Category Archives: Editor’s Choices

Editor’s and Fellows’ Journal Club Choices, February 2013

Editor’s Choices

Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage • J.P. Cruz, C. O’Kelly, M. Kelly, J.H. Wong, W. Alshaya, A. Martin, J. Spears, and T.R. Marotta
The authors used the Pipeline device to treat 20 patients with acutely ruptured intracranial aneurysms. The most common types of aneurysms treated were blister and dysplastic/dissecting. Procedure-related morbidity/mortality overall was 15%, and 1 death directly related to the procedure occurred. Occlusion rates were 75% and 94% at 6 months and 12 months, respectively. The authors concluded that the Pipeline device offers a feasible treatment option in acute or subacute ruptured aneurysms, especially the … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, January 2013

Editor’s Choices

Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma • F.E. Valles, C.L. Perez-Valles, S. Regalado, R.F. Barajas, J.L. Rubenstein, and S. Cha
Here, the authors sought to determine if ADC values and perfusion measurements provided prognostic information in 25 treatment-naïve immunocompetent patients with brain lymphoma. The studied parameters were obtained from the enhancing tumor regions. The results of this investigation reinforce the validity of ADC values as a prognostic biomarker and provide evidence of low tumor CBV as a novel risk factor for adverse prognosis in immunocompetent … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, December 2012

Editor’s Choices

Association between Carotid Artery Plaque Type and Cerebral Microbleeds • L. Saba, R. Montisci, E. Raz, R. Sanfilippo, J.S. Suri, and M. Piga
This article explores the relationship between brain microbleeds and the type of plaque occurring in the carotid arteries of these patients. The authors assessed the plaques using CT and brain MRI with blood-sensitive gradient-echo sequences (they did not use SWI). Thirty percent of patients showed microbleeds; one-half were symptomatic. A statistically significant association between cerebral microbleeds and fatty carotid plaques was found.

Efficacy and Safety of Flow Diversion for Paraclinoid Aneurysms: A Matched-Pair Analysis Compared Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, November 2012

Editor’s Choices

Spinal Dural Fistulas without Swelling and Edema of the Cord as Incidental Findings • W.J. van Rooij, R.J. Nijenhuis, J.P. Peluso, M. Sluzewski, G.N. Beute, and B. van der Pol
This short report describes 5 patients with incidentally found spinal dural AVFs without cord edema. All patients were adults and were being imaged for nonspecific back pain. Four AVFs were conal and one was cervical. Generally, at the time of diagnosis, patients with spinal AVFs have long-standing symptoms and cord edema and the classic imaging triad of cord edema, dilated perimedullary veins, and, at times, contrast cord enhancement … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, October 2012

Editor’s Choices

Closed-Cell Stent for Coil Embolization of Intracranial Aneurysms: Clinical and Angiographic Results • A.K. Wakhloo, I. Linfante, C.F. Silva, E.A. Samaniego, G. Dabus, V. Etezadi, G. Spilberg, and M.J. Gounis
Because recanalization is observed in 20–40% of endovascularly treated aneurysms, these authors report their experience using a closed-cell stent. They treated 161 wide-neck ruptured or unruptured aneurysms with the device and found a nearly 5% death rate and a 3.5% incidence of neurologic deficits. Of the ones available for follow-up, 10% of patients showed recanalization and 6% required retreatment. In-stent stenosis was seen in only 1 instance. Treatment … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, August 2012

Editor’s Choices

Carotid Atherosclerotic Plaque Progression and Change in Plaque Composition Over Time: A 5-Year Follow-Up Study Using Serial CT Angiography  M.J. van Gils, D. Vukadinovic, A.C. van Dijk, D.W.J. Dippel, W.J. Niessen, and A. van der Lugt
These authors studied temporal changes in plaque size and composition using CTA. Their subjects were 109 patients who underwent baseline and follow-up CTA of the extracranial internal carotid arteries during an average 5-year period. When plaque volumes increased (69%) these did so at a rate of 1.2% per year. Composition changes included decreasing lipids (1.8%) and fibrous tissues (1.5%) as well … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, June/July 2012

Editor’s Choices

Interobserver Reliability of Baseline Noncontrast CT Alberta Stroke Program Early CT Score for Intra-Arterial Stroke Treatment Selection • A.C. Gupta, P.W. Schaefer, Z.A. Chaudhry, T.M. Leslie-Mazwi, R.V. Chandra, R.G. González, J.A. Hirsch, and A.J. Yoo
The ASPECTS has been shown to predict outcomes of early ischemic patients after intra-arterial therapy by providing semiquantitative data regarding infarction core. In this article the authors assessed the interobserver reliability of this scale in patients with proximal occlusions. CT studies in 155 patients were retrospectively analyzed by 2 independent observers. Among patients with anterior circulation proximal artery occlusions who were eligible for … Continue reading >>

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Editor’s and Fellows’ Journal Club, May 2012

Editor’s Choices

Clinical Correlation of a New MR Imaging Method for Assessing Lumbar Foraminal Stenosis • H.-J. Park, S.S. Kim, S.-Y. Lee, N.-H. Park, M.-H. Rho, H.-P. Hong, H.-J. Kwag, S.-H. Kook, and S.-H. Choi
Two different systems for grading foraminal stenosis, the Wildermuth (degree of fat obliteration) and the Lee system (type of stenosis, degree of fat obliteration, and nerve root compression) were assessed and correlated with clinical findings. Interobserver agreement was greater with the Lee system. Both systems had good correlation with clinical symptoms, especially for older patients, but the Lee system was better for younger subjects. Although … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, April 2012

Editor’s Choices

Delayed Ipsilateral Parenchymal Hemorrhage Following Flow Diversion for the Treatment of Anterior Circulation Aneurysms • J.P. Cruz, M. Chow, C. O’Kelly, B. Marotta, J. Spears, W. Montanera, D. Fiorella, and T. Marotta
Acute and subacute complications from the use of the Pipeline device are becoming evident. Here, the authors report delayed ipsilateral hemorrhage in 8.5% of patients with anterior circulation aneurysms treated with this device. All bleeds were distant from the treated aneurysms. All procedures were done without complications and when waking after the embolization all patients were normal. Despite this, hemorrhages occurred 1–6 days postprocedure, and were … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, March 2012

Editor’s Choices

Comparison of Hospitalization Costs and Medicare Payments for Carotid Endarterectomy and Carotid Stenting in Asymptomatic Patients • R.J. McDonald, D.F. Kallmes, and H.J. Cloft
What is more expensive, carotid endarterectomy or stenting? The authors used Medicare data from elderly patients to explore this issue and identify variables that increased costs. Data were obtained from government sources for 2001-2008 and a total of 12,485 stentings and 181,200 endarterectomies were studied. Not surprisingly, the payments for stenting were $3241 less than costs and those for endarterectomy were $1318 less than costs. Greater disparities between payment and costs were found for … Continue reading >>

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