular malformation affecting the central nervous system that can present with intracerebral hemorrhage, seizure, and new focal neurologic deficits resulting in substant ...
Full textLink to itemCite
Journal ArticleNeurosurg Rev · October 3, 2023
Chronic subdural hematoma (cSDH) is common among the elderly, with surgical evacuation as a prevalent treatment, facing recurrence rates up to 30%. Recently, middle meningeal artery embolization (MMAE) has emerged as a promising approach, offering reduced ...
Full textLink to itemCite
Journal ArticleInterv Neuroradiol · October 2023
INTRODUCTION: Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic r ...
Full textLink to itemCite
Journal ArticleJ Neurointerv Surg · August 2023
BACKGROUND: Aneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively. OBJECTIVE: To use a new quantitative tool ...
Full textLink to itemCite
Journal ArticleStroke · July 2023
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke frequently affecting young to middle-aged adults, with an unmet need to improve outcome. This special report focusses on the development of intrathecal haptoglobin supplementation as ...
Full textLink to itemCite
Journal ArticleRedox Biol · June 2023
Ferumoxytol (FMX) is an FDA-approved magnetite (Fe3O4) nanoparticle used to treat iron deficiency anemia that can also be used as an MR imaging agent in patients that can't receive gadolinium. Pharmacological ascorbate (P-AscH-; IV delivery; plasma levels ...
Full textLink to itemCite
Journal ArticleJ Neurosurg · March 1, 2023
OBJECTIVE: Endovascular electroencephalography (evEEG) uses the cerebrovascular system to record electrical activity from adjacent neural structures. The safety, feasibility, and efficacy of using the Woven EndoBridge Aneurysm Embolization System (WEB) for ...
Full textLink to itemCite
Journal ArticleActa Neurochir (Wien) · February 2023
OBJECTIVE: Brain aneurysms comprise different compartments that undergo unique biological processes. A detailed multimodal analysis incorporating 3D aneurysm wall enhancement (AWE), computational fluid dynamics (CFD), and finite element analysis (FEA) data ...
Full textLink to itemCite
Journal ArticleInterv Neuroradiol · August 2022
OBJECTIVE: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic manage ...
Full textLink to itemCite
Journal ArticleTransl Stroke Res · August 2022
Current MR-vessel wall imaging (VWI) of unruptured intracranial aneurysms (UIAs) permits the visualization of wall structures. Aneurysm wall enhancement (AWE) was associated with atherosclerotic remodeling of the aneurysm wall accompanied by infiltration o ...
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Journal ArticleNeurosurgery · May 1, 2022
BACKGROUND: The anterior communicating artery (AcoA) is the most common location for intracranial aneurysms. OBJECTIVE: To present occlusion outcomes, complication rate, recurrence rate, and predictors of recurrence in a large cohort with AcoA aneurysms tr ...
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Journal ArticleJ Neurosurg · May 1, 2022
OBJECTIVE: Wide-neck bifurcation cerebral aneurysms have historically required either clip ligation or stent- or balloon-assisted coil embolization. This predicament led to the development of the Woven EndoBridge (WEB) aneurysm embolization system, a self- ...
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Journal ArticleNeurosurg Rev · April 2022
The Woven EndoBridge (WEB) device is becoming increasingly popular for treatment of wide-neck aneurysms. As experience with this device grows, it is important to identify factors associated with occlusion following WEB treatment to guide decision making an ...
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Journal ArticleJ Neurosurg · April 1, 2022
OBJECTIVE: There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In ...
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Journal ArticleJ Neurosurg · April 1, 2022
OBJECTIVE: Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. To address this challenge, investigators with an established record of dAVF investigation formed an international, multic ...
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Journal ArticleJ Neurosurg · April 1, 2022
OBJECTIVE: Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reporte ...
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Journal ArticleJ Neurosurg · April 1, 2022
OBJECTIVE: The risk-to-benefit profile of treating an unruptured high-grade dural arteriovenous fistula (dAVF) is not clearly defined. The aim of this multicenter retrospective cohort study was to compare the outcomes of different interventions with observ ...
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Journal ArticleJ Neurosurg · April 1, 2022
OBJECTIVE: Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) without cortical venous drainage (CVD) have a benign clinical course. However, no large study has evaluated the safety and efficacy of current treatments and their ...
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Journal ArticleFrontiers in Neurology · December 10, 2021
Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relat ...
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Journal ArticleStroke · December 2021
BACKGROUND AND PURPOSE: Microthrombosis could play a role in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Tirofiban has shown promising results in reducing delayed cerebral ischemia in retrospective studies. However, the safety of us ...
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Journal ArticleClin Neurol Neurosurg · December 2021
Edema coursing the optic apparatus has traditionally been associated with sellar and para-sellar tumors. However, postoperative aneurysmal volume expansion following endovascular treatment has been reported to induce cranial neuropathies, such as vision lo ...
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Journal ArticleNeuroradiol J · December 2021
OBJECTIVES: High-resolution magnetic resonance imaging has the potential of characterising arterial wall changes after endovascular mechanical thrombectomy. The purpose of this study is to evaluate high-resolution magnetic resonance imaging features of lar ...
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Journal ArticleJ Neurointerv Surg · December 2021
BACKGROUND: Intracranial fusiform aneurysms are complex and poorly characterized vascular lesions. High-resolution magnetic resonance imaging (HR-MRI) and computational morphological analysis may be used to characterize cerebral fusiform aneurysms. OBJECTI ...
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Journal ArticleClin Neurol Neurosurg · November 2021
BACKGROUND: Delayed cerebral ischemia (DCI) is a cause of morbidity associated with aneurysmal subarachnoid hemorrhage (aSAH). Neuroinflammation contributes to the development of DCI. Melatonin is a sleep-promoting hormone known to have cerebral anti-infla ...
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Journal ArticleWorld Neurosurg · October 2021
BACKGROUND: Renal cell carcinoma with metastases to the spine (RCCMS) requires a multidisciplinary approach. We reviewed our institutional experience with RCCMS patients undergoing spinal surgery in order to identify factors that may affect clinical outcom ...
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Journal ArticleNeurosurgery · September 15, 2021
BACKGROUND: High-resolution vessel wall imaging plays an increasingly important role in assessing the risk of aneurysm rupture. OBJECTIVE: To introduce an approach toward the validation of the wall enhancement as a direct surrogate parameter for aneurysm s ...
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Journal ArticleSci Rep · September 15, 2021
Aneurysm wall enhancement (AWE) after the administration of contrast gadolinium is a potential biomarker of unstable intracranial aneurysms. While most studies determine AWE subjectively, this study comprehensively quantified AWE in 3D imaging using a semi ...
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Journal ArticleWorld Neurosurg · September 2021
OBJECTIVE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a pressing public health issue. Although most cases do not result in severe illness requiring hospitalization, there is increasing evidence that SARS-CoV-2-induced infl ...
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Journal ArticleJ Am Heart Assoc · August 3, 2021
Delayed cerebral ischemia is a major predictor of poor outcomes in patients who suffer subarachnoid hemorrhage. Treatment options are limited and often ineffective despite many years of investigation and clinical trials. Modern advances in basic science ha ...
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Journal ArticleDiagnostics · August 1, 2021
The rupture of an intracranial aneurysm (IA) causes devastating hemorrhagic strokes. Yet, most IAs remain asymptomatic and undetected until they rupture. In the search for circulating biomarkers of unruptured IAs, we previously performed transcriptome prof ...
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Journal ArticleNeuroradiology · August 2021
PURPOSE: Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embo ...
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Journal ArticleStroke · April 2021
BACKGROUND AND PURPOSE: Atherosclerotic remodeling of the aneurysm wall, which could be detected as aneurysm wall enhancement (AWE) by magnetic resonance-vessel wall imaging, is a part of degenerative change of unruptured intracranial aneurysms (UIAs). The ...
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Journal ArticleStroke · March 2021
BACKGROUND AND PURPOSE: Decompressive hemicraniectomy has been used to treat spontaneous intracerebral hemorrhage, but the benefit of evacuating the hematoma during the procedure is unclear. We aim to evaluate the utility of performing clot evacuation duri ...
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Journal ArticleAJNR Am J Neuroradiol · March 2021
BACKGROUND AND PURPOSE: Aneurysm wall enhancement has been proposed as a biomarker for inflammation and instability. However, the mechanisms of aneurysm wall enhancement remain unclear. We used 7T MR imaging to determine the effect of flow in different reg ...
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Journal ArticleJ Neurosurg · March 1, 2021
OBJECTIVE: External ventricular drain (EVD) placement is a common neurosurgical procedure. While this procedure is simple and effective, infection is a major limiting factor. Factors predictive of infection reported in the literature are not conclusive. Th ...
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Journal ArticleJ Neurosurg · March 1, 2021
OBJECTIVE: Inflammation plays an integral role in the formation, growth, and progression to rupture of unruptured intracranial aneurysms (UIAs). Animal and human studies have suggested that, due to its antiinflammatory effect, aspirin (ASA) may decrease th ...
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Journal ArticleJ Neurosurg · March 1, 2021
OBJECTIVE: High-resolution vessel wall imaging (HR-VWI) has emerged as a valuable tool in assessing unruptured intracranial aneurysms (UIAs). There is no standardized method to quantify contrast enhancement of the aneurysm wall. Contrast enhancement can be ...
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Journal ArticleWorld Neurosurg · March 2021
OBJECTIVE: To correlate the presence of objectively measured wall enhancement on high-resolution vessel wall imaging (HR-VWI) with the clinical predictive scales PHASES, ELAPSS, and UIATS. METHODS: Patients with unruptured intracranial aneurysm (UIAs) pros ...
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Journal ArticleOper Neurosurg (Hagerstown) · January 13, 2021
BACKGROUND: Hemorrhage is one of the most feared complications following ventriculostomy placement. Current studies have assessed factors associated with increased risk of ventriculostomy-related hemorrhage (VRH). However, the clinical significance of VRH ...
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Journal ArticleRoyal Society Open Science · January 1, 2021
Vessel wall enhancement (VWE) in contrast-enhanced magnetic resonance imaging (MRI) is a potential biomarker for intracranial aneurysm (IA) risk stratification. In this study, we investigated the relationship between VWE features, risk metrics, morphology ...
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Conference2021 IEEE International Symposium on Antennas and Propagation and North American Radio Science Meeting, APS/URSI 2021 - Proceedings · January 1, 2021
Deep brain stimulation is a multipurpose therapy indicated for a host of neuropsychiatric disorders including treatment resistant depression, Parkinson's disease, and refractory epilepsy. However, current systems require invasive surgery and have a high ri ...
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Journal ArticleInterv Neuroradiol · December 2020
OBJECTIVE: The Woven EndoBridge (WEB) device can be used for complex intracranial aneurysms (IAs), mostly under general anesthesia (GA). However, it remains controversial if anesthetic management could affect procedural outcomes after endovascular treatmen ...
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Journal ArticleHosp Pract (1995) · December 2020
BACKGROUND/OBJECTIVE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) may be at risk for complications related to excessive environmental noise. Our ICU utilizes a variety of universal interventions to minimize ambient noise levels, but patients wi ...
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Journal ArticleStroke · December 2020
BACKGROUND AND PURPOSE: High-resolution vessel wall imaging (HR-VWI) is a powerful tool in diagnosing intracranial vasculopathies not detected on routine imaging. We hypothesized that 7T HR-VWI may detect the presence of atherosclerotic plaques in patients ...
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Journal ArticleJ Neurosurg · November 1, 2020
OBJECTIVE: Aspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors' goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm. METHO ...
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Journal ArticleJ Stroke Cerebrovasc Dis · November 2020
BACKGROUND AND PURPOSE: Prior literature suggests after-hours delay leads to poor functional outcomes in stroke patients undergoing thrombectomy. We aimed to evaluate the impact of time of presentation on mechanical thrombectomy (MT) metrics and its associ ...
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Journal ArticleFrontiers in Neurology · October 22, 2020
Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonst ...
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Journal ArticleNeurosurgery · October 15, 2020
BACKGROUND: There has not been any effective prophylaxis for delayed cerebral ischemia delayed cerebral ischemia (DCI) since the introduction of nimodipine. Platelet inhibition may reduce the risk by preventing the formation of microthrombi. Tirofiban has ...
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Journal ArticleAJNR Am J Neuroradiol · October 2020
BACKGROUND AND PURPOSE: There is mounting evidence supporting the benefit of intra-arterial administration of vasodilators in diagnosing reversible cerebral vasoconstriction syndrome. We prospectively quantified the degree of luminal diameter dilation afte ...
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Journal ArticleJ Neurosurg · October 1, 2020
OBJECTIVE: Differences in clinical outcomes between centers and countries may reflect variation in patient characteristics, diagnostic and therapeutic policies, or quality of care. The purpose of this study was to investigate the presence and magnitude of ...
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Journal ArticleWorld Neurosurg · October 2020
BACKGROUND: Contrast-induced neurotoxicity (CIN) is an infrequent complication of endovascular procedures, and its understanding remains poor. We aimed to study and characterize the clinical and imaging features of a case series of CIN after neurointervent ...
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Journal ArticleJ Clin Neurosci · October 2020
The Woven Endobridge (WEB, Sequent Medical, Aliso Viejo, California) device has emerged as an FDA approved endosaccular flow diverting alternative for patients with complex aneurysm morphology. We describe for the first time, in patients with dual anti pla ...
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Journal ArticleJ Neurointerv Surg · October 2020
BACKGROUND: Inflammation of the arterial wall may lead to aneurysm formation. The presence of aneurysm enhancement on high-resolution vessel wall imaging (HR-VWI) is a marker of wall inflammation and instability. We aim to determine if there is any associa ...
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Journal ArticleOper Neurosurg (Hagerstown) · September 15, 2020
BACKGROUND: The femoral artery is the most common access route for cerebral angiography and neurointerventional procedures. Complications of the transfemoral approach include groin hemorrhages and hematomas, retroperitoneal hematomas, pseudoaneurysms, arte ...
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Journal ArticleNeurosurgery · September 15, 2020
BACKGROUND: A dramatic improvement in obliteration rates of large, wide-necked aneurysms has been observed after the FDA approved the Pipeline Embolization Device (PED) in 2011. OBJECTIVE: To assess the predictors of complications, morbidity, and unfavorab ...
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Journal ArticleWorld Neurosurg · September 2020
BACKGROUND: Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we re ...
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Journal ArticleOper Neurosurg (Hagerstown) · August 1, 2020
Flow-diversion with pipeline embolization devices (PED, Medtronic, Dublin, Ireland) is widely used for embolization of complex intracranial aneurysms.1 In-stent thrombosis can be a dreadful complication after PED deployment. Intra-arterial glycoprotein IIb ...
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Journal ArticleSci Rep · July 16, 2020
Cerebral vasospasm (VSP) is a common phenomenon after aneurysmal subarachnoid hemorrhage (aSAH) and contributes to neurocognitive decline. The natural history of the pro-inflammatory immune response after aSAH has not been prospectively studied in human ce ...
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Journal ArticleNeurosurgery · July 1, 2020
BACKGROUND: Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an ...
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Journal ArticleJ Neurointerv Surg · July 2020
BACKGROUND: Following publication of the International Subarachnoid Aneurysm Trial (ISAT), treatment paradigms for cerebral aneurysms (CAs) shifted from open surgical clipping to endovascular embolization as primary therapy in a majority of cases. However, ...
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Journal ArticleJ Neurosurg · June 1, 2020
OBJECTIVE: MRI and MRA studies are routinely obtained to identify the etiology of intracerebral hemorrhage (ICH). The diagnostic yield of MRI/MRA in the setting of an acute ICH, however, remains unclear. The authors' goal was to determine the utility of ea ...
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Journal ArticleOper Neurosurg (Hagerstown) · June 1, 2020
BACKGROUND: Most trials have assessed intracranial atherosclerotic disease (ICAD) severity based on angiographic stenosis. However, anatomic stenosis might not accurately identify the actual state of functional post-stenotic flow limitation. OBJECTIVE: To ...
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Journal ArticleJ Neurointerv Surg · June 2020
Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracranial malformations. However, they may have angiographic features that increase the risk of rupture: cortical venous drainage, venous ectasia, venous stenosis and ...
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Journal ArticleJ Neurointerv Surg · June 2020
INTRODUCTION: Stroke is a leading cause of adult death and disability. Although acute ischemic stroke (AIS) in pregnancy is rare, it has devastating consequences on the life of the mother and fetus. Pregnancy was an exclusion criterion in endovascular thro ...
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Journal ArticleFrontiers in Neurology · May 7, 2020
Background: Transcirculation approaches, which consist of primary catheterization of a target artery from the contralateral side or opposite cerebral circulation, provide alternate endovascular routes when anterograde interventions are not feasible. We aim ...
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Journal ArticleJournal of Clinical Medicine · April 1, 2020
Background: MR-quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) wall associated with sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited, due to associated skull base b ...
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Journal ArticleJ Neurosurg · April 1, 2020
OBJECTIVE: Revascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aim ...
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ConferenceWorld Neurosurg · March 2020
BACKGROUND: Endovascular procedures such as intraarterial (IA) vasodilator injection and balloon angioplasty are used to treat medically refractory cerebral vasospasm. The effects of IA therapy may be short lived and thus require multiple treatments. Ballo ...
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Journal ArticleWorld Neurosurg · February 2020
OBJECTIVE: We present our initial experience with the off-label use of the Woven EndoBridge (WEB) device. METHODS: We performed a retrospective study from 2 institutions of patients with intracranial aneurysms who underwent treatment with the WEB device al ...
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Journal ArticleWorld Neurosurg · February 2020
BACKGROUND: Unfavorable anatomy can preclude traditional anterograde endovascular interventions. Transcirculation approaches, which consist of primary catheterization of a target artery from the contralateral side or opposite cerebral circulation, can prov ...
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Journal ArticleInterv Neuroradiol · February 2020
BACKGROUND AND PURPOSE: Systemic anticoagulation is the standard treatment for cerebral venous sinus thrombosis (CVST). Several endovascular techniques have been described as salvage therapy for anticoagulation refractory CVST cases. We aim to evaluate the ...
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Journal ArticleCerebrovasc Dis · 2020
INTRODUCTION: Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young adults. Our understanding of the specific risk factors and clinical course of CeAD is still evolving. In this study, we evaluated the differential risk factors and ...
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Journal ArticleWorld Neurosurgery: X · January 1, 2020
Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surg ...
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Journal ArticleStroke Vasc Neurol · 2020
Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for ...
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Journal ArticleInterventional Neurology · January 1, 2020
Background: The use of Pipeline Embolization Device (PED) is approved by the US Food and Drug Administration (FDA) to treat aneurysms located between the petrous and superior hypophyseal segments of the internal carotid artery. The purpose of this study is ...
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Journal ArticleStroke Vasc Neurol · December 2019
BACKGROUND: While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown. M ...
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Journal ArticleNeurosurgery · December 1, 2019
BACKGROUND: Hemorrhagic complications are a major concern for aneurysmal subarachnoid hemorrhage patients treated with stenting or stent-assisted coiling and undergoing additional procedures such as shunting, ventriculostomy placement, and craniotomies/cra ...
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Journal ArticleJ Neurosurg Sci · December 2019
BACKGROUND: Flow-diverting stents had gained prominence among neurointerventionalists. Aneurysms originating from distal vessels, particularly dissecting or fusiform, pose more technical challenges. The aim of the following single center large series was t ...
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Journal ArticleJ Stroke Cerebrovasc Dis · December 2019
BACKGROUND: Computed tomography angiogram (CTA) derived from computed tomography perfusion (CTP) has been proposed to avoid addition of separate CT perfusion protocol for selection of large vessel occlusion in acute stroke patients. Previous studies have v ...
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Journal ArticleOper Neurosurg (Hagerstown) · November 1, 2019
BACKGROUND: Embolization of intracranial aneurysms with the pipeline embolization device (PED; Medtronic, Dublin, Ireland) is a widely used technique. Despite adequate dual antiplatelet therapy and intraprocedural anticoagulation, in-stent thrombosis has b ...
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Journal ArticleWorld Neurosurg · November 2019
BACKGROUND: Reports have emerged describing the successful endovascular recanalization of the chronically occluded internal carotid artery (COICA). The impact this restoration of flow has on the sensitive carotid sinus baroreceptors has not been previously ...
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Journal ArticleJ Neurointerv Surg · November 2019
High-resolution vessel wall imaging (HR-VWI) is becoming a useful tool in the characterization and identification of unstable unruptured brain aneurysms. However, it has not been validated for clinical use. The current evidence on HR-VWI techniques for cha ...
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Journal ArticleJ Neurosurg Sci · October 2019
BACKGROUND: The aim of this paper is to describe our experience with the transradial approach (TRA) for intracranial aneurysms treatment using the Pipeline Embolization device (PED). We also performed a logistic regression comparing outcomes between TR and ...
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Journal ArticleWorld Neurosurg · October 2019
INTRODUCTION: Pivotal trials have shown the tremendous efficacy of mechanical thrombectomy in proximal occlusions. However distal occlusions involving second-order branches of the middle cerebral artery and beyond, anterior cerebral and posterior cerebral ...
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Journal ArticleWorld Neurosurg · October 2019
The Woven EndoBridge (WEB) device, an intrasaccular flow-diverter that does not require long-term antiplatelet use, has recently emerged as an alternative to embolize complex intracranial aneurysms; however, there are limitations to the WEB device. First, ...
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Journal ArticleJ Neurointerv Surg · October 2019
BACKGROUND AND PURPOSE: To evaluate the accuracy and inter-observer variability when CT angiography is used to identify unruptured intracranial aneurysm growth. METHODS: Two silicone phantom models were used in this study. Each phantom had eight aneurysms ...
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Journal ArticleJ Neurointerv Surg · September 2019
BACKGROUND: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. OBJECTIVE: To describe a multicenter approach with flow diversion using the pipeline embolization devi ...
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Journal ArticleOper Neurosurg (Hagerstown) · July 1, 2019
BACKGROUND: The use of the pipeline embolization device (PED; Medtronic, Dublin, Ireland) in the posterior circulation has been limited and infrequently reported compared to other off-label utilizations. Posterior inferior cerebellar artery aneurysms (PICA ...
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Journal ArticleWorld Neurosurg · July 2019
BACKGROUND: Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these compl ...
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Journal ArticleJ Stroke Cerebrovasc Dis · July 2019
BACKGROUND: Mechanical thrombectomy is the standard of care for patients with large vessel occlusion (LVO) presenting with severe symptoms; however, little is known about the best treatment for patients with LVO and mild symptoms. The absence of good colla ...
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Journal ArticleNeurocrit Care · June 2019
INTRODUCTION: The Common Data Elements (CDEs) initiative is a National Institute of Health/National Institute of Neurological Disorders and Stroke (NINDS) effort to standardize naming, definitions, data coding, and data collection for observational studies ...
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Journal ArticleNeurocrit Care · June 2019
INTRODUCTION: Development of clinical biomarkers to guide therapy is an important unmet need in aneurysmal subarachnoid hemorrhage (SAH). A wide spectrum of plausible biomarkers has been reported for SAH, but none have been validated due to significant var ...
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Journal ArticleNeurocrit Care · June 2019
INTRODUCTION: In studies on aneurysmal subarachnoid hemorrhage (SAH), substantial variability exists in the use and timing of outcomes and endpoints, which complicates interpretation and comparison of results between studies. The aim of the National Instit ...
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Journal ArticleNeurocrit Care · June 2019
OBJECTIVES: The goal for this project was to develop a comprehensive set of common data elements (CDEs), data definitions, case report forms and guidelines for use in unruptured intracranial aneurysm (UIA) and subarachnoid hemorrhage (SAH) clinical researc ...
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Journal ArticleNeurocrit Care · June 2019
INTRODUCTION: Variability in usage and definition of data characteristics in previous cohort studies on unruptured intracranial aneurysms (UIA) complicated pooling and proper interpretation of these data. The aim of the National Institute of Health/Nationa ...
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Journal ArticleNeurocrit Care · June 2019
INTRODUCTION: Lack of homogeneous definitions for imaging data and consensus on their relevance in the setting of subarachnoid hemorrhage and unruptured intracranial aneurysms lead to a difficulty of data pooling and lack of robust data. The aim of the Nat ...
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Journal ArticleNeurocrit Care · June 2019
OBJECTIVES: The goal for the long-term therapies (LTT) working group (WG) of the Unruptured Intracranial Aneurysm (UIA) and Subarachnoid Hemorrhage (SAH) common data elements (CDEs) was to develop a comprehensive set of CDEs, data definitions, case report ...
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Journal ArticleNeurocrit Care · June 2019
BACKGROUND: The National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) have been generated to standardize and define terms used by the scientific community. The widespread use of these CDEs promotes harmonized data coll ...
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Journal ArticleNeurocrit Care · June 2019
BACKGROUND: Clinical studies of subarachnoid hemorrhage (SAH) and unruptured cerebral aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing ...
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Journal ArticleJ Neurosurg · May 1, 2019
OBJECTIVE: The overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%-7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can ...
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Journal ArticleJ Neurosurg · April 1, 2019
OBJECTIVE: Intracranial electroencephalography (iEEG) provides valuable information that guides clinical decision-making in patients undergoing epilepsy surgery, but it carries technical challenges and risks. The technical approaches used and reported rate ...
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Journal ArticleJ Neurosurg · April 1, 2019
OBJECT: Sentinel headaches (SHs) associated with cerebral aneurysms (CAs) could be due to microbleeds, which are considered a sign that an aneurysm is unstable. Despite the prognostic importance of these microbleeds, they remain difficult to detect using r ...
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Journal ArticleJ Stroke Cerebrovasc Dis · April 2019
IMPORTANCE: Understanding of the epidemiology, outcomes, and management of spontaneous subarachnoid hemorrhage (sSAH) during pregnancy is limited. Small, single center series suggest a slight increase in morbidity and mortality. OBJECTIVE: To determine if ...
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Journal ArticleJ Clin Neurosci · April 2019
BACKGROUND: Telemedicine rapidly connects patients, with acute ischemic stroke symptoms, with neurovascular specialists for assessment to reduce chemical thrombolysis delivery times. Management of AIS includes maintaining target systolic blood pressures (S ...
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Journal ArticleStroke Vasc Neurol · March 2019
BACKGROUND: Endovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic co ...
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Journal ArticleJ Stroke Cerebrovasc Dis · March 2019
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital ...
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Journal ArticleJ Stroke Cerebrovasc Dis · March 2019
BACKGROUND: Most of the literature describing morphological features of intracranial aneurysms (IAs) is from North-America, East-Asia, and Europe. There is limited data from South-America. We describe the epidemiologic and angiographic features of ruptured ...
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Journal ArticleJ Neurosurg · February 1, 2019
OBJECTIVE: Aneurysm growth is considered predictive of future rupture of intracranial aneurysms. However, how accurately neuroradiologists can reliably detect incremental aneurysm growth using clinical MRI is still unknown. The purpose of this study was to ...
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Journal ArticleNeurosurgery · February 1, 2019
BACKGROUND: Stenting and flow diversion for aneurysmal sub arachnoid hemorrhage (aSAH) require the use of dual antiplatelet therapy (DAPT). OBJECTIVE: To investigate whether DAPT is associated with hemorrhagic complication following placement of external v ...
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Journal ArticleFrontiers in Neurology · January 1, 2019
Objective: To report a single-center experience using drug-eluting balloon mounted stents (DES) for endovascular treatment of atherosclerotic ostial vertebral artery stenosis (OVAS). Background: Posterior circulation is affected in up to 25% of strokes, 20 ...
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Journal ArticleNeurosurgical Focus · January 1, 2019
Over the past decade substantial advances in diagnostic imaging, classification, and understanding the natural history of intracranial dural arteriovenous fistula (dAVF) have been made. Paralleling these improvements in patient evaluation and risk assessme ...
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Journal ArticleWorld Neurosurg · January 2019
OBJECTIVE: The management of chronic complete internal carotid artery (ICA) occlusion (COICA) has been challenging. Endovascular procedures have been performed with variable success and risks, depending on the type of occlusion and distal revascularization ...
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Journal ArticleJ Clin Neurosci · January 2019
Emergent stroke is mostly evaluated using hospital based imaging. Quick imaging allows for rapid administration of IV thrombolysis and outcome improvement. Microwave imaging (MI) is an emerging portable imaging modality. Iron oxide nanoparticles are known ...
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Journal ArticleInterv Neuroradiol · December 2018
INTRODUCTION: Few liquid embolic materials are available for treatment of arteriovenous malformations. We describe the in vivo experience with the new PHIL low viscosity (LV) liquid embolic agent in a swine rete mirabile model. METHODS: Eight swine were tr ...
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Journal ArticleNeurosurgery · December 1, 2018
BACKGROUND: Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. OBJECTIVE: To assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Emboliz ...
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Journal ArticleJ Clin Neurosci · December 2018
BACKGROUND AND PURPOSE: Flow-diversion therapy (FDT) for large and complex intracranial aneurysms is effective and considered superior to primary coil embolization. Data evaluating common treatment with both FDT and coiling continues to emerge, but informa ...
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Journal ArticleJ Neurosurg · November 1, 2018
OBJECTIVEThromboembolic complications continue to be encountered with Pipeline embolization devices (PEDs) despite routine clopidogrel/aspirin antiplatelet therapy. This study examined the safety and efficacy of prasugrel in the management of clopidogrel-r ...
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Journal ArticleJ Neurosurg · October 2018
OBJECTIVE: Intracranial stenting and flow diversion require the use of dual antiplatelet therapy (DAPT) to prevent in-stent thrombosis. DAPT may significantly increase the risk of hemorrhagic complications in patients who require subsequent surgical interv ...
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Journal ArticleJ Am Heart Assoc · September 4, 2018
Background Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ...
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Journal ArticleJ Neurosurg · September 2018
OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of ...
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Journal ArticleJ Neurosurg · August 2018
OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialis ...
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Journal ArticleNeurosurgery · July 1, 2018
BACKGROUND: Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE: To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS: We ...
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Journal ArticleJ Neurosurg · July 2018
Intracranial electroencephalography (iEEG) provides invaluable information in determining seizure focus and spread due to its high spatial and temporal resolution, which are not afforded by noninvasive studies. Electrodes of various types (e.g., grid, stri ...
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Journal ArticleClin Neurol Neurosurg · July 2018
OBJECTIVE: The objective of this study is to determine the impact of intraventricular hemorrhage (IVH) on the cognitive prognosis of subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm, independent of the presence of intraparenchymal hemorrhage ...
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Journal ArticleClin Neurol Neurosurg · May 2018
OBJECTIVES: Neurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its p ...
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Journal ArticleArterioscler Thromb Vasc Biol · March 2018
OBJECTIVE: Cigarette smoke exposure (CSE) is a risk factor for cerebral aneurysm (CA) formation, but the molecular mechanisms are unclear. Although CSE is known to contribute to excess reactive oxygen species generation, the role of oxidative stress on vas ...
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Journal ArticleJ Neurointerv Surg · March 2018
The treatment of palpebral and periorbital fistulas may be challenging due to the presence of multiple anastomosis with eloquent ophthalmic and intracranial vascular territories. Moreover, cosmetic and functional characteristics of this area pose unique ch ...
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Journal ArticleACS Applied Nano Materials · January 26, 2018
An intracranial aneurysm is a local dilation of an artery in the cerebral circulation and can be endovascularly treated with two types of medical devices known as intracranial stents or flow diverters-both are metallic devices that help redirect blood from ...
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Journal ArticleBMJ · January 18, 2018
OBJECTIVE: To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). DESIGN: Cohort study with logistic regression analysis to combine predictors a ...
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Journal ArticleCrit Care Res Pract · 2018
Acute ischemic stroke (AIS) remains a leading cause of death and long-term disability. The paradigms on prehospital care, reperfusion therapies, and postreperfusion management of patients with AIS continue to evolve. After the publication of pivotal clinic ...
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Journal ArticleWorld Neurosurg · January 2018
OBJECTIVE: Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow-diversion device (FDD) and a specific acute ...
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Journal ArticleOtol Neurotol · January 2018
OBJECTIVE: To study the indications and outcomes of lateral sphenoidectomy as part of a combined skull base approach in the treatment of tumors involving Meckel's cave (MC) and cavernous sinus (CS). STUDY DESIGN: Retrospective patient series. SETTING: Tert ...
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Journal ArticleJ Am Heart Assoc · October 17, 2017
BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exi ...
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Journal ArticleWorld Neurosurg · October 2017
BACKGROUND: Clopidogrel/aspirin antiplatelet therapy routinely is administered 7-10 days before pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600-mg loading dose of clopidogrel 24 hours before Pipeline Embolization Device (PE ...
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Journal ArticleNeurosurgery · July 1, 2017
BACKGROUND: Flow diversion is typically reserved for large, giant, or morphologically complex aneurysms. Coiling remains a first-line treatment for small, morphologically simple aneurysms. OBJECTIVE: To compare coiling and flow diversion in small, uncompli ...
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Journal ArticleWorld Neurosurg · July 2017
BACKGROUND: Sentinel headache (SH) occurs before aneurysm rupture in an estimated 15%-60% of cases of aneurysmal subarachnoid hemorrhage (aSAH). By definition, noncontrast computed tomography (CT) scan of the brain and lumbar puncture are both negative in ...
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Journal ArticleOtol Neurotol · June 2017
OBJECTIVE: Define the indications and outcomes for subjects undergoing treatment utilizing the extended middle cranial fossa approach (EMCF). STUDY DESIGN: Retrospective records review. SETTING: University-based tertiary referral center. PATIENTS: Subjects ...
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Journal ArticleNeurosurg Focus · June 2017
The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to ...
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Chapter · March 7, 2017
Primary intraventricular hemorrhage (IVH) refers to bleeding directly into the ventricular system. Secondary IVH occurs more frequently and refers to bleeding extending from the parenchyma or subarachnoid space into the ventricular chambers. Aneurysms, art ...
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Journal ArticleWorld Neurosurg · February 2017
BACKGROUND: Transient loss of consciousness (LOC) is one of the most common presentations of aneurysmal subarachnoid hemorrhage (SAH) and may be an indicator of early brain injury. In this study, we examined the association of LOC and functional outcomes i ...
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Journal ArticleExpert Rev Neurother · February 2017
Cavernous carotid aneurysms can cause significant symptomatology through mass effect and may rupture, resulting in carotid-cavernous fistula or epistaxis. Traditional treatment options included endovascular or surgical parent vessel occlusion, or embolizat ...
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Journal ArticleJ Neurosurg · February 2017
OBJECTIVE The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the poster ...
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Journal ArticleCrit Care Res Pract · 2017
Neurocritical care patients are at risk of developing secondary brain injury from inflammation, ischemia, and edema that follows the primary insult. Recognizing clinical deterioration due to secondary injury is frequently challenging in comatose patients. ...
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Journal ArticleWorld Neurosurg · January 2017
BACKGROUND: Risk of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) with asymptomatic angiographic vasospasm on admission is unclear in the literature. The goal of this study is to identify predictors of clinical ...
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Journal ArticleWorld Neurosurg · December 2016
OBJECTIVE: The Pipeline Embolization Device (PED) has been used and shown to be safe under monitored anesthesia care (MAC). We present the results of the first study, to our knowledge, assessing the safety and feasibility of same-day discharge in patients ...
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Journal ArticleWorld Neurosurg · November 2016
OBJECTIVE: Studies that showed endovascular coiling of ruptured intracranial aneurysms (RAs) to be superior to microsurgical clipping have compared dedicated endovascular interventionists versus open cerebrovascular surgeons. This is the first study to eva ...
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Journal ArticleClin Neurol Neurosurg · November 2016
While intervention for ruptured arteriovenous malformations (AVMs) of the brain is typically warranted, the management of unruptured AVMs remains controversial. Despite numerous retrospective studies, only one randomized controlled trial has been conducted ...
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Journal ArticleHypertension · August 2016
We previously found that aspirin decreases the risk of cerebral aneurysm rupture in humans. We aim to assess whether a sex differential exists in the response of human cerebral aneurysms to aspirin and confirm these observations in a mouse model of cerebra ...
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Journal ArticleNeurocrit Care · August 2016
BACKGROUND: Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheri ...
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Journal ArticleClin Neurol Neurosurg · June 2016
OBJECTIVE: Data regarding the role of alternative access routes in neuro-endovascular interventions is limited. Our aim is to evaluate the safety and efficacy of alternative access in endovascular management of cerebrovascular diseases. METHODS: 29 patient ...
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Journal ArticleNeurosurgery · May 2016
BACKGROUND: Flow diversion is increasingly used to treat intracranial aneurysms. In previous reports, patients were pretreated with aspirin and clopidogrel before the intervention for the prevention of thromboembolic complications. OBJECTIVE: To assess the ...
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Journal ArticleAJNR Am J Neuroradiol · May 2016
BACKGROUND AND PURPOSE: The use of the Pipeline Embolization Device in the management of recurrent previously stented cerebral aneurysms is controversial. The aim of this study was to evaluate the efficacy and safety of the Pipeline Embolization Device in ...
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Journal ArticleTop Magn Reson Imaging · April 2016
Inflammation is increasingly being recognized as contributing to the underlying pathophysiology of cerebral aneurysms and brain arteriovenous malformation. Ferumoxytol is being increasingly used for both its prolonged intravascular imaging characteristics ...
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Journal ArticleJ Neurosurg · February 2016
OBJECTIVE: The goal of this prospective longitudinal study was to test whether image-derived metrics can differentiate unruptured aneurysms that will become unstable (grow and/or rupture) from those that will remain stable. METHODS: One hundred seventy-eig ...
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Journal ArticleJ Neurointerv Surg · February 2016
Advances in the management and endovascular treatment of intracranial aneurysms are progressing at a tremendous rate. Developments in novel imaging technology may improve diagnosis, risk stratification, treatment planning, intraprocedural assessment, and f ...
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Journal ArticleNeurosurgery · December 2015
BACKGROUND: The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms. OBJECTIVE: To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS). METHODS: Angiogra ...
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Journal ArticleNeurosurgery · November 2015
BACKGROUND: The biggest downside of cerebral aneurysm coiling is the high rates of recurrence and retreatments. With the increasing number of aneurysm recurrences after failed coiling procedures, the best retreatment strategy remains unknown. OBJECTIVE: To ...
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Journal ArticleJ Neurosurg · November 2015
OBJECT: Endovascular interventions have become an essential part of a neurosurgeon's practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess th ...
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Journal ArticleNeurosurgery · October 2015
BACKGROUND: Inflammation plays an important role in formation and rupture of intracranial aneurysms. Expression of microsomal prostaglandin E2 (PGE2) synthase type 1 (mPGES-1) is increased in the wall of intracranial aneurysms in humans. PGE2, a by-product ...
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Journal ArticleNeurosurgery · October 2015
BACKGROUND: Flow diverters have emerged as a major tool in the treatment of cerebral aneurysms. A crucial issue with the use of flow diverters is the patency of side branches covered by the device, most importantly the ophthalmic artery (OA). OBJECTIVE: To ...
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Journal ArticleNeurology · September 8, 2015
OBJECTIVE: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among ...
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Journal ArticleComput Methods Biomech Biomed Engin · August 2015
Indices of the intra-aneurysm hemodynamic environment have been proposed as potentially indicative of their longitudinal outcome. To be useful, the indices need to be used to stratify large study populations and tested against known outcomes. The first obj ...
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Journal ArticleHypertension · August 2015
Formation and rupture of cerebral aneurysms have been associated with chronic hypertension. The effect of transient increase in blood pressure and its effect on intra-aneurysmal hemodynamics have not been studied. We examined the effects of controlled incr ...
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Journal ArticleHypertension · July 2015
Vascular inflammation plays a critical role in the pathogenesis of cerebral aneurysms. Peroxisome proliferator-activated receptor γ (PPARγ) protects against vascular inflammation and atherosclerosis, whereas dominant-negative mutations in PPARγ promote ath ...
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Journal ArticleAnesth Analg · July 2015
BACKGROUND: Our intention in this case series was to review the postoperative care and neurologic outcomes of patients who had undergone elective endovascular treatment of unruptured intracranial aneurysms. The case series is unique managerially in that a ...
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Journal ArticleJ Neurosurg · June 2015
OBJECT Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PE ...
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Journal ArticleStroke · June 2015
BACKGROUND AND PURPOSE: Cerebral aneurysm (CA) affects 3% of the population and is associated with hemodynamic stress and inflammation. Myeloperoxidase, a major oxidative enzyme associated with inflammation, is increased in patients with CA, but whether my ...
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Journal ArticleHypertension · March 2015
Inflammation plays a key role in formation and rupture of intracranial aneurysms. Because hepatocyte growth factor (HGF) protects against vascular inflammation, we sought to assess the role of endogenous HGF in the pathogenesis of intracranial aneurysms. C ...
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Journal ArticleJ Neurosurg · March 2015
OBJECT: The literature has conflicting reports about the prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to investigate the prognostic value of premorbid hypertension ...
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Journal ArticleNeurosurgery · March 2015
BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device ...
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Journal ArticleJ Cereb Blood Flow Metab · February 2015
Cerebral arteriovenous malformations (AVMs) entail a significant risk of intracerebral hemorrhage owing to the direct shunting of arterial blood into the venous vasculature without the dissipation of the arterial blood pressure. The mechanisms involved in ...
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Journal ArticleNeurosurgery · February 2015
BACKGROUND: The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED in ruptured intracranial aneurys ...
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Journal ArticleCerebrovasc Dis · 2015
BACKGROUND: Inflammation is a key element behind the pathophysiology of cerebral aneurysm formation and rupture. Aspirin is a potent inhibitor of cyclooxygenase-2 (COX), which plays a critical role in the expression of immune modulators known to contribute ...
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Journal ArticleDNA Cell Biol · January 2015
Macrophages play a central role in the inflammatory response leading to aneurysm formation, progression, and rupture. The purpose of this study was to determine whether granulocyte-monocyte colony-stimulating factor (GM-CSF) plays a role in the progression ...
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Journal ArticleScientificWorldJournal · 2015
INTRODUCTION: Idiopathic intracranial hypertension (IIH) may result in a chronic debilitating disease. Dural venous sinus stenosis with a physiologic venous pressure gradient has been identified as a potential etiology in a number of IIH patients. Intracra ...
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Journal ArticlePLoS One · 2015
BACKGROUND AND PURPOSE: In recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism. We test the hypothesis that aneurysm growth is the primary recurrence mechanism. We also test the hypothesis tha ...
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Journal ArticleClin Neurol Neurosurg · December 2014
OBJECT: This study aims to evaluate the use of endovascular therapy to treat very young (≤ 35 years) patients with acute ischemic stroke from large vessel occlusion. METHODS: We identified from a prospectively maintained database young patients (≤ 35 years ...
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Journal ArticleNeurosurgery · December 2014
BACKGROUND: Epidemiological studies have indicated that postmenopausal women have a higher incidence of intracranial aneurysms than men in the same age group. OBJECTIVE: To investigate whether estrogen or estrogen receptors (ERs) mediate protective effects ...
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Journal ArticleNeurocrit Care · December 2014
Researchers and other stakeholders continue to express concern about the failure of randomized clinical trials (RCT) in subarachnoid hemorrhage (SAH) to show efficacy of new treatments. Pooled data may be particularly useful to generate hypotheses about ca ...
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Journal ArticleJ Neurosurg · October 2014
OBJECTIVE: It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in subarachnoid hemorrhage (SAH) patients with an existing ventriculostomy. At Thomas Jefferson University and Jefferson Hospital for Neuros ...
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Journal ArticleAJNR Am J Neuroradiol · August 2014
BACKGROUND AND PURPOSE: The Pipeline Embolization Device has emerged as an important treatment option for intracranial aneurysms. The number of devices needed to treat an aneurysm is uncertain and is the subject of vigorous debate. The purpose of this stud ...
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Journal ArticleJ Clin Neurosci · August 2014
Several treatment strategies are available to manage large and giant cerebral aneurysms, including surgical, endovascular and combined approaches. We present our experience with microsurgical clipping of large and giant aneurysms. A total of 138 patients w ...
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Journal ArticleHypertension · August 2014
Angiotensin II (Ang II) stimulates vascular inflammation, oxidative stress, and formation and rupture of intracranial aneurysms in mice. Because Ang 1-7 acts on Mas receptors and generally counteracts deleterious effects of Ang II, we tested the hypothesis ...
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Journal ArticleNeurochirurgie · August 2014
BACKGROUND: Melanoma lesions in the brainstem can be difficult to distinguish radiographically and clinically from cavernous malformations. However, the treatment modalities and clinical course of these two diseases differ considerably. We report two cases ...
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Journal ArticleNeurosurg Clin N Am · July 2014
Endovascular management has become the treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique ...
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Journal ArticleHypertension · June 2014
Clinical observations suggest that postmenopausal women have a higher incidence of aneurysmal rupture than premenopausal women. We hypothesize that a relative deficiency in estrogen may increase the risks of aneurysmal growth and subarachnoid hemorrhage in ...
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Journal ArticleTransl Stroke Res · June 2014
Vascular smooth muscle cells (SMC) maintain significant plasticity. Following environmental stimulation, SMC can alter their phenotype from one primarily concerned with contraction to a pro-inflammatory and matrix remodeling phenotype. This is a critical p ...
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Journal ArticleNeurosurgery · May 2014
BACKGROUND: Endovascular vessel reconstruction with the pipeline embolization device (PED) has become common practice. Data on the safety and efficacy of the PED in blister-like aneurysms (BLAs) are limited. OBJECTIVE: To retrospectively present our experi ...
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Journal ArticleStroke · May 2014
BACKGROUND AND PURPOSE: To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields ...
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Journal ArticleJ Neurosurg · May 2014
OBJECT: Medial acoustic neuroma is a rare entity that confers a distinct clinical syndrome. It is scarcely discussed in the literature and is associated with adverse features. This study evaluates the clinical and imaging features, pertinent surgical chall ...
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Journal ArticleJ Neuroinflammation · April 16, 2014
BACKGROUND: Alterations in TNF-α expression have been associated with cerebral aneurysms, but a direct role in formation, progression, and rupture has not been established. METHODS: Cerebral aneurysms were induced through hypertension and a single stereota ...
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Journal ArticleTransl Stroke Res · April 2014
Inflammation is a key component in the pathogenesis of cerebrovascular lesions. Two agents have emerged as promising possibilities for imaging cerebrovascular lesions. These agents are ferumoxytol and myeloperoxidase (MPO)-specific paramagnetic magnetic re ...
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Journal ArticleTransl Stroke Res · April 2014
Inflammation is a critical process behind cerebral aneurysm formation and rupture. Tumor necrosis factor alpha (TNF-α) is a key immune modulator that has been implicated in cerebral aneurysm pathophysiology. This may occur through TNF-α-mediated endothelia ...
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Journal ArticleClin Neurol Neurosurg · March 2014
OBJECTIVE: To retrospectively assess the safety and efficacy of endovascular treatment of cerebral vasospasm with different modalities and assess predictors of outcome. METHODS: Endovascular treatment was indicated in the event of neurological deterioratio ...
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Journal ArticleAJNR Am J Neuroradiol · March 2014
BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 1 ...
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Journal ArticleNeurosurg Focus · January 2014
OBJECT: Endovascular therapy has become a widely used method for achieving arterial recanalization in patients who are ineligible for intravenous thrombolysis or those in whom it is unsuccessful. Young stroke patients with large vessel occlusions may parti ...
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Journal ArticleStroke · January 2014
BACKGROUND AND PURPOSE: Flow diverters are currently indicated for treatment of large and complex intracranial aneurysms. The purpose of this study was to determine whether the indications of flow diversion can be safely extended to unruptured, small, sacc ...
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Journal ArticleJ Clin Neurosci · January 2014
Technological advancement within the field of neuroendovascular therapy may lead to safer and more robust treatment options for patients with lesions traditionally not favorable to coil occlusion. We analyze and report our outcomes with the Orbit Galaxy De ...
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Journal ArticleBrain Inj · 2014
BACKGROUND: The management of impalement penetrating brain injuries (IPBI) from non-missile objects is extremely challenging, especially when vascular structures are involved. Cerebral angiography is a crucial tool in initial evaluation to assess for vascu ...
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Journal ArticleScientificWorldJournal · 2014
Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous e ...
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Journal ArticleScientificWorldJournal · 2014
The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to ...
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Journal ArticleBiomed Res Int · 2014
Cerebral vasospasm (CV) remains the leading cause of delayed morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). However, increasing evidence supports etiologies of delayed cerebral ischemia (DCI) other than CV. Estrogen, specifical ...
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Journal ArticleClin Neurol Neurosurg · December 2013
OBJECTIVE: Surgical clipping and coil embolization of distally located intracranial aneurysms can be challenging. The goal of this study was to assess the feasibility, safety and efficacy of treatment of distal aneurysms with the liquid embolic agent Onyx ...
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Journal ArticleClin Neurol Neurosurg · December 2013
OBJECTIVE: Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. We compare the safety and efficacy of CT perfusion (CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke ...
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Journal ArticleClin Neurol Neurosurg · December 2013
BACKGROUND: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. OBJECTIVE: We report our institutional experience with the embolization of hypervascular extradural ...
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Journal ArticleAJNR Am J Neuroradiol · December 2013
Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and ...
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Journal ArticleFuture Neurol · November 1, 2013
The formation of cerebral aneurysms and their rupture propensity is of immediate clinical importance. Current management includes observation with expectant management, microsurgical clipping and/or endovascular coiling. The surgical options are invasive a ...
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Journal ArticleJ Neurosurg · October 2013
OBJECT: The use of an intracranial stent requires dual antiplatelet therapy to avoid in-stent thrombosis. In this study, the authors sought to investigate whether the use of dual antiplatelet therapy is a risk factor for hemorrhagic complications in patien ...
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Journal ArticleEchocardiography · September 2013
BACKGROUND: Subarachnoid hemorrhage (SAH) induced myocardial dysfunction (often labeled neurogenic stunned myocardium) encompasses a spectrum of clinical presentations ranging from an isolated elevation of cardiac enzymes to cardiogenic shock. OBJECTIVE: W ...
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Journal ArticleStroke · September 2013
BACKGROUND AND PURPOSE: Inflammation may play an important role in the formation and rupture of cerebral aneurysms. Chemokines act as chemoattractants for leukocytes directing them toward sites of tissue inflammation. The purpose of this study was to deter ...
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Journal ArticleNeurosurgery · September 2013
BACKGROUND: Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that w ...
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Journal ArticleMolecules · August 13, 2013
Inflammation is increasingly being understood to be a key component to the pathophysiology of cerebrovascular lesions. Ferumoxytol, an iron oxide nanoparticle coated by a carbohydrate shell, has been used in MRI studies as an inflammatory marker because it ...
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Journal ArticleStroke · August 2013
BACKGROUND AND PURPOSE: Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical ...
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Journal ArticleNeuroradiology · August 2013
INTRODUCTION: Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combin ...
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Journal ArticleNeurosurgery · July 2013
BACKGROUND: The Pipeline Embolization Device (PED) has emerged as a promising treatment for intracranial aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED, to analyze the effect of operator experience on the complication rate, and to ident ...
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Journal ArticleJ Neuroradiol · July 2013
BACKGROUND AND PURPOSE: Daily intake of aspirin was shown to decrease human cerebral aneurysm rupture by 60%. The feasibility of imaging macrophages in human cerebral aneurysm walls using ferumoxytol-enhanced MRI has been demonstrated. The goal of the pres ...
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Journal ArticleClin Neurol Neurosurg · June 2013
OBJECTIVE: Aneurysmal subarachnoid hemorrhage (SAH) is relatively uncommon in young adults. There is a paucity of data pertaining to the management of aneurysmal SAH in young patients, especially with endovascular therapy. METHODS: We reviewed all SAH pati ...
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Journal ArticleTransl Stroke Res · June 2013
Outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved over the last decades. Yet, case fatality remains nearly 40% and survivors often have permanent neurological, cognitive and/or behavioural sequelae. Other than nimodipine drug o ...
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Journal ArticleCardiovasc Eng Technol · March 2013
The objective of this study is to assess the sensitivity of intracranial aneurysm geometry to the modality of imaging. Four imaging modalities-3D rotational angiography (3DRA), computed tomography angiography (CTA), contrast enhanced magnetic resonance ang ...
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Journal ArticleJ Am Heart Assoc · February 22, 2013
BACKGROUND: Inflammatory cells and molecules may play a critical role in formation and rupture of cerebral aneurysms. Recently, an epidemiologic study reported that acetylsalicylic acid (ASA) decreases the risk of aneurysm rupture. The goal of this study w ...
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Journal ArticleNeurocrit Care · February 2013
BACKGROUND: Clinical prediction models can enhance clinical decision-making and research. However, available prediction models in aneurysmal subarachnoid hemorrhage (aSAH) are rarely used. We evaluated the methodological validity of SAH prediction models a ...
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Journal ArticleBiomed Res Int · 2013
The management of mycotic aneurysm has always been subject to controversy. The aim of this paper is to review the literature on the intracranial infected aneurysm from pathogenesis till management while focusing mainly on the endovascular interventions. Th ...
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Journal ArticlePLoS One · 2013
BACKGROUND: The role of smooth muscle cell (SMC) phenotypic modulation in the cerebral circulation and pathogenesis of stroke has not been determined. Cigarette smoke is a major risk factor for atherosclerosis, but potential mechanisms are unclear, and its ...
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Journal ArticleWorld Neurosurg · 2013
The outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved slowly over the past 25 years. This improvement may be due to early aneurysm repair by endovascular or open means, use of nimodipine, and better critical care management. De ...
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Journal ArticleBiomed Res Int · 2013
Head-of-bed (HOB) elevation is usually restricted in patients with aneurysmal subarachnoid hemorrhage (SAH). The goal of this study is to correlate HOB changes (0° and 90°) with cerebral blood flow using transcranial Doppler (TCD) and thermal diffusion pro ...
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Journal ArticleStroke · December 2012
BACKGROUND AND PURPOSE: The clinical significance of early (ie, within the first 24 hours) uptake of ferumoxytol by macrophages in the wall of human cerebral aneurysms is not clear. The purpose of this study was to determine whether early uptake of ferumox ...
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Journal ArticleJ Neurosurg · November 2012
OBJECT: The optimal antiplatelet medication protocol for prevention of thrombotic complications after stent-assisted coil embolization of cerebral aneurysms is unclear. Early cessation of antiplatelet agents may be associated with an increased risk of cere ...
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Journal ArticleJ Neuroinflammation · September 21, 2012
BACKGROUND: M1 and M2 cells are two major subsets of human macrophages that exert opposite effects on the inflammatory response. This study aims to investigate the role of macrophage M1/M2 imbalance and mast cells in the progression of human cerebral aneur ...
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Journal ArticleNeurosurgery · September 2012
BACKGROUND: Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy. OBJECTIVE: To assess the safety and efficacy of tirofiban in stent-assisted coiling. ...
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Journal ArticleJ Clin Neurosci · September 2012
Spontaneous cerebellar hemorrhage often requires surgical suboccipital decompression and clot evacuation. Predictors of postoperative neurological deficits and outcome are not widely addressed in the literature. A retrospective review was conducted on 37 c ...
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Journal ArticleNeurosurgery · August 2012
BACKGROUND: Recent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared with conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneur ...
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Journal ArticleWorld Neurosurg · July 2012
OBJECTIVE: To highlight pertinent aspects of emergent endovascular management of carotid rupture, or carotid blowout syndrome (CBS), an emergent, life-threatening complication of head and neck cancer and its treatments. METHODS: A retrospective chart revie ...
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Journal ArticleTransl Stroke Res · July 2012
Inflammation cell infiltration and cytokine expression are seen in the vascular walls and intervening stroma of resected brain arteriovenous malformation (bAVM) specimens, even in unruptured and previously untreated lesions. Macrophages may play a critical ...
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Journal ArticleStroke · July 2012
BACKGROUND AND PURPOSE: Cyclooxygenase-2 (COX-2) and Microsomal Prostaglandin E2 Synthase-1 (mPGES-1) catalyze isomerization of the cyclooxygenase product PGH2 into PGE2. Deletion of COX-2/mPGES-1 suppresses carotid artery atherogenesis and angiotensin II- ...
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Journal ArticleNeurosurgery · June 2012
BACKGROUND: Stent-assisted coiling in the setting of subarachnoid hemorrhage remains controversial. Currently, there is a paucity of data regarding the utility of this procedure and the risks of hemorrhagic and ischemic complications. OBJECTIVE: To assess ...
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Journal ArticleNeurosurg Focus · May 2012
OBJECT: Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transart ...
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Journal ArticleArterioscler Thromb Vasc Biol · April 2012
OBJECTIVE: Macrophages play a critical role in cerebral aneurysm formation and rupture. The purpose of this study is to demonstrate the feasibility and optimal parameters of imaging macrophages within human cerebral aneurysm wall using ferumoxytol-enhanced ...
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Journal ArticleInterv Neuroradiol · March 2012
Endovascular treatment of complex, wide-necked bifurcation cerebral aneurysms is challenging. Intra/extra-aneurysmal stent placement, the "waffle cone" technique, has the advantage of using a single stent to prevent coil herniation without the need to del ...
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Journal ArticleStroke · March 2012
BACKGROUND AND PURPOSE: Coil compaction is thought to be the main mechanism for recurrence in cerebral aneurysms with previously successful coil embolization. We hypothesize that sac growth may be equally or more important. The objective was to study the r ...
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Journal ArticleWorld Neurosurg · February 2012
OBJECTIVE: Prompt access to arterial occlusion is the key to successful endovascular revascularization in acute stroke. We present the first reported case utilizing anterior-to-posterior circulation approach for a successful mechanical thrombectomy and che ...
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Journal ArticleCase Rep Med · 2012
Background. Coil and stent migration is a potentially catastrophic complication in endovascular neurosurgery, which may lead to cerebral thromboembolism. Techniques for removing migrated coil and stent are not well established. Methods and Results. We pres ...
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Journal ArticleStroke · November 2011
BACKGROUND AND PURPOSE: Chronic inflammation is postulated as an important phenomenon in intracranial aneurysm wall pathophysiology. This study was conducted to determine if aspirin use impacts the occurrence of intracranial aneurysm rupture. METHODS: Subj ...
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Journal ArticleJ Clin Neurosci · July 2011
Duplication of the extracranial internal carotid artery is a rare anatomic variant. We present the first patient with unilateral duplication of the cervical internal carotid artery with severe stenosis. Stent-assisted percutaneous transluminal angioplasty ...
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Journal ArticleNeurosurg Focus · June 2011
Intravenous and intraarterial recombinant tissue plasminogen activator remains underutilized in the treatment of acute ischemic stroke, largely due to strict adherence to the concept of the therapeutic time window for administration. Recent efforts to expa ...
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Journal ArticleJ Neurosurg · April 2011
OBJECT: Intracranial stenting has improved the ability to treat wide-neck aneurysms via endovascular techniques. However, stent placement necessitates the use of antiplatelet agents, and the latter may complicate the treatment of patients with acutely rupt ...
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Journal ArticleNeurosurgery · March 2011
BACKGROUND: The incidence of subarachnoid hemorrhage is increasing, especially in the elderly as life expectancy increases. Aggressive treatment of aneurysms in the elderly is usually avoided because of a presumed poor prognosis. OBJECTIVE: The aim of this ...
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Journal ArticleJ Clin Neurosci · October 2010
Understanding cerebrovascular anatomy and its variations is of utmost importance in treating vascular malformations. The two patients presented here demonstrate yet to be reported anomalous origins of the cortical branches of the posterior cerebral artery. ...
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Journal ArticleJ Clin Neurosci · September 2010
Most patients with direct carotid-cavernous fistulas (CCFs) present with dramatic symptoms including proptosis, chemosis, and diplopia. We report a patient with a direct/high-flow CCF whose only initial symptom was pulse-synchronous tinnitus. Following dia ...
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Journal ArticleJ Clin Neurosci · June 2010
Multiple symptomatic vertebral artery (VA) loops are rare and their management is challenging. A 55-year-old man presented with a 5-year history of frequent episodes of presyncope and mild left C5 radiculopathy that was exacerbated by flexion or extension ...
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Journal ArticleAJNR Am J Neuroradiol · June 2010
BACKGROUND AND PURPOSE: Blister aneurysms of the supraclinoid ICA represent a rare but well-documented cause of subarachnoid hemorrhage. These aneurysms are difficult to detect, and their surgical treatment is challenging, with high morbidity and mortality ...
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Journal ArticleJ Clin Neurosci · May 2010
Campomelic dysplasia is a rare autosomal dominant syndrome that often results in congenital spinal deformity. As a result of improvements in respiratory care, some patients survive into childhood, requiring treatment of their spinal deformities. We present ...
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Journal ArticleAJNR Am J Neuroradiol · April 2010
BACKGROUND AND PURPOSE: Blister aneurysms of the supraclinoid ICA represent a rare but potentially catastrophic cause of SAH, often presenting both diagnostic and therapeutic dilemmas. We explore the utility of CTA in the identification and characterizatio ...
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Journal ArticleJ Pediatr Hematol Oncol · January 2010
Considering the poor prognosis of pediatric patients with invasive fungal infections due to zygomycosis, we present the case of a female adolescent with acute lymphoblastic leukemia, who successfully completed her chemotherapy despite a disseminated double ...
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Journal ArticleJ Neurosurg · November 2008
OBJECT: Midline clival lesions, whether involving the clivus or simply situated anterior to the brainstem, present a technical challenge for adequate exposure and safe resection. The authors describe, as a minimally invasive technique, an anterior clivecto ...
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Chapter · January 1, 2006
The first reported case of cervical spine injury in a patient with ankylosing spondylitis (AS) appeared in 1933 (1). Subsequently, numerous publications have shown the incidence of traumatic cervical injury in patients with AS to be appreciably higher than ...
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Journal ArticleNeurosurgery · July 2004
OBJECTIVE: Acute occlusion of the proximal middle cerebral artery (MCA) can lead to rapid development of fatal brain swelling and ischemic strokes. Decompressive surgery, if performed early in this subpopulation of patients, can reduce mortality and result ...
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Journal ArticlePediatrics · December 2002
INTRODUCTION: The entity of hindbrain herniation without myelodysplasia in the very young child has been poorly described. A retrospective analysis of children diagnosed with Chiari I malformation (CM I) before their sixth birthday is presented. METHODS: S ...
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