Early thrombectomy of a proximal middle cerebral artery occlusion leading to complete recovery with no infarct

Many recent trials show the benefit of mechanical thrombectomy in acute ischemic stroke caused by thrombi lodged in large arteries. We report the case of a 55-year-old patient who developed sudden-onset right-sided hemiplegia and aphasia. Computed tomography angiography showed a thrombus in the M1 segment of the left middle cerebral artery. The thrombus was removed by mechanical thrombectomy 85 min after the onset of symptoms. A magnetic resonance imaging (MRI) scan showed no infarct, and the patient was discharged symptom free. To the best of our knowledge, this is the first report of thrombectomy of a symptomatic proximal middle cerebral artery occlusion leading to complete rescue, both clinically and radiologically assessed by MRI. Our case report shows that an early thrombectomy can provide an excellent outcome

Favorable effects on arterial stiffness after renal sympathetic denervation for the treatment of resistant hypertension: a cardiovascular magnetic resonance study

Aims: Renal sympathetic denervation (RDN) has recently been suggested to be a novel treatment strategy for patients with treatment-resistant hypertension. However, the latest randomized studies have provided conflicting results and the influence of RDN on arterial stiffness remains unclear. Therefore, this study aimed to detect the effects of RDN on arterial stiffness as measured with aortic pulse wave velocity (PWV) and distensibility in addition to cardiac function and T1 mapping at baseline and at 6-month follow-up. Methods: RDN was performed in a total of 16 patients with treatment-resistant hypertension, and the procedures were conducted at two university hospitals using two different RDN devices. All patients and age-matched controls underwent a comprehensive clinical examination and cardiac magnetic resonance protocols both at baseline and at a 6-month follow-up. Results: In the treatment group, the systolic blood pressure (SBP) was found to be decreased at the follow-up visit (office SBP; 173±24 compared to 164±25 mmHg [P= 0.033]), the 24-hour ambulatory SBP had decreased (163±25 compared to 153±20 mmHg [P=0.057]), the aortic PWV had decreased from 8.24±3.34 to 6.54±1.31 m/s (P=0.053), and the aortic distensibility had increased from 2.33±1.34 to 3.96±3.05 10−3 mmHg−1 (P=0.013). The changes in aortic PWV and distensibility were independent of the observed reductions in SBP. Conclusion: The arterial stiffness, as assessed with aortic PWV, and distensibility were improved at 6 months after RDN. This improvement was independent of the reduction in SBP

Incidental Intracranial Findings and Their Clinical Impact; The HUNT MRI Study in a General Population of 1006 Participants between 50-66 Years

Objectives Evaluate types and prevalence of all, incidental, and clinically relevant incidental intracranial findings, i.e. those referred to primary physician or clinical specialist, in a cohort between 50 and 66 years from the Nord-Trøndelag Health (HUNT) study. Types of follow-up, outcome of repeated neuroimaging and neurosurgical treatment were assessed. Material and Methods 1006 participants (530 women) underwent MRI of the head at 1.5T consisting of T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2* weighted and FLAIR sequences plus time of flight cerebral angiography covering the circle of Willis. The nature of a finding and if it was incidental were determined from previous radiological examinations, patient records, phone interview, and/or additional neuroimaging. Handling and outcome of the clinically relevant incidental findings were prospectively recorded. True and false positives were estimated from the repeated neuroimaging. Results Prevalence of any intracranial finding was 32.7%. Incidental intracranial findings were present in 27.1% and clinically relevant findings in 15.1% of the participants in the HUNT MRI cohort. 185 individuals (18.4%) were contacted by phone about their findings. 40 participants (6.2%) underwent ≥ 1 additional neuroimaging session to establish etiology. Most false positives were linked to an initial diagnosis of suspected glioma, and overall positive predictive value of initial MRI was 0.90 across different diagnoses. 90.8% of the clinically relevant incidental findings were developmental and acquired cerebrovascular pathologies, the remaining 9.2% were intracranial tumors, of which extra-axial tumors predominated. In total, 3.9% of the participants were referred to a clinical specialist, and 11.7% to their primary physician. 1.4% underwent neurosurgery/radiotherapy, and 1 (0.1%) experienced a procedure related postoperative deficit. Conclusions In a general population between 50 and 66 years most intracranial findings on MRI were incidental, and >15% of the cohort was referred to clinical-follow up. Hence good routines for handling of findings need to be in place to ensure timely and appropriate handling

Favorable effects on arterial stiffness after renal sympathetic denervation for the treatment of resistant hypertension: a cardiovascular magnetic resonance study

Aims: Renal sympathetic denervation (RDN) has recently been suggested to be a novel treatment strategy for patients with treatment-resistant hypertension. However, the latest randomized studies have provided conflicting results and the influence of RDN on arterial stiffness remains unclear. Therefore, this study aimed to detect the effects of RDN on arterial stiffness as measured with aortic pulse wave velocity (PWV) and distensibility in addition to cardiac function and T1 mapping at baseline and at 6-month follow-up. Methods: RDN was performed in a total of 16 patients with treatment-resistant hypertension, and the procedures were conducted at two university hospitals using two different RDN devices. All patients and age-matched controls underwent a comprehensive clinical examination and cardiac magnetic resonance protocols both at baseline and at a 6-month follow-up. Results: In the treatment group, the systolic blood pressure (SBP) was found to be decreased at the follow-up visit (office SBP; 173±24 compared to 164±25 mmHg [P= 0.033]), the 24-hour ambulatory SBP had decreased (163±25 compared to 153±20 mmHg [P=0.057]), the aortic PWV had decreased from 8.24±3.34 to 6.54±1.31 m/s (P=0.053), and the aortic distensibility had increased from 2.33±1.34 to 3.96±3.05 10−3 mmHg−1 (P=0.013). The changes in aortic PWV and distensibility were independent of the observed reductions in SBP. Conclusion: The arterial stiffness, as assessed with aortic PWV, and distensibility were improved at 6 months after RDN. This improvement was independent of the reduction in SBP

A new removable airway stent

Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use

Examples of the different scan sequences and incidental intracranial findings in the HUNT MRI cohort, i.e. meningioma (T1W 3D), glioma (FLAIR), arteriovenous malformation (T2* weighted), arachnoidal cyst (T2W weighted), aneurysms (Time of Flight angio) and silent infarctions (T1W 3D scan).

<p>Examples of the different scan sequences and incidental intracranial findings in the HUNT MRI cohort, i.e. meningioma (T1W 3D), glioma (FLAIR), arteriovenous malformation (T2* weighted), arachnoidal cyst (T2W weighted), aneurysms (Time of Flight angio) and silent infarctions (T1W 3D scan).</p

False and true positive intracranial findings and positive predictive value of initial MRI based on follow-up neuroimaging in participants in the HUNT MRI cohort with a suspected neurosurgical condition.

<p>False and true positive intracranial findings and positive predictive value of initial MRI based on follow-up neuroimaging in participants in the HUNT MRI cohort with a suspected neurosurgical condition.</p

Typical examples of Fazekas grade 1, 2 and 3 white matter hyperintensities (WMH).

<p>The examples are from the FLAIR scans of three HUNT MRI participants.</p

Scan parameters for the different sequences in HUNT MRI.

<p>Scan parameters for the different sequences in HUNT MRI.</p

Flow diagram and overview of inclusion and exclusion of participants in the HUNT MRI study, the types and prevalence of classes of intracranial findings, follow up and outcome in the included participants.

<p>Flow diagram and overview of inclusion and exclusion of participants in the HUNT MRI study, the types and prevalence of classes of intracranial findings, follow up and outcome in the included participants.</p