Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial

The final results (10-year followup data) from the Barrow Ruptured Aneurysm Trial have been recently reported here .  The study found that the final outcome as measured by percentage of patients with mRS > 2 was similar in the coiling (46.6%) vs. clipping (44.5%) group at 10 years.  There were 2 re-bleeding patients in the coiling group during follow-up period.  The aneurysm obliteration rate at 10 years favors clipping. More »

Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial

Multiple clinical trials have demonstrated the clinical benefit of mechanical thrombectomy and established thrombectomy as standard of care for appropriate patients, predominantly with use of stent retriever.   This is a multicentre, randomized, blinded outcome, non-inferiority trial evaluating the use of aspirational thrombectomy as a first-line approach for large vessel occlusion.  First pass thrombectomy with direct aspiration demonstrated non-inferior functional outcomes at 90 days when compared with stent retriever.  More »

2018-2019 Inaugural AANS/CNS Cerebrovascular Traveling Fellowship Awardees report their experience

The 2018-2019 Inaugural AANS/CNS Cerebrovascular Traveling Fellowship Awardees Andrew P. Carlson, MD, MS, FAANS and Peter Kan, MD, FAANS have completed their fellowships. Dr. Kan visited the Barrow Neurological Institute while Dr. Carlson spent time at the Université de Montréal. Dr. Carlson’s letter on his ... More »

Small Aneurysms Account for the Majority and Increasing Percentage of Aneurysmal Subarachnoid Hemorrhage: A 25-Year, Single Institution Study

Treatment of small intracranial aneurysms (IA’s) remains controversial due to perceived higher risks of treatment for small aneurysm as compared to the very lower rupture rates demonstrated during multiple prospective clinical trials. However, ruptured small IA’s are commonly encountered during clinical practice. This retrospective observational analysis of a prospectively maintained database suggests that over 25 years the percentage of very small ruptured IA’s rose from 29% in the first 5 year period, to 50% in the most recent period.  IA’s <10mm in size accounted for 84% of the aSAH.   More »

Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia

A recent study published in the journal Neurosurgery compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7,658 aneurysmal subarachnoid hemorrhage patients in Europe, USA, and Australia from 2007-2013. The findings were further explored in a large ... More »

Neck Remnants and the Risk of Aneurysm Rupture After Endovascular Treatment With Coiling or Stent-Assisted Coiling: Much Ado About Nothing?

Neck remnants are relatively common following endovascular treatment of intracranial aneurysms.  In this retrospective cohort of aneurysm patients treated with coil embolization the rate of rupture of patients with known remnants was investigated.  During the study period, factors predictive of rupture were, rupture at initial presentation, aneurysm size, and increase age of the patient.  Risk of neck remnant rupture was 0.6% and 3.4%, for aneurysms unruptured and ruptured at initial presentation, respectively.   More »

2018 AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke

The 2018 American Heart Association/American Stroke Association guidelines for early management of patients with acute ischemic stroke (AIS) has been published.  This is an updated document from 2013 AHA/ASA Acute Ischemic Stroke guidelines and 2015 AHA/ASA AIS guidelines regarding endovascular therapy. A few highlights from the current guideline are included here More »

Ralph G. Dacey, Jr. Medal for Outstanding Cerebrovascular Research

The inaugural Ralph G. Dacey, Jr. Medal for Outstanding Cerebrovascular Research was awarded to Ralph G. Dacey, Jr. at the 2018 Joint Cerebrovascular Section Meeting in Los Angeles, CA! More »

Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex

The Pipeline embolization device was initially approved by the FDA in 2011 and in 2015 the FDA approved the second generation Pipeline Flex device.  The Pipeline Flex device had the same stent technology but had enhancements allowing for resheathing, improved opening and improved navigability.  This is a single center retrospective analysis comparing 252 classic and 316 Flex Pipeline cases.  Complication rates are significantly lower with the second generation Flex device and a trend in aneurysm characteristics treated evolved toward smaller ICA and distal anterior circulation aneurysms.     More »

Spinal dural and spinal epidural arteriovenous fistula: Angiographic and clinical characteristics

In this  article  recently published in Stroke the authors analyzed 168 patients with spinal dural and epidural arteriovenous fistulas from 31 centers. Six readers analyzed the angioarchitecture. Approximately half of the epidural fistulas were incorrectly diagnosed as dural fistulas at the individual centers highlighting the ... More »

DAWN Trial - Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

This is a prospective randomized controlled trial comparing best medical therapy vs. thrombectomy plus best medical therapy for patients who presented with acute stroke to thrombectomy capable centers with a last known well of 6 to 24 hours earlier. Patients were screened using automated software to determine the volume of core infarction at presentation by MRI or CT-Perfusion.  Patients with a mismatch between clinical deficit and stroke volume permissible by the inclusion criteria were randomized to best medical therapy vs. thrombectomy plus best medical therapy.  Of patients randomized, patients were more likely have less disability in the interventional arm at 90 days compared to the best medical therapy arm.     More »

Field Testing of Medicare Episode-Based Cost Measures

CMS is currently field testing a number of episode-based cost measures that could be used to determine Medicare physician payment adjustments (both penalties and bonuses) under the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program.    During the field test, clinicians who ... More »

Significant morbidity and mortality associated with peri-operative stroke even in the era of mechanical thrombectomy

Perioperative strokes (POS) are rare but serious complications and usually cannot be treated with IV thrombolysis depending on the surgical site and of the delay from surgery.  A recent  study  aims to investigate the safety and effectiveness of mechanical thrombectomy in this group of patients. The investigators conducted ... More »

NEW Joint Cerebrovascular Section Traveling fellowship for mid-career cerebrovascular/endovascular specialists

JCVS Traveling fellowship Introducing the NEW Joint CV Section Neurovascular Traveling Fellowship for the 2018-2019 Year   The fellowship grant is a funded travel experience designed to allow mid-career trained cerebrovascular/endovascular specialists match with a host institution for 5 days to gain targeted experience in ... More »

2017 Dempsey Awardees announced

The CV section would like to congratulate the 2017 Dempsey Awardees:   Sean Polster, MD from the University of Chicago with his project, “Epithelial Barrier Dysfunction in CCM Disease.”   Tristan Stani, MD from Oregon Health and Science University Center ... More »

Robert Starke, MD from the University of Miami wins L. Nelson "Nick" Hopkins NREF Young Clinician Investigator Award

Robert Starke, MD from the University of Miami wins L. Nelson "Nick" Hopkins NREF Young Clinician Investigator Award. Project: The Role of Endothelial Cell Dysfunction & Differentiation in Aneurysms Progression & Healing https://www.nref.org/en/Research-Grants-and-Young-Clinician-Investigators/ More »

Intracranial Aneurysm Parameters for Predicting a Future Subarachnoid Hemorrhage: A Long-Term Follow-up Study.

Many retrospectives studies have suggested that morphologic features of aneurysms may represent a risk factor for subarachnoid hemorrhage(SAH).  This prospective aneurysm cohort analysis including 142 patients with 182 aneurysms demonstrates that aneurysm volume, volume to ostium area ratios(VOR), bottleneck factor separately as continuous variable predictive of aneurysm rupture.   More »

Contact aspiration versus stent retriever for mechanical thrombectomy: ASTER trial

The Contact Aspiration vs Stent Retriever for Successful Revascularization ( ASTER ) trial was a randomized, open-label, blinded endpoint multicenter study conducted in comprehensive stroke centers across France from October 2015 to October 2016. Patients who presented with acute ischemic stroke and a large vessel ... More »

Training standards in neuroendovascular surgery and CAST certification process published

The Joint Section of Cerebrovascular Surgery (JSCVS) for the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Society of NeuroInterventional Surgery (SNIS), and the Society of Vascular and Interventional Neurology (SVIN) have published a  consensus document detailing the organizational structure and requirements for institutional accreditation of training programs in neuroendovascular surgery (NES).  More »

Accuracy in Identifying the Source of Subarachnoid Hemorrhage in the Setting of Multiple Intracranial Aneurysms

In the setting of a patient with aneurysmal subarachnoid hemorrhage and multiple intracranial aneurysms the hemorrhage pattern is often the indicator of the symptomatic lesion.  However, in the setting of an indeterminate hemorrhage pattern identification of the ruptured aneurysm relies on the angiographic appearance of the lesions including ... More »

Head positioning in acute stroke

What is the ideal head position in the setting of an acute stroke? Does lying flat increase cerebral perfusion and improve clinical outcome? A recent study published in the New England Journal of Medicine assigned over 11,000 patients with an acute stroke, ... More »

Nonprocedural Symptomatic Infarction and In-Stent Restenosis After Intracranial Angioplasty and Stenting in the SAMMPRIS Trial

SAMMPRIS trial showed  30-day rate of stroke or death was higher in the PTAS group and than in the medical-management group.  In a  follow-up study , in vestigators studied th e  f requency of symptomatic in-stent restenosis (ISR) and its contribution to nonprocedural symptomatic infarction. More »

Use of Platelet Function Testing Before Pipeline Embolization Device (PED) Placement – A Mutlicenter Cohort Study

Thromboembolic complications are a significant source morbidity related to neurointerventional procedures, especially with consideration to the use of flow diverters.  Use of the PED necessitates the use of dual antiplatelet therapy to reduce this risk.  Platelet function testing remains controversial before PED placement.  Clopidogrel non-responders who received a boost dose prior to the procedure or who were converted to ticagrelor had significantly lower thromboembolic complication rates, with no significant hemorrhage complication rates, when compared to non-responders who remained on clopidogrel.   More »

Recent national database for hospital-reported outcome study shows decreased mortality for patients undergoing endovascular care for acute ischemic stroke in high-volume centers

The study included 118 institutions and 8533 patients (endovascular treatment for acute ischemic stroke) and was published in the journal Stroke recently. Both mortality and mortality index, the ratio of observed to expected mortality based on the comorbidity and demographic profile, were assessed. ... More »

Apply for a Brain Aneurysm Foundation Research Grant!

In conjunction with the Brain Aneurysm Foundation, the CV Section is happy to announce the opportunity for funding of your cerebrovascular research endeavors through the Brain Aneurysm Foundation. Please utilize this  link .  Last year the BAF awarded $310,000 to 11 recipients. ... More »

Higher risk of symptomatic ICH after thrombectomy for acute ischemic stroke in Asian population

A recently published study from a large stroke database in China found that risk of symptomatic ICH in Asian population was higher than previous RCTs, which predominantly enrolled Caucasians.  The investigators utilized data from Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry (ACTUAL), a multicenter registry program in China, to study the predictors for symptomatic ICH.   More »

Distance from lesion-to-eloquence in brain arteriovenous malformation resection

Eloquence is one of the most critical features surrounding the natural history and management of brain arteriovenous malformations (AVMs). In a  study published ahead-of-print this week in the Journal of Neurosurgery, 201 consecutive patients with brain AVMs that underwent preoperative functional MRI and diffusion-tensor imaging followed by ... More »

Vessel Wall Enhancement and Blood–Cerebrospinal Fluid Barrier Disruption After Mechanical Thrombectomy

In this recently published study, the investigators performed gadolinium-enhanced MRI to identify the rate of vessel wall permeability impairment and blood-CSF barrier (BCSFB) disruption. More »

Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial

Published ahead of print last week online in the Journal of Neurosurgery the Barrow Ruptured Aneurysm Trial (BRAT) published their subgroup analysis of only the saccular aneurysms included in the study.  The BRAT6 year results have previously been published however this subgroup analysis included review of only ... More »

The natural history of untreated, ruptured cerebral aneurysms

Data on ruptured cerebral aneurysms left unsecured are from the 1960s. This month in the journal Stroke, a group of researchers from Helsinki in Finland published their findings in a more recent cohort. The authors identified 510 patients ... More »

Coronary artery disease and diabetes associated with higher annual growth rate of brain aneurysms

In  this study  recently presented at the International Stroke Conference, investigators followed a large cohort of patients with known intracranial aneurysms and analyzed demographic and clinical factors that are associated with aneurysm growth.     Not surprisingly, the study found that mean initial size ... More »

Woven EndoBridge (WEB) technique for cerebral aneurysms

The Woven EndoBridge (WEB) technique represents an intrasaccular device designed to obliterate cerebral aneurysms and was first introduced approximately 4 years ago. Currently there are 3 versions including a double and single layer cube and a single ... More »

Winter 2017 CV Section Newsletter now available

CV Section News Now Available Dear AANS/CNS Cerebrovascular Section Members: The new issue of CV Section News is now available at CV Section Winter 2017 newsletter. The Winter edition features the Chairman's Message, presented by Kevin M. Cockroft, M.D., M.Sc. Other highlights include: ... More »

Intraventricular Nimodipine Reduces Delayed Cerebral Ischemia after aSAH

This study is a randomized, phase 1/2a, dose-escalation trial to investigate the safety and efficacy of intraventricular sustained-release nimodipine (EG-1962) in aneurysmal subarachnoid hemorrhage. The authors showed that EG-1962 is safe at 800 mg and is associated with reduced delayed cerebral ischemia and better outcome than conventional ... More »

Stereotactic radiosurgery for cerebral arteriovenous malformation: evaluation of long-term outcomes in a multicenter cohort

In this month’s Journal of Neurosurgery, a multicenter cohort study was published.  The cohort consists of 2236 patients with arteriovenous malformations (AVM) treated with stereotactic radiosurgery (SRS) and represents the largest reported series of AVM treated with SRS.  Mean patient age was 36 years and 49.6% were female.  ... More »

Calcification of the intracranial internal carotid artery affects recanalization and functional outcome after thrombectomy

In 2015, 5 large randomized clinical trials demonstrated that mechanical thrombectomy substantially improves functional outcome of patients presenting with acute ischemic stroke. The positive results of the trials were largely attributed to screening for large vessel occlusion and high recanalization ... More »

New Territory Infarction after Treatment Administration in ESCAPE trial

This study  a nalyzed infarction in a new, previously unaffected territory after acute stroke treatment in a large randomized, controlled trial and re-affirmed that endovascular thrombectomy procedure is safe and elucidated that new territory infarcts are likely "epiphenomena" of the ischemic stroke process rather than a complication ... More »

CV Section member in the news

Col. Rafael Rodriguez–Mercado,  member of the CV section,  professor of Neurosurgery at the University of Puerto Rico (UPR), School of Medicine and Director of the Endovascular Neurosurgeon and Stroke Center and  Command Surgeon for the 1st Mission Support Command (MSC), was  nominated  as ... More »

Aneurysm growth and de novo aneurysms during aneurysm surveillance

This study investigates the rate of aneurysm growth of UIAs and de novo aneurysm formation during aneurysm surveillance.   The study includes surveillance of 234 aneurysms in 192 patients.  Over the 793 years of aneurysm follow up the annual UIA growth was approximately 3.5% and the risk of de novo ... More »

Publication of the Flow Diversion in the Treatment of Intracranial Aneurysm Trial (FIAT): a randomized care trial and registry

This month the results of the Flow Diversion in the Treatment of Intracranial Aneurysm Trial (FIAT) were published ahead-of-print in the Journal of Neurosurgery. From 2011 to 2015, 78 patients were randomized between flow diversion and standard management, and 34 patients received flow diversion within a registry at 3 ... More »

Research collaboration and study recruitment

The AANS/CNS Joint Cerebrovascular Section is excited to announce that members can now take advantage of the section's electronic resources to recruit sites and co-investigators for studies or surveys.  Members with studies sponsored by institutions, government, or foundations are invited to submit a call for collaborators through the ... More »

Registration and join us for the AANS/CNS Joint Cerebrovascular Annual Meeting in Los Angeles

Registration and hotel booking is now open for the AANS/CNS Joint Cerebrovascular Annual Meeting in Los Angeles, held again in conjunction with the SNIS, February 15-16, 2016.  We anticipate an outstanding meeting.  Come hear Jean Raymond deliver the Luessenhop lecturer, and attend sessions such as 'the high-risk patient', ... More »

CAST certification pathway has been finalized

Please review the attached press release that was provided by the Neuroendovascular Surgery Advisory Committee (NESAC).  This document announces the initial step in centralized certification of training in the specialty of NeuroEndovascular Surgery as agreed upon by the specialties of Neurosurgery, Radiology and Neurology.    CAST NES Press Release 9.1.15.pdf   More »

September is Brain Aneurysm month

  September is Brain Aneurysm Month! Now for almost a decade and originally established by the Brain Aneurysm Foundation the CV section helps to provide awareness, education, research to address to improve the lives of our patients suffering from brain aneurysms   Consider going to  http://www.bafound.org ... More »

New Summer 2015 issue of CV Section News is now available

CV Section News Now Available Dear AANS/CNS Cerebrovascular Section Members: The new Summer 2015 issue of CV Section News is now available at  http://www.cvsection.org/newsletter-archive  or directly at  CV Section Summer 2015 newsletter.pdf .    Read the Chair's report, ... More »

Strong evidence for the efficacy of mechanical thrombectomy for acute stroke revealed at the International

Three randomized controlled trials, ESCAPE, EXTEND-IA, and SWIFT PRIME, presented today at the International Stroke Conference in Nashville, TN demonstrate that for acute ischemic stroke caused by large vessel occlusions, mechanical thrombectomy plus IV thrombolysis improves functional outcomes compared with IV-tPA alone. ESCAPE and ... More »

New CV Section Newsletter available!

CV Section News Now Available Dear AANS/CNS Cerebrovascular Section Members:   The new issue of  CV Section News  is now available at  CV Section Winter 2015 newsletter   The Winter edition features the Chairman's Message, presented by Brian Hoh MD, FAANS, FACS, FAHA ... More »

Registration for annual meeting 2015 is open now!

The registration for the  2015 Annual Meeting of the  AANS/CNS Cerebrovascular Section  held in partnership with the Society for Neurointerventional Surgeons (SNIS)  in  Nashville, Tennessee on February 9-10, 2015 is open now - please visit the meeting page for  details .    More »

Cerebrovascular article of the month Flow-Diverting Stents for Intracranial Bifurcation Aneurysm Treatment

Treatment of cerebral aneurysm located at vascular bifurcations with flow diverting devices has been linked with questions about the fate of the covered branch and the risk of symptomatic thromboembolic devices. A new article in NEUROSURGERY offers some data .  Dr. Saleme and colleagues  ... More »

MR CLEAN trial published - a positive randomized trial of intraarterial treatment for acute ischemic stroke

Today the New England Journal of Medicine published online first the results of the MR CLEAN trial from the Netherlands. Results.  500 patients were enrolled in the Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The authors found an absolute ... More »

CV sections now welcomes medical students!

The CV section is pleased to announce that medical students interested in the issues of cerebrovascular and endovascular neurosurgery are now welcome to join the section.  Medical student membership in the section may be granted to medical students who are already either Student ... More »

Summer 2014 CV Section Newsletter Now Available

CV Section News Now Available Dear AANS/CNS Cerebrovascular Section Members: The new issue of CV Section News is now available at  http://www.cvsection.org/mm/ files/newsletter/CV%20Section% 20Summer%202014%20newsletter. pdf The Summer edition features the Chairman's Message, presented by Brian Hoh ... More »

Call to action to support initiatives to designate September 2014 "National Brain Aneurysm Awareness Month"

Call for action by all members to support the initiatives by US representatives Pat Tiberi (R-OH) and Richard Neal (D-MA) have introduced a resolution ( H. Res. 522 ) that would designate September 2014 as “National Brain Aneurysm Awareness Month.”  A similar resolution ( ... More »

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