Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report

<p>Abstract</p> <p>Background</p> <p>The primitive trigeminal artery (PTA) is the most commonly described fetal anastomosis between the carotid and vertebrobasilar circulations.</p> <p>Case presentation</p> <p>We report a 42-year-old patient presenting with internal carotid dissection, and imaging features of brainstem infarction.</p> <p>Conclusion</p> <p>Based on the imaging studies we presume occlusive carotid dissection with extensive thrombosis within a persistent trigeminal artery as the cause of this brainstem ischemia.</p

Standards of Practice in Acute Ischemic Stroke Intervention: International Recommendations

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Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry

Introduction Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. Methods A multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (>= 90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up. Results A total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259 +/- 120 min vs 305 +/- 202 min;p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b-3 reperfusion was lower in the EICA occlusion group (70% vs 81%;p=0.03). The favorable outcome (90-day mRS 0-2), intracerebral hemorrhage and procedural complications were similar in both groups. Conclusion Atherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b-3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis

Automated registration of 3D x-ray angiography images to magnetic resonance images

International audienceAn automated algorithm for frameless registration of intra-cranial 3D X-ray angiograms (3DXA) to Magnetic Resonance (MR) images is described and evaluated. The registration procedure starts with the manual designation of a pre-defined anatomical point in both modalities. Then, the registration is performed through an iterative process that alternatively estimates the rotation and translation using an original correlation optimization scheme. The evaluation procedure implied comparisons with both manual (11 cases) and stereotactic frame based (9 cases) registration. The results encompass that manual registration is not a viable method of reference for registering such volumes whereas stereotactic frame (or equivalent means) is acceptable for validation purpose. A maximum error of 4 mm was measured for our automated algorithm while variations of up to 5 mm were considered on the initial point location. Convergence time was below 1 minute while an average time of 30 minutes was required to perform manual registration. This validation procedure demonstrates a good precision for the automated algorithm when compared to a stereotactic frame based matching. Such an algorithm could make the intra-cranial pathology assessment more reliable, enable frameless radiotherapy planning of AVMs in 3D, ease biopsy planning in neurosurgery or be helpful foreducational purpose

Standards of practice in acute ischemic stroke intervention: international recommendations

This article was first published in JNIS. Cite this article as: Pierot L, Jayaraman MV, Szikora I, et al. Standards of practice in acute ischemic stroke intervention: international recommendations. Journal of NeuroInterventional Surgery. Published Online First: 28 August 2018. doi: 10.1136/neurintsurg-2018-014287

Standards of practice in acute ischemic stroke intervention: international recommendations

This article was first published in JNIS. Cite this article as: Pierot L, Jayaraman MV, Szikora I, et\ua0al. Standards of practice in acute ischemic stroke intervention: international recommendations. Journal of NeuroInterventional Surgery. Published Online First: 28 August 2018. doi: 10.1136/neurintsurg-2018-014287