Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry

Introduction

The ENDOSTROKE registry aims to accompany the spreading use of endovascular stroke treatment (EVT) in academic and non-academic hospitals. This analysis focuses on preprocedural imaging, patient handling and referral, as well as on different treatment modalities in mechanical recanalization.

Methods

Data for this study were from observational registry study in 12 stroke centers in Germany and Austria with online assessment of prespecified variables concerning endovascular stroke therapy.

Results

Data from 734 patients undergoing EVT were analyzed. Preferred imaging modality prior to EVT was CT (83 %) and CTA (78 %). In 95 %, EVT was performed under general anesthesia. In 55 % of patients, a combination of intravenous (IV) thrombolysis and EVT was used, followed by pure EVT (25 %), intra-arterial (IA) thrombolysis plus EVT (13 %) and IV?+?IA thrombolysis plus EVT (7 %). Intrahospital time delay until start of EVT was 91 and 99 min in anterior and vertebrobasilar circulation stroke, respectively. Average duration of EVT was 60 min. Overall thrombolysis in myocardial infarction grade 2/3 recanalization rate was 85 %. Stent retrievers were used in 75 %, being associated with higher recanalization rates than non-stent retrievers. Hemorrhagic complications (symptomatic and asymptomatic) occurred in 12 %. Overall vessel occlusion time was approximately 60 min longer in patients being referred from a primary care hospital for EVT.

Conclusion

This study gives an overview of procedure-related factors in current EVT practice. It gives estimates on preprocedural imaging modalities, periprocedural handling, and treatment combinations used for EVT. Patient referral for EVT from primary care hospitals is associated with longer vessel occlusion times.     

Initial experience of carotid artery stenting using the Carotid WALLSTENT and FilterWire EZ in Japan

Purpose

The Carotid WALLSTENT (CWS) and Filter-Wire EZ (FWEZ) embolic protection devices for use in carotid arterial stenting (CAS) were newly approved for national health insurance coverage in Japan in April 2010. This article describes our initial experience of CAS using the CWS and FWEZ.

Material and methods

A group of 14 patients (12 men, 2 women; mean age 70.1 years, range 59?C83 years) with 15 carotid artery stenoses at high risk for carotid endarterectomy were treated by CAS using the CWS and FWEZ. Of these stenoses, 5 were symptomatic with ??50% stenosis of the common or internal carotid artery (ICA), and 10 were asymptomatic with ??80% stenosis. The rates of technical success, ICA flow impairment during filter protection, periprocedural ischemic stroke, 30-day major adverse events (MAEs) (stroke, death, myocardial infarction), and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed.

Results

CAS was successful in all cases. There was no ICA flow impairment, periprocedural ischemic stroke, or MAEs. DWI showed new ipsilateral ischemic lesions in only one patient (6.7%).

Conclusion

Our initial clinical experience using the CWS and FEWZ for CAS was generally excellent, and the incidence of postprocedural ischemic lesions was low.     

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

Purpose

Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS.

Methods

In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic ≥50 %, asymptomatic ≥80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C ≥120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C <120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed.

Results

Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (β = 0.74, 95 % confidence interval 0.070–1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.

Conclusion

Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.     

Complication rate in unprotected carotid artery stenting with closed-cell stents

Introduction

The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs.

Methods

We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals.

Results

The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month.

Conclusion

Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable.     

Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease

Background

Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD.

Methods

From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%.

Results

Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ≥100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ≥400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100-399 and ≥400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms.

Conclusions

CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD.     

Carotid artery stenting: findings based on 8 years’ experience

Purpose

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates.

Materials and methods

In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure.

Results

Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses >80% were treated with a repeated endovascular procedure.

Conclusions

A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.     

Calcium at the carotid siphon as an indicator of internal carotid artery stenosis

Objectives

Carotid siphon calcification is often visible on unenhanced head CT (UCT), but the relation to proximal carotid artery stenosis (CAS) is unclear. We investigated the association of carotid siphon calcification with the presence of CAS.

Methods

This IRB-waived retrospective study included 160 consecutive patients suspected of stroke (age 64?±?14 years, 63 female) who underwent head UCT and CTA of the head and neck. CAS was rated on CTA as not present or present with non-significant (<50 %), moderate (50–69 %) or significant (≥70 %) stenosis. Presence, shape (on UCT) and volume (on CTA) of carotid siphon calcifications were related to CAS.

Results

Carotid siphon calcification was absent in 41 % of patients and bilateral in 94 % of those with calcifications. Presence, shape and volume of calcification resulted in odds ratios for having significant CAS of 10.1, 3.9 and 8.4, with 95 % CIs of 1.3–79.6, 1.1–14.1 and 2.6–26.8, respectively. Corresponding NPVs were 0.98, 0.98 and 0.96, while PPVs were 0.14, 0.07 and 0.29, respectively.

Conclusion

Absence of calcification in the carotid artery siphon on UCT has high negative predictive value for carotid artery stenosis in patients with suspected stroke. However, siphon calcification is not a reliable indicator of significant carotid artery stenosis.

Key Points

? Many stroke patients do not have calcification in the carotid artery siphon. ? Carotid stenosis ≥50?% is unlikely in stroke patients without siphon calcification. ? Carotid siphon calcium is a poor indicator of significant carotid artery stenosis.     

Karotisstents – eine Standortbestimmung

Clinical/methodical issue

Therapy of carotid stenosis should be based on an accurate assessment of the stenosis and a differentiation between symptomatic and asymptomatic patients.

Standard radiological methods

According to current guidelines carotid artery stenting (CAS) can be considered as an established therapeutic alternative to carotid endarterectomy (CEA).

Methodical innovations

For the therapy of carotid stenosis CAS has become established as a minimally invasive alternative to CEA because the complication rate has been reduced due to growing experience, technical innovations and external quality assessment.

Performance

The CAS procedure should be performed in centers with documented complication rates of <?3?% for asymptomatic and <?6?% for symptomatic stenoses.

Achievements

Overall there are no significant differences between CAS and CEA in the treatment of carotid stenosis concerning the secondary prophylactic effect.

Practical recommendations

Ideally an interdisciplinary approach should be chosen for the therapy regime. Revascularization of asymptomatic stenoses should be considered critically as these patients might profit from optimized conservative medicinal therapy.     

Predictive factors of outcome and hemorrhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever

Introduction

The study attempts to identify notable factors predicting poor outcome, death, and intracranial hemorrhage in patients with acute ischemic stroke undergoing mechanical thrombectomy with stent retriever. These data could be useful to improve the selection of patients for thrombectomy.

Methods

Patients with acute ischemic stroke treated with the Solitaire FR device were retrospectively analyzed from a prospectively collected database. We assessed the effect of selected demographic characteristics, clinical and imaging factors on poor outcome at 3 months (modified Rankin score 3–6), mortality at 3 months, and hemorrhage at day 1 (symptomatic and asymptomatic).

Results

From May 2010 to April 2012, 59 consecutive patients with an acute ischemic stroke underwent mechanical thrombectomy. At 3 months, 57.6 % of the patients were functionally independent (modified Rankin Scale 0–2) and mortality was 20.4 %. Multivariate analyses revealed that a thrombus length?>?14 mm (p?=?0.02; OR 7.55; 95 % CI 1.35–42.31) and longer endovascular procedure duration (p?=?0.01; OR 1.04; 95 % CI 1.01–1.07) were independently associated with poor outcome. A higher baseline Alberta Stroke Program Early CT (ASPECT) score (p?=?0.04; OR 0.79 per point; 95 % CI 0.63–0.99) and successful recanalization (p?=?0.02; OR 0.07; 95 % CI 0.01–0.72) were independent predictors of good functional outcome. Baseline ASPECT score (p?<?0.01; OR 0.65; 95 % CI 0.54–0.78) independently predicted symptomatic intracranial hemorrhage at day 1.

Conclusion

Absolute baseline ASPECT score reflects early symptomatic hemorrhage risk and functional outcome at 3 months. Thrombus length measured on MRI play an important role on functional outcome at 3 months after thrombectomy. Further analyses are needed to determine its importance in the selection of patients for mechanical thrombectomy.     

Mechanical thrombectomy in acute ischemic stroke—experience from 6 years of practice

Introduction

We present our results from the first 6 years with mechanical thrombectomy in the treatment of ischemic stroke.

Methods

Every patient treated with mechanical thrombectomy for acute ischemic stroke from September 2005 to December 2011 was consecutively included in this retrospective analysis. Baseline and outcome data were retrieved from computerized records at the hospital. National Institute of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were used as outcome parameters. Favorable outcome was defined as a mRS score of 0–2, corresponding to independence in activities of daily living. We also evaluated revascularization and severe adverse events, with focus on symptomatic intracranial hemorrhage.

Results

Good functional outcome (mRS 0–2) was achieved in 50 % (120/240) of all patients. For patients with no neurological deficit prior to stroke onset (i.e., mRS?=?0 before stroke), the proportion with good functional outcome was 54 %. Symptomatic hemorrhages occurred in 4.6 % of the cases (5.7 % in the anterior circulation).

Conclusion

In summary, our results supports that mechanical thrombectomy is a safe and effective method to restore blood flow in selected patients suffering from an acute ischemic stroke.     

Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review

Objective

To review the literature regarding normal labral variants at MRI.

Methods

A systematic search was performed in PubMed/MEDLINE and Embase. For each included study, information regarding normal labral variants and findings in asymptomatic subjects was extracted.

Results

There were 24 studies in symptomatic patients, evaluating 822 hips. The presence of a sublabral sulcus was reported by four studies in 41 hips (5 % of all evaluated hips), occurring at all anatomical locations. There were 3 cadaver studies, investigating 32 hips and reporting no normal labral variants. There were 8 studies in asymptomatic subjects, evaluating 1,096 hips. Labral tears were reported in 213 hips (19 %); no sublabral sulci were reported. Labral shape was most commonly triangular (59–89 %), whereas rounded (11–16 %), flattened (13–37 %) and teardrop (41 %) shapes were less frequently seen. Overall methodological quality of included studies was moderate, with median total quality scores of 43 % (symptomatic patients), 71 % (cadavers) and 70 % (asymptomatic subjects).

Conclusion

At MRI, a sublabral sulcus can be found at any anatomical location. Our results suggest that its prevalence is at least 5 % in symptomatic patients. The most common labral shape is triangular. Rounded, flattened and teardrop shapes are less frequent but are also encountered in asymptomatic subjects.

Key Points

? A sublabral sulcus can be detected by MRI at any anatomical site ? Its prevalence is estimated to be at least 5 % in symptomatic patients ? The most common shape of the hip labrum is triangular ? Rounded, flattened and teardrop shapes are less frequent     

Prognostic performance of coronary computed tomography angiography in asymptomatic individuals as compared to symptomatic patients with an appropriate indication

Introduction

Current Appropriatene Usa Criteria exclude coronary computed tomography angiography (CTA) in asymptomatic individuals. We compared the prognostic value of coronary CTA in asymptomatic individuals to symptomatic patients with “definitely appropriate” indications for coronary CTA.

Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

Purpose

Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS.

Methods

Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up.

Results

The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482–0.977] at 6 months and 72.7 % (95 % CI 0.390–0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587–0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156–2,282).

Conclusion

The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.     

Outcome of mechanical thrombectomy with Solitaire stent as first-line intra-arterial treatment in intracranial internal carotid artery occlusion

Introduction

Acute stroke from occlusion of the intracranial internal carotid artery (ICA) is associated with a poor clinical outcome despite a thrombolytic treatment. The purpose of this study was to evaluate the outcome of mechanical thrombectomy using the Solitaire stent for the treatment of acute stroke patients with intracranial ICA occlusion.

Methods

A total of 104 consecutive patients with acute stroke were treated with mechanical thrombectomy using the Solitaire stent as a first-line intra-arterial treatment. We retrospectively reviewed data from 26 of these patients who presented with acute stroke attributable to intracranial ICA occlusion. Rescue treatments in cases of failed Solitaire thrombectomy included intra-arterial urokinase, angioplasty, and forced suction thrombectomy. Successful recanalization was defined as thrombolysis in cerebral ischemia grades 2b to 3. Outcome measure was the modified Rankin Scale (mRS) score of 0–2 at 3 months.

Results

Successful recanalization was achieved in 77 % (20/26) of patients. Recanalization was achieved with the Solitaire stent alone in 69 % (18/26) of patients. Ten patients (39 %) had a good clinical outcome (mRS score of 0–2) at 3 months. There was a good outcome in 50 % of patients (10/20) with recanalization and no good outcome in patients (0/6) without recanalization (P?=?0.027). None of eight patients who received rescue treatments showed a good outcome. No symptomatic intracerebral hemorrhage occurred. Mortality was 8 % (2/26) at 3 months.

Conclusion

Mechanical thrombectomy using the Solitaire stent can achieve a high rate of successful recanalization and a very low rate of symptomatic hemorrhage and thus improve a clinical outcome in patients with acute intracranial ICA occlusion.     

Perforation rate in CT colonography: a systematic review of the literature and meta-analysis

Purpose

The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication.

Methods

Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I² was used to evaluate heterogeneity between studies.

Results

Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28 %) asymptomatic individuals and 30,773 (30 %) symptomatic patients; this characteristic was not reported in the remaining subjects (42 %). Colon distension was obtained manually in 69,222 (67 %) and using an automated carbon dioxide insufflator in 26,479 (26 %) patients; in the remaining 7 % of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04 % (95 % CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P?=?0.001). The surgical rate was 0.008 %. No CTC-related deaths were reported.

Conclusions

The perforation rate in CTC is very low, particularly considering asymptomatic individuals.

Key Points

? This is the first meta-analysis on this topic, based on 100,000 patients. ? The CTC-related colorectal perforation rate is 0.04 %, 0.02 % in asymptomatic subjects. ? The CTC-induced surgery rate is 0.008 % (1:12,500). ? The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals.     

Safety and Efficacy of the Gunther Tulip Retrievable Vena Cava Filter: Midterm Outcomes

Purpose

To evaluate of the medium-term integrity, efficacy, and complication rate associated with the Gunther Tulip vena cava filter.

Methods

A retrospective study was performed of 369 consecutive patients who had infrarenal Gunther Tulip inferior vena cava filters placed over a 5-year period. The mean patient age was 61.8 years, and 59 % were men. Venous thromboembolic disease and a contraindication to or complication of anticoagulation were the indications for filter placement in 86 % of patients; 14 % were placed for prophylaxis in patients with a mean of 2.3 risk factors. Follow-up was obtained by review of medical and radiologic records.

Results

Mean clinical follow-up was 780 days. New or recurrent pulmonary embolus occurred in 12 patients (3.3 %). New or recurrent deep-vein thrombosis occurred in 53 patients (14.4 %). There were no symptomatic fractures, migrations, or caval perforations. Imaging follow-up in 287 patients (77.8 %) at a mean of 731 days revealed a single (0.3 %) asymptomatic fracture, migration greater than 2 cm in 36 patients (12.5 %), and no case of embolization. Of 122 patients with CT scans, asymptomatic perforations were identified in 53 patients (43.4 %) at a mean 757 days.

Conclusion

The Gunther Tulip filter was safe and effective at 2-year follow-up. Complication rates were similar to those reported for permanent inferior vena cava filters.     

Comparison of the atherosclerotic burden among asymptomatic patients vs matched volunteers

Background

While asymptomatic patients should have a lower risk of cardiac events compared to symptomatic patients referred for cardiac stress testing, comparable event rates have been noted in some prior prognostic studies. To test if a high burden of undetected atherosclerosis among asymptomatic patients helps explain such findings, we compared atherosclerotic burden, as measured by coronary artery calcium (CAC) scanning, in propensity-matched groups of volunteers and asymptomatic patients.

Methods

CAC scans were performed on a research basis in 136 asymptomatic patients referred for exercise myocardial perfusion SPECT and in 1,398 volunteers. We performed matching by propensity scores to compare volunteers with the same CAD risk factor profile as our asymptomatic patients.

Results

Among our matched groups, asymptomatic patients had significantly greater mean CAC scores than volunteers (394 ± 805 vs 151 ± 349, P = .001), primarily due to a higher frequency of CAC scores >1,000 (15.4% vs 2.5%, P < .001). Inducible myocardial ischemia by SPECT was present in 7% of patients, but was selectively concentrated among those with CAC scores >1,000, occurring in 27.0% of such patients vs only 1.9% among patients with CAC scores <1,000 (P < .0001).

Conclusions

In contrast to asymptomatic volunteers, asymptomatic patients referred for cardiac stress testing possess more extensive atherosclerosis as measured by CAC. Among asymptomatic patients with high CAC scores, the frequency of concomitant inducible myocardial ischemia is high. These results help explain prior prognostic studies concerning asymptomatic patients and indicate the importance of making a clinical distinction between healthy subjects and asymptomatic patients with respect to atherosclerotic risk.     

Efficacy and safety of an early Solitaire stent retrieval technique for acute ischemic stroke

Purpose

The aim of this study was to retrospectively evaluate the efficacy and safety of early pull-back of a Solitaire stent as a thrombectomy device in patients with acute ischemic stroke.

Methods

The study group comprised 23 consecutive cases presenting with acute ischemic stroke who were treated with intra-arterial therapy using the Solitaire device as a first-line endovascular procedure. The stent was deployed to cover the thrombus and then left in place for 1–2 min. Immediate angiographic results are presented. Neurologic status was assessed according to the NIH Stroke Scale score (NIHSS) and the modified Rankin Scale (mRS) score.

Results

Successful recanalization (TICI grade ≥2b) was achieved in 21 of the 23 (91.3 %) treated vessels, and 6 of the patients showed immediate flow restoration after the deployment of the first stent. The mean number of passes for maximal recanalization was 1.96. There were no symptomatic procedure-related complications. Of the cases, 34.8 % improved by >10 points on the NIHSS at discharge; 30.4 % of cases revealed good functional outcome (mRS score 0–2) at 90 days.

Conclusions

The early retrieval technique with the Solitaire stent appears to be a safe and effective method in patients with acute ischemic stroke.     

Herniation pits as a radiographic indicator of pincer-type femoroacetabular impingement in symptomatic patients

Purpose

The role of herniation pits as a radiographic indicator is still debated. This case–control study was to determine (1) the prevalence and sizes of herniation pits and (2) the relationship between herniation pits and femoral and acetabular bony morphology consistent with femoroacetabular impingement.

Methods

This comparative study was performed on 151 patients (151 hips; median patient age 46 years; range 16–73 years) with mechanical symptoms, who underwent multi-detector computed tomography (MDCT) arthrography (the symptomatic group), and an age-, gender-, site (left or right)-, and time (at diagnosis)-matched group of control patients that underwent multi-detector computed tomography due to an ureter stone (the asymptomatic group). Two orthopaedic surgeons reviewed images to evaluate the prevalence, sizes of herniation pits, and relationship with morphological abnormality.

Results

The prevalences of herniation pits in symptomatic and asymptomatic groups were 23.8 % (36/151) and 3.3 % (5/151), respectively (OR 9.14, 95 % CI 3.47–24.30; p < 0.001). Herniation pits were found to be significantly associated with pincer-type abnormality (p = 0.034), especially central acetabular retroversion (p < 0.001).

Conclusions

This study shows that the prevalence of herniation pits is higher in symptomatic patients with femoroacetabular impingement, and herniation pits are associated with central acetabular retroversion. Furthermore, herniation pits were also found to be a useful predictor of pincer-type femoroacetabular impingement.

Level of evidence

III.     

British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry

Purpose

The British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry was produced to provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety.

Methods

The IVC filter registry is a web-based registry, launched by the BSIR on behalf of its membership in October 2007. This report is based on prospectively collected data from October 2007 to March 2011. This report contains analysis of data on 1,434 IVC filter placements and 400 attempted retrievals performed at 68 UK centers. Data collected included patient demographics, insertion and retrieval data, and patient follow-up.

Results

IVC filter use in the majority of patients in the UK follows accepted CIRSE guidelines. Filter placement is usually a low-risk procedure, with a low major complication rate (<0.5 %). Cook Gunther Tulip (560 filters: 39 %) and Celect (359 filters: 25 %) filters constituted the majority of IVC filters inserted, with Bard G2, Recovery filters, Cordis Trapease, and OptEase constituting most of the remainder (445 filters: 31 %). More than 96 % of IVC filters deployed as intended. Operator inexperience (<25 procedure) was significantly associated with complications (p < 0.001). Of the IVC filters initially intended for temporary placement, retrieval was attempted in 78 %. Of these retrieval was technically successful in 83 %. Successful retrieval was significantly reduced for implants left in situ for >9 weeks versus those with a shorter dwell time. New lower limb deep vein thrombosis (DVT) and/or IVC thrombosis was reported in 88 patients following filter placement, there was no significant difference of incidence between filter types.

Conclusions

This registry report provides interventional radiologists and clinicians with an improved understanding of the technical aspects of IVC filter placement to help improve practice, and the potential consequences of IVC filter placement so that we are better able to advise patients. There is a significant learning curve associated with IVC filter insertion, and when a filter is placed with the intention of removal, procedures should be in place to avoid the patient being lost to follow-up.