Mary Jensen

University of Virginia | UVa · Department of Radiology and Medical Imaging

A correction to this paper has been published: https://doi.org/10.1007/s00234-021-02735-6

Purpose: There is little data and lack of consensus regarding antiplatelet management for intracranial stenting due to underlying intracranial atherosclerosis in the setting of endovascular treatment (EVT). In this DELPHI study, we aimed to assess whether consensus on antiplatelet management in this situation among experienced experts can be achie...

Background and purpose: There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and...

In 2015, stroke was the second leading cause of death worldwide, trailed only by ischemic heart disease in global mortality (World Health Organization Global Health Observatory Data. May 2017. http://www.who.int/gho). Recognized symptoms include facial droop, extremity weakness, altered mental status, and aphasia. Strokes can be categorized into is...

Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe...

Introduction Subarachnoid hemorrhage (SAH) from posterior circulation perforator aneurysms (PCPAs) is rare and its natural history is unknown. Diagnosis may be difficult, acute management is poorly defined, and long-term recurrent SAH rates and clinical outcome data are lacking. Methods We searched our institution's records for cases of PCPA ruptu...

Objective Embolization of cerebral arteriovenous malformations (AVMs) is commonly performed prior to surgical resection in order to reduce intraoperative bleeding and improve the safety of resection. Although most modern embolization procedures utilize permanent embolic agents, silk suture and polyvinyl alcohol (PVA) particles may offer unique adva...

The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke.

Trauma involving the cervical region can result in either blunt or penetrating injury to the cervicocerebral vessels, with attendant hemorrhagic and/or neurologic sequelae. The reported incidence of carotid or vertebral artery injury in all trauma patients is 1.2-1.6 %, with an associated risk of acute cerebral ischemia in 12-15 % of affected indiv...

Background and purpose: While recent literature has described the prevalence of transverse sinus stenosis in patients with idiopathic intracranial hypertension, tinnitus, and refractory headaches, it is unclear what the prevalence is in the general population. This study evaluates the prevalence of venous sinus stenosis and hypoplasia in the gener...

Background and purpose: The Pipeline Embolization Device (PED) has been shown to effectively treat complex internal carotid artery aneurysms while maintaining patency of covered side branches. The purpose of this retrospective matched cohort study is to evaluate the effect of flow diversion on the patency of the ophthalmic artery when treating oph...

Background Overnight stay in the ICU is standard protocol after elective endovascular intracranial aneurysm coiling. Given the low expected complication rate of elective aneurysm embolizations, as well as limited resources and cost of Neuroscience ICU, we wanted to evaluate if transitioning patients to a lower acuity floor bed would be appropriate...

We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures. Patients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0-10 scale) and disability asse...

Aim: To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. Materials and methods: Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a...

Object: The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique. Methods: The authors' first 100 cons...

Background and purpose: As aneurysms arising from the ophthalmic segment of the internal carotid artery increase in size, they can compress the optic nerve, prompting patients to present with visual disturbances. The purpose of this article is to describe the clinical and angiographic results with an emphasis on visual outcomes following the endov...

The treatment of intracranial aneurysms with microsurgical clipping is associated with a very low rate of recurrence. However, in cases of aneurysm recurrence after previous clipping, microsurgical dissection due to adhesions and fibrosis may be challenging, and it may be difficult to safely occlude the recurrent lesion without the risk of signific...

Introduction/purpose Evaluation of stents using noninvasive imaging can be difficult. Artefact from the metallic struts often limits visibility within the stent on computed tomography angiograms (CTA). Special techniques developed for visualization of cardiac stents using CTA can be adapted for cervical and intracranial stent evaluation. Materials...

Introduction The treatment of large, complex intracranial aneurysms is being increasingly performed using flow-diverting stents (FDS) such as the Pipeline Embolization Device (PED). Malapposition of a FDS to the parent artery wall decreases the likelihood of aneurysm obliteration and increases the risk of both immediate and delayed complications. D...

Introduction Flow-diverting stents (FDS), such as the Pipeline Embolization Device (PED) have drastically altered the therapeutic strategies for giant intracranial aneurysms. Gaining endovascular access with a microcatheter to the portion of the parent artery distal to the aneurysm neck is requisite for safe and effective stent deployment. Giant an...

Introduction The basilar apex is the most common posterior circulation location for aneurysmal subarachnoid haemorrhage (SAH). In the current era of intracranial aneurysm treatment, the vast majority of basilar apex aneurysms are being targeted with endovascular therapy. While the obliteration and retreatment rates of endovascular aneurysm occlusio...

Introduction/purpose Aneurysms arising from the ophthalmic segment of the internal carotid artery (ICA) account for approximately 5% of all intracranial aneurysms. The Pipeline Embolization Device (PED) is a relatively new device available for treatment of these aneurysms. Here, we compare our experience with PED versus coil embolization in the tre...

Treatment of giant intracranial aneurysms, via either surgical or endovascular approaches, is associated with a high level of technical difficulty as well as a high rate of treatment-related morbidity and mortality. Flow-diverting stents, such as the Pipeline embolization device (PED), have drastically altered the therapeutic strategies for the tre...

The treatment of large, complex intracranial aneurysms is being increasingly performed using flow-diverting stents (FDS) such as the Pipeline Embolization Device (PED; ev3, Irvine, CA, USA). Malapposition of a FDS to the parent artery wall decreases the likelihood of aneurysm obliteration and increases the risk of both immediate and delayed complic...

Endovascular treatment of wide-necked aneurysms is challenging. Stent-assisted coiling (SAC) is associated with increased complications and requires dual antiplatelet therapy. To compare treatment of unruptured, wide-necked aneurysms with a dual-microcatheter technique (DMT) versus SAC. Between 2006 and 2011, 100 patients with unruptured wide-necke...

Intracranial atherosclerotic disease is the cause of up to 10% of ischemic strokes and transient ischemic attacks. Intracranial stenting with off-label balloon mounted coronary stents (BMCS) may be a viable alternative for patients with symptomatic intracranial stenosis who fail best medical therapy. Between December 2005 and June 2012, 42 symptoma...

We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction. Persistent trigeminal arteries are commonly associa...

Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. The Brain Attack Coalition conducted a...

Coil migration during endovascular treatment of intracranial aneurysms occurs in 2-6% of cases. As endovascular coiling of aneurysms has become increasingly popular and as endovascular technology continues to rapidly evolve, the prevalence of intraprocedural coil migration will invariably rise. Since coil masses are highly thrombogenic, migration o...

Introduction/Purpose Within the literature, controversy exists regarding the optimal treatment of ophthalmic segment internal carotid artery aneurysms. The close proximity of the ophthalmic artery and optic nerve increase the complexity of the disease, and the adjacent clinoid process impedes surgical exposure. This study investigates the safety an...

Introduction/Purpose Scientific data currently demonstrates the superiority of coil embolisation over open surgical clipping for the treatment of intracranial aneurysms. As technological advancements continue within the endovascular arena, these endovascular outcomes are expected to improve. Adjunct measures such as balloon remodelling and stent-as...

Introduction: The SAMMPRIS trial demonstrated that stenting for symptomatic intracranial stenosis (ICS) (70-99%) with the Wingspan system is significantly more dangerous than best medical management. The Wingspan involves a complicated four step deployment procedure; when conversely, the balloon mounted coronary stent (BMCS) is a single step proces...

Introduction: Posterior circulation perforator artery aneurysms are sparsely reported in the literature. The natural history of these rare lesions remains unclear and their diagnosis and management are not well-defined. Methods: We reviewed our institution's medical records and performed a comprehensive literature search for cases of posterior c...

Object: The objective of this study was to evaluate the incidence, severity, clinical manifestations, and risk factors of radiation-induced imaging changes (RIICs) following Gamma Knife surgery (GKS) for cerebral arteriovenous malformations (AVMs). Methods: A total of 1426 GKS procedures performed for AVMs with imaging follow-up available were a...

Stroke is the third leading cause of death in the United States, Canada, Europe, and Japan. According to the American Heart Association and the American Stroke Association, there are now 750,000 new strokes that occur each year, resulting in 200,000 deaths, or 1 of every 16 deaths, per year in the United States alone. Endovascular therapy for patie...

Introduction Endovascular coil embolization of intracranial aneurysms has been proven to be safe and efficacious, withstanding side-by-side comparison to microsurgical clipping in multiple studies. Anterior communicating artery (ACOM) aneurysms comprise approximately 30% of all ruptured aneurysms and represent the most common site of rupture. There...

Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person...

These guidelines were developed by consensus of a multidisciplinary panel of specialists interested in the evaluation and treatment of patients with arteriovenous malformations (AVMs) of the CNS. The reporting criteria described will serve as a template for trial design and for clinical investigators who wish to report on endovascular therapy of ce...

The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed...

Introduction Hemangiopericytomas (HPC) comprise 1% of intracranial neoplasms and are traditionally treated with preoperative embolization and resection. This is a case of direct transcranial puncture and Onyx embolization of a right extra-axial tentorial HPC. Materials and Methods A 61-year-old woman presented to the University of Virginia Medical...

LEARNING OBJECTIVES Discuss the evidence hierarchy and the role of randomized controlled trials (RCTs). Review the methods of INVEST and the rationale for choosing a blinded RCT to evaluate vertebroplasty. Explore the importance of blinding in the evaluation of pain by Comparing the results of INVEST to non-blinded studies of vertebroplasty. Interp...

The use of the Wingspan stent in severe intracranial stenosis is associated with a relatively high in-stent re-stenosis rate. Reported management strategies for re-stenosis have included angioplasty alone or angioplasty with placement of a second Wingspan stent. A case is presented in which thrombosis within a Wingspan stent was treated with a ball...

HANDOUT:MARY JENSEN http://media.rsna.org/media/abstract/2010/9020424/prpy275_9020424_dqww842_9020424_Jensen_final_RSNA_talk.ppt Sub-Events

Stroke is the third leading cause of death in the USA, Canada, Europe, and Japan. According to the American Heart Association and the American Stroke Association, there are now 750,000 new strokes that occur each year, resulting in 200,000 deaths, or 1 of every 16 deaths, per year in the USA alone. Endovascular therapy for patients with acute ische...

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 rates. The reports currently in the literature that describe the surgical and endovascular treatment of these aneurys...

In July 2009, Volume 1 of Journal of NeuroInterventional Surgery (JNIS) was published. The Standards and Guidelines Committee of the Society of NeuroInterventional Surgery (SNIS) were already working on the latest iteration of practice guidelines. The Executive Committee of the SNIS and the editorial leadership of the JNIS opted to publish these st...

Stroke is the third-leading cause of death in the United States, Canada, Europe, and Japan. According to the American Heart Association and the American Stroke Association, 750,000 new strokes occur each year, resulting in 200,000 deaths (or 1 of every 16 deaths) per year in the United States alone. Endovascular therapy for patients with acute isch...

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 characterization of ICA blister aneurysms. We performed a retrospective review of catheter cerebral angiograms obtained at our instit...

Purpose: The current standard of care following endovascular treatment of unruptured intracranial aneurysms entails postprocedural recovery and observation in an ICU setting. The purpose of this study is to determine whether these patients need ICU care postprocedurally, and to define predictive factors for the potential need for such care. Materi...

Fusiform aneurysms of the basilar artery present difficult challenges for the treating physician. On one hand, these aneurysms are difficult and dangerous to treat. On the other, the relatively high rupture rate, risk of thromboemboli, and the frequent presence of mass effect on the brainstem often demand treatment rather than observation. While co...

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite impr...

and designed to assist both patient and provider in decision-making about the clinical circumstance that they may en- counter. Where possible, clinical practice guidelines are statements of best practice that should be based on outcomes data of the treatments we employ. In 1989, Congress mandated the crea- tion of the Agency for Healthcare Policy a...

Stroke is the third leading cause of death in the USA, Canada, Europe, and Japan. According to the American Heart Association and the American Stroke Association, there are now 750,000 new strokes that occur each year, resulting in 200,000 deaths, or 1 of every 16 deaths, per year in the USA alone. Endovascular therapy for patients with acute ische...

To evaluate the technical and clinical success of HydroCoils in patients who underwent peripheral embolization procedures. Between July 2006 and June 2007, 12 peripheral embolization procedures with HydroCoils in 11 patients (six male patients and five female patients; age range, 4-74 years; mean age, 46 y) were available for this retrospective rev...

There is little doubt that the development and implementation of intracranial stents such as the Neuroform (Boston Scientific) and more recently the Enterprise stent (Cordis Neurovascular) in the US has enabled the successful endovascular treatment of intracranial aneurysms previously not amenable to endovascular techniques. Stent-assisted coil emb...

This article focuses on the major clinical findings, therapeutic options, and endovascular treatments available for some of the more common vascular diseases involving the intracranial circulation. The imaging modalities used in the diagnosis of the major vascular anomalies affecting the cerebral vasculature are discussed elsewhere in this volume.

It is the position of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology (‘the Societies’) that percutaneous vertebral augmentation with vertebroplasty and kyphoplasty is a...

This report describes a series of patients for whom dural arteriovenous fistulae (DAVFs) of the cavernous sinus were successfully embolized using a percutaneous, transorbital technique to directly cannulate the cavernous sinus. A vascular access needle and catheter are percutaneously advanced along the inferolateral aspect of the orbit to access th...

This 34-year-old man with a 10-year history of HIV infection presented with an acute onset of severe headache, fever, nausea, vomiting, and left-sided weakness. Computed tomography (CT) scanning demonstrated diffuse subarachnoid hemorrhage (SAH), and subsequent CT angiography revealed multiple large and giant intracranial aneurysms with diffuse vas...

Kyphoplasty is a new procedure for the treatment of vertebral compression fractures that is being performed with increasing frequency. Representing the Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology, we present a review of the available information regarding this new technology.

Endovascular coil embolisation is increasingly used to treat unruptured intracranial aneurysms (UIA). Endovascular coil embolisation of UIA is associated with a 5-10% risk of morbidity and nearly zero mortality from the procedure. Complete or near complete occlusion is usually achieved in >90% of cases, and endovascular therapy seems to reduce the...

This review, aimed at current practitioners of vertebroplasty, highlights recent changes in patient work-up and procedural techniques that have streamlined the authors' clinical practice. Preprocedural work-up, including history, physical examination, and adjunctive imaging techniques, are discussed. Technical details are reviewed, including types...

Percutaneous vertebroplasty procedures require relatively long durations of fluoroscopic guidance, which might lead to substantial radiation dose to operators. Specialized injection devices have been proposed to limit operator exposure. Our purpose was to compare the radiation dose to the operator's hands during vertebroplasty when using 1-cc syrin...

To describe the immediate outcome of a large cohort of patients who underwent percutaneous polymethylmethacrylate (PMMA) vertebroplasty for treatment of one or more vertebral fractures. This retrospective cohort study included seven university-based and private hospitals in the United States. Of 488 consecutive patients (mean age, 76 years) who und...

Some operators use the lack of point tenderness over compression fractures to exclude patients from undergoing percutaneous vertebroplasty procedures. The purpose of this study was to determine whether this lack of tenderness portends a poorer clinical outcome after vertebroplasty than is achieved in patients with such tenderness. The authors condu...

Recurrent pain after vertebroplasty is relatively common, usually representing a new fracture at a different vertebral level. In a small cohort described herein, clinical and imaging findings indicated that recurrent pain arose from abnormality of the previously treated level. Our purpose was to demonstrate that repeat percutaneous vertebroplasty p...

Thromboembolic events are a common source of complications during Guglielmi detachable coil (GDC) treatment of intracranial aneurysms. Thrombus formation at the coil-parent artery interface is not commonly reported but is an important potential source of emboli. We describe nine cases in which thrombus propagated from GDCs into the parent artery du...

Vertebroplasty performed in the mid- and upper thoracic spine presents technical challenges that differ from those in the lower thoracic and lumbar region. We herein report results of percutaneous vertebroplasty for treatment of painful, osteoporotic compression fractures in the mid- and upper thoracic spine. Retrospective chart review identified v...

Controversy exists regarding the utility of antecedent venography in percutaneous vertebroplasty. Our purpose was to determine whether antecedent venography improves clinical outcomes and/or decreases extravertebral cement extravasation in these procedures. We retrospective reviewed outcomes of consecutive percutaneous vertebroplasty procedures per...

Previous investigators have described an association between polymethylmethacrylate (PMMA) use in hip arthroplasty and cardiovascular derangement. Our purpose was to evaluate the effects of PMMA injection on patient vital signs during percutaneous vertebroplasty. We retrospectively reviewed patient charts at our institution to gather blood pressure...

Percutaneous vertebroplasty is a minimally invasive, radiologically-guided interventional procedure originally developed in France for the treatment of painful vertebral hemangiomas. The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of an acrylic polymer to provide bone augmentation and preven...

To compare the radiographic and clinical outcomes of a unipediculate approach with those of standard bipediculate vertebroplasty. Retrospective review of percutaneous vertebroplasties yielded 18 vertebrae in 17 patients that were treated with a standard bipediculate approach and 57 vertebrae in 32 patients that were treated with a modified unipedic...

The patient populations that are most likely to benefit from percutaneous vertebroplasty (PVP) are uncertain. Our purpose was to evaluate the effect of the age of vertebral compression fracture (VCF) on clinical improvement after PVP. We performed a retrospective review of charts of patients who had undergone PVP for painful osteoporotic VCFs at ou...