Don Heck's research while affiliated with Winston-Salem State University and other places

Publications (24)

Article
Background The DAWN and DEFUSE-3 trials showed the benefit of endovascular treatment (EVT) in acute ischemic stroke patients presenting beyond 6 hours from last known well (LKW) and selected by perfusion imaging criteria. The ESCAPE NA1-trial selected patients based on non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS) and multi...
Article
The overwhelming benefit of endovascular therapy in patients with large-vessel occlusions suggests that more patients will be screened than treated. Some of those patients will be evaluated first at primary stroke centers; this type of evaluation calls for standardizing the imaging approach to minimize delays in assessing, transferring, and treatin...
Conference Paper
Introduction Various thrombectomy devices promise high rates of recanalization and reduction of disability. A recent meta-analysis of the Solitaire device demonstrated its utility as safe and effective in revascularization of large vessel occlusions. The present analysis seeks to determine if good clinical outcome can similarly be achieved by the 3...
Article
Recent randomized clinical trials1–5 established the superiority of endovascular recanalization techniques, specifically mechanical embolectomy, compared with best medical therapy alone for the treatment of patients with emergent large vessel occlusion (ELVO) stroke. ELVO stroke is defined as a stroke secondary to anterior circulation large vessel...
Article
Vascular malformations, including VM and LM, of the head and neck are effectively treated by percutaneous sclerotherapy with an excellent clinical response in the majority of patients. Minor complications related to treatment occur in 10-12% of patients treated with detergent sclerosants and in up to 50% of patients when absolute ethanol is used. M...
Article
The field of neurointerventional surgery (NIS) has undergone a truly remarkable maturation over the past decade. This maturation is largely based upon two fundamental, but sometimes seemingly diametrically opposed, factors. First, industry-driven research and development provides us with new devices at an accelerating pace. Some are truly novel (eg...
Article
Full-text available
To summarize the current literature regarding the initial hospital management of patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO), and to offer recommendations designed to decrease the time to endovascular treatment (EVT) for appropriately selected patients with stroke. Using guidelines for evidenced-bas...
Article
Full-text available
Stroke is the leading cause of adult disability in North America and is the fifth most common cause of death.1 ,2 The natural history of patients with acute ischemic stroke and occlusion of a major intracranial vessel such as the internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery is dismal, with high rates of mortality a...
Article
Purpose The Penumbra RubyTM Coil system (Penumbra Inc., Alameda, California) is a new generation of larger (0.020 inch) platinum detachable coils that are designed for arterial and venous embolization in the peripheral vasculature. Recent literature has been published indicating the importance of higher packing density and its impact on occlusion s...
Article
Purpose Thin-section (≤2.5 mm) NCCT is a dependable method for measurement of clot length in documented anterior circulation occlusions. A majority of clots in the proximal anterior circulation are ≥8 mm, which have low probability of revascularization with IV rtPA alone. Nevertheless, past studies have had sampling restrictions, and correlations o...
Article
Introduction/Purpose The Penumbra START Trial is a multicentre, prospective, single-arm trial with a primary aim of determining whether core infarct size on pre-treatment neuroimaging predicts clinical response to intra-arterial acute stroke therapy. Materials and Methods For this study, major inclusion criteria include presence of proximal artery...
Article
Background and purpose: Revascularization of acute ischemic stroke from a large vessel occlusion continues to be a challenge with current thrombectomy devices. The purpose of the SPEED study was to report the safety and effectiveness of the Penumbra 054 Reperfusion Catheter System in revascularizing large vessel occlusions. Methods: In this retr...
Article
Introduction/purpose There is no standard imaging approach for EVT patient selection. CT remains the most widely used modality for stroke evaluation. Ischemic change on non-contrast CT (NCCT) quantified using ASPECTS has been demonstrated to predict clinical response to EVT. To date, definitive studies evaluating the impact of CTA source image (CTA...
Article
Major ischemic strokes secondary to proximal artery occlusions are responsible for significant morbidity and mortality. Owing to extensive clot burden, these strokes are poorly responsive to intravenous tissue plasminogen activator. The introduction of endovascular therapy, particularly mechanical devices, has resulted in markedly improved recanali...
Article
PurposeThe 054 reperfusion catheter is a newly introduced component of the Penumbra System specifically designed to enhance aspiration efficiency by increasing the catheter diameter. The goal of this study was to compare its safety and effectiveness in reducing clot burden in the internal carotid artery (ICA) and the middle cerebral artery (MCA).Me...

Citations

... Several simplified, less restrictive imaging selection modalities involving more specific imaging parameters such as the Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast computed tomography (NCCT) 8 or the collateral circulation status on CT angiography (CTA) have been researched in some studies, and showed that the NCCT±CTA imaging selection modality may be safe and beneficial for EVT in selected patients in the late time window. [9][10][11][12] This study aims to compare the more simplified NCCT±CTA imaging with CTP imaging for patient selection for EVT in the extended window. A meta-analysis of published high-quality observational studies was conducted. ...
... 120 The adoption of NCCT and CTA-based imaging selection for the 6-to 24-hour time window would also have implications for stroke systems of care because this simplified imaging paradigm can be used at centers that lack CTP and acute phase MRI capabilities to triage patients for EVT without the need for implementing perfusion imaging. 12,121 While this would expand access, it may not identify all patients who could benefit from EVT. ASPECTS has limited correlation with lesion volume and many patients with low ASPECTS can have relatively small ischemic core volumes and would be eligible for treatment using a mismatch paradigm. ASPECTS also has limited applicability outside patients with M1 occlusion. ...
... The guidelines recommend maintaining BP after EVT below the level of 180/105 mmHg. However the expert opinion in EVT is to lower BP to 140/90 mmHg in patients with successful reperfusion, aiming to prevent cerebral haemorrhage and reperfusion injury as it was conducted in the DAWN trial [57]. Recent studies seem unanimous in concluding that higher BP values 24 hours after thrombectomy are associated with worse functional outcomes (Tab. 1) [37,38,[58][59][60]. ...
... Hospital variables included bed size, teaching status, and SAH case-volume (>20 annual cases defined as certified stroke center by Joint Commission). 7 Preexisting comorbidities of interest included autosomal dominant polycystic kidney disease, collagen vascular disorder (includes Ehler-Danlos and Marfan syndromes), chronic kidney disease (CKD), coronary artery disease, congestive heart failure, diabetes with/without chronic complications, chronic HTN, obesity, and peripheral vascular disease. 5 Substance use disorders included alcohol, cannabis, tobacco smoking, and stimulants. ...
... This is intended to avoid the EVT treatment delays and worse outcomes associated with initial transportation to a non-EVT centre followed by an interfacility transfer to an EVT centre. [2][3][4][5] Most scales assign points based on the absence, presence or gradations of severity of examination findings and provide either a binary positive or negative result or a total score. LVO prediction scales that provide total scores each have a standard scale score threshold, often suggested by the researchers who created the scale, that is typically used to declare it positive or negative. ...
... It is significantly more effective in macrocystic LMs [20] than microcystic LMs [21]. Sclerosants, generally used as monotherapy, are tissue irritants that cause endothelial damage and inflammation, thus leading to fibrosis and vascular obliteration [22,23]. They are injected after aspiration of the cystic content and opacification, for a volume of 30% to 50% of the aspirated cystic content. ...
... Dural arteriovenous fistulas (DAVF), also known as dural arteriovenous shunts, are abnormal acquired intracranial vascular malformations consisting of pathological connections located within the dura between the pial arteries (occasionally) and the veno vasora, comprising the walls of the dural sinuses, bridging veins, or transosseous emissary veins [1]. It was described for the first time in 1881 by Rizzoli, and the first angiographic description was reported by Sachs in 1931 [2]. ...
... RCTs remain poorly accepted by patients and the medical community alike [10,[50][51][52]. One obstacle is the notion that by participating in a RCT, the clinician abdicates and the patient exchanges a personalized decision for randomized allocation, a method whose sole purpose is to decrease bias and provide generalizable knowledge. ...
... No guidelines have provided recommendations for the onset-to-reperfusion time. The guidelines from the Society of Neurointerventional Surgery state that door-to-puncture and door-to-reperfusion should be performed within 60 min and 90 min, respectively [17]. A literature search for clinical studies on door-to-puncture, door-to-reperfusion, and onset-to-puncture yielded 56, 27, and 61 articles, respectively. ...
... The 2011 Penumbra SPEED study [20] assessed the safety and efficiency of the 054 catheter, which was added to the existing 3 catheters of the Penumbra system in 2009. It features a larger, 0.064 in., proximal internal diameter for enhanced aspiration efficiency. ...