Moyamoya Disease in Adults: The Role of Cerebral Revascularization

Moyamoya disease is a disorder characterized by bilateral progressive steno-occlusion of the terminal internal carotid arteries with associated development of a fragile network of basal collateral vessels. It most commonly presents in children, but is also frequently seen in adults, especially in the third or fourth decade of life. Adults afflicted with this disease have very different clinical characteristics as compared with children. For example, adults more commonly present with hemorrhage than cerebral ischemia, while children present with cerebral ischemia nearly 75% of the time and very rarely present with hemorrhage. This significantly impacts treatment considerations for the adult-onset moyamoya patient, as cerebral revascularization, though well accepted in the context of cerebral ischemia, is relatively controversial for the prevention of rehemorrhage. The purpose of this article is to review the pertinent general features of moyamoya disease, examine the clinical characteristics associated with the adult-onset form of this disease, and provide a detailed discussion regarding the indications, operative techniques, and outcomes of direct and indirect revascularization surgical procedures

Use of a side branch in a saphenous vein interposition graft for high-flow extracranial-intracranial bypass procedures. Technical note.

Saphenous vein (SV) interposition grafts are often used for high-flow extracranial-intracranial bypass procedures. During these procedures, it is essential to remove air and debris from the graft and to evaluate blood flow through the graft after it has been anastomosed to other cortical vessels. In this paper, the authors describe the preservation of a large side branch on the proximal end of the SV. This side branch can be used to flush out air and debris from the graft and to evaluate blood flow during revascularization

Successful Treatment of Optic Nerve Splitting secondary to an Internal Carotid Artery Ophthalmic Segment Aneurysm: case report and literature review

Background: Ophthalmic segment aneurysms that divide the optic nerve are exceedingly rare. We present a unique case of asymptomatic optic nerve splitting secondary into internal carotid artery ophthalmic segment aneurysm that was successfully treated with flow diversion.Case Description: A 58-year-old female presented to an outside hospital with an intermittent “rubbing sound” in her right ear. Imaging was remarkable for a left anterior skull base meningioma and a left internal carotid artery ophthalmic segment aneurysm. Humphrey visual field testing confirmed lack of scotoma or visual deficit. Intraoperatively, during craniotomy for resection of the meningioma, the aneurysm dome was noted to be splitting the optic nerve with a thin layer covering the dome.Given that the patient was asymptomatic and had intact visual function, it was decided that flow diversion would be safer option than clipping to avoid any optic nerve manipulation. On follow up, the patient remained free of visual impairment with an occluded aneurysm. Conclusion: This case presentation of a unique, asymptomatic ophthalmic segment aneurysm with splitting of the optic nerve, demonstrates successful treatment with flow diversion. It is notable both for the asymptomatic presentation and for highlighting the successful treatment of this kind of aneurysm with flow diversion

Design and development of a cardiopulmonary resuscitation mattress

This study introduces the design and construction of a mattress insert to produce more effective cardiopulmonary resuscitation (CPR). The mattress insert deflates, making the mattress insert a rigid surface. Using a device that administers a constant compression depth onto a manikin, we were able to show that our mattress insert more effectively directed the compressive force to the manikin compared to the current practice of using a headboard on top of a mattress. The mattress insert produced a statistically significant increase in the compression efficiency when compared to the current practice of using the headboard (81% vs. 53%). Because the mattress insert starts deflating immediately after the vacuum is turned on, 1 person is needed to initiate chest compressions. Compression begins while the mattress deflates. Running compression tests at incremental time periods, we found that our design reaches and surpasses the compression efficiency when using a headboard in 10 seconds. © 2009 SAGE Publications

Aggressive vertebral hemangioma masquerading as neurological disease in a pediatric patient.

Aggressive hemangioma is a rare vertebral lesion in pediatric patients which can present with deteriorating neurological function. It can mimic malignancy on imaging, particularly as it regularly has an extrasosseous soft tissue component. We present a case of a 13-year-old male who presented with a three month history of lower extremity weakness that was found to have an infiltrative mass at T10 with associated cord compression from epidural extension of the lesion. In this report we review the characteristic imaging findings associated with aggressive hemangioma, including its appearance on read-out segmented diffusion-weighted images. It is imperative that radiologists who interpret studies of children be aware that this lesion exists and what it looks like, as it can be associated with massive hemorrhage if encountered unexpectedly during surgery

Abstract Number ‐ 25: Acute Ischemic Stroke Intervention With Penumbra RED Reperfusion Catheters: Updated Subset Analysis From INSIGHT Registry

Introduction The prospective INSIGHT Registry is a multicenter ‘multi‐omic’ analysis of thrombi associated with acute hemorrhagic or ischemic stroke. This updated interim analysis evaluated the performance of Penumbra RED catheters used during aspiration thrombectomy for acute ischemic stroke (AIS). Methods All AIS cases in which Penumbra RED aspiration catheters (RED 62, 68, or 72) were utilized as a frontline treatment were included in the analysis. Retrieved clot fragments were classified based on their gross appearance. Key time metrics and procedural data were also collected, including first‐pass / post‐procedure modified Treatment in Cerebral Ischemia (mTICI) score. Results Of 400 patients enrolled across 25 US centers, 161 underwent thrombectomy with Penumbra RED catheters over ten months (Jul 2021 through Apr 2022). The mean patient age was 70.7 years, and 50.9% were female. The middle cerebral artery first segment (M1) was the most common primary occlusion site (60.4%; 96/159). IV t‐PA was administered before the procedure in 13.7% (22/161) of patients. The median time from stroke onset / last known well to mTICI≥ 2b was 5.0 hrs. [IQR 3‐11], and the median time from a puncture to mTICI≥ 2b was 23.0 mins [IQR 15‐31]. Firm‐red clots represented 45.3% (67/148), while soft‐red clots were found in 37.8% (56/148) of retrieved clots. In turn, firm‐white and soft‐white clots were seen in 11.5% (17/148) and 5.4% (8/148) of cases, respectively. Rates of the first pass and final mTICI≥ 2b scores by clot type are shown in Table 1. Conclusions Aspiration thrombectomy with Penumbra RED catheters resulted in good revascularization rates for all clot types