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Ashfaq Shuaib,
Natan M Bornstein,
Hans-Christoph Diener,
William Dillon,
Marc Fisher,
Maxim D Hammer,
Carlos A Molina,
J Neal Rutledge,
Jeffrey L Saver,
Peter D Schellinger, Harish Shownkeen
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ABSTRACT: Fewer than 5% of patients with acute ischemic stroke are currently treated, and there is need for additional treatment options. A novel catheter treatment (NeuroFlo) that increases cerebral blood flow was tested to 14 hours.
The Safety and Efficacy of NeuroFlo in Acute Ischemic Stroke trial is a randomized trial of the safety and efficacy of NeuroFlo treatment in improving neurological outcome versus standard medical management. The primary safety end point was the incidence of serious adverse events through 90 days. The primary efficacy end point on a modified intent-to-treat population was a global disability end point at 90 days. Secondary end points included mortality, intracranial hemorrhage, modified Rankin scale score outcome of 0 to 2, and modified Rankin scale shift analysis.
Between October 2005 and January 2010, 515 patients were enrolled at 68 centers in 9 countries. The primary efficacy end point did not reach statistical significance (OR, 1.17; CI, 0.81-1.67; P=0.407). The primary safety end point did not show a difference in serious adverse events (P=0.923). Ninety-day mortality was 11.3% (26/230) in treatment and 16.3% (42/257) in control (P=0.087). Post hoc analyses showed that patients presenting within 5 hours (OR, 3.33; CI, 1.31-8.48), with NIHSS score 8 to 14 (OR, 1.80; CI, 0.99-3.30), or older than age 70 years (OR, 2.02; CI, 1.02-4.03) had better modified Rankin scale score outcomes of 0 to 2; additionally, there were fewer stroke-related deaths in treatment compared to control groups (7.4% = 17/230; 14.4% = 37/257).
The trial met its primary safety end point but not its primary efficacy end point. Signals of treatment effect were suggested on all-cause mortality, in patients presenting early, older than age 70 years, or with moderate strokes, but these require confirmation.
URL: http://clinicaltrials.gov. Unique identifier: NCT00119717.
Stroke 06/2011; 42(6):1680-90. · 5.73 Impact Factor
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ABSTRACT: Coil embolization is a non-invasive method for treating intracranial vascular malformations by inducing thrombus formation. It is particularly useful in management of cerebral aneurysms and avoids the risks associated with surgical clipping. Occasionally, embolic complications occur which result in transient or permanent loss of vision.
Case report of a 29-year-old Caucasian woman who underwent coil embolization and balloon occlusion of an intracavernous carotid aneurysm. Shortly thereafter she described visual changes and a droopy eyelid.
Examination revealed pupillary miosis and mild ptosis of the right upper lid. Perimetry showed an arcuate scotoma superiorly and an inferonasal step in the right eye. Fundus examination revealed multiple cotton-wool spots along the peripapillary area and along the temporal vascular arcades reminiscent of Purtscher retinopathy. After 4 weeks, she had marked improvement in her visual symptoms. Most of the cotton-wool spots had resolved and the visual field had normalized. However, the ptosis and anisocoria remained unchanged.
Coil embolization is a non-invasive method for treating carotid aneurysms. However, it carries the risk of ophthalmic events, warranting baseline ophthalmic examinations prior to such intervention.
Albrecht von Graæes Archiv für Ophthalmologie 02/2005; 243(1):60-2. · 2.17 Impact Factor
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ABSTRACT: Intracranial dural arteriovenous fistulas account for 10 to 15% of all intracranial arteriovenous malformations. Tentorial dural arteriovenous fistulas with spinal medullary venous drainage causing spinal cord myelopathy are very rare, but have been previously described. We describe a case using a cranio-orbito zygomatic approach with intraoperative angiography for the surgical treatment of a tentorial artery dural arteriovenous fistula causing spinal cord myelopathy.
A 42-year-old male presented complaining of a 1-year history of incoordination and dizziness and a 2-month history of progressive myelopathy with bowel and bladder incontinence. The patient had magnetic resonance imaging (MRI) performed along with cerebral and spinal angiography that revealed a right tentorial artery dural arteriovenous fistula with spinal medullary venous involvement down to T11. Angiographic embolization was attempted, but selective catheterization was unsuccessful. The patient underwent a cranio-orbito zygomatic approach with obliteration of the dural arteriovenous fistula. An intraoperative angiogram confirmed complete obliteration of the dural arteriovenous fistula.
Intracranial dural arteriovenous fistulas are a rare cause of spinal cord myelopathy. When a patient presents with suspicion of spinal dural fistula and negative spinal angiography, an intracranial origin should be suspected and a cerebral angiogram performed. Skull base approaches along with intraoperative angiography provide an alternative modality for obliteration of the dural arteriovenous fistula nidus, thereby eliminating the venous congestion and hence the spinal cord ischemia.
Surgical Neurology 12/2004; 62(5):463-7; discussion 467. · 1.67 Impact Factor
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ABSTRACT: Vertebral arteriovenous fistulas are rare in children and the congenital form has been seldom reported in the literature. Prior to using endovascular therapy techniques, only surgery was the main treatment. The most common endovascular treatment is through the use of detachable balloons. This report describes the clinical and radiological findings of a congenital vertebral artery fistula in a 20-month-old child. Balloons could not be safely employed; therefore, embolization was performed with Guglielmi detachable microcoils. We review the history and treatment of these lesions, their clinical presentation, and imaging features, including their outcome, with particular attention to the pediatric population.
Pediatric Radiology 06/2003; 33(5):354-6. · 1.67 Impact Factor
