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Objectives: CT angiography (CTA) is essential in acute stroke to detect emergent large vessel occlusions (ELVO) and must be interpreted by radiologists with and without subspecialized training. Additionally, grayscale inversion has been suggested to improve diagnostic accuracy in other radiology applications. This study examines diagnostic performance in ELVO detection between neuroradiologists, non-neuroradiologists, and radiology residents using standard and grayscale inversion viewing methods. Methods: A random, counterbalanced experimental design was used, where 18 radiologists with varying experiences interpreted the same patient images with and without grayscale inversion. Confirmed positive and negative ELVO cases were randomly ordered using a balanced design. Sensitivity, specificity, positive and negative predictive values as well as confidence, subjective assessment of image quality, time to ELVO detection, and overall interpretation time were examined between grayscale inversion (on/off) by experience level using generalized mixed modeling assuming a binary, negative binomial, and binomial distributions, respectively. Results: All groups of radiologists had high sensitivity and specificity for ELVO detection (all >.94). Neuroradiologists were faster than non-neuroradiologists and residents in interpretation time, with a mean of 47 s to detect ELVO, as compared with 59 and 74 s, respectively. Residents were subjectively less confident than attending physicians. With respect to grayscale inversion, no differences were observed between groups with grayscale inversion vs. standard viewing for diagnostic performance (p = 0.30), detection time (p =.45), overall interpretation time (p =.97), and confidence (p =.20). Conclusions: Diagnostic performance in ELVO detection with CTA was high across all levels of radiologist training level. Grayscale inversion offered no significant detection advantage. Key Points: • Stroke is an acute vascular syndrome that requires acute vascular imaging. • Proximal large vessel occlusions can be identified quickly and accurately by radiologists across all training levels. • Grayscale inversion demonstrated minimal detectable benefit in the detection of proximal large vessel occlusions. [ABSTRACT FROM AUTHOR]

The article presents abstracts on results of several medical studies based on major trials have published comparing endovascular therapy with standard medical therapy alone. Also mentioned is that Stroke is the leading cause of adult disability in North America and is the fifth most common cause of death. Among acute ischemic stroke, Emergent Large Vessel Occlusion (ELVO) accounts for the greatest proportion of patients with long-term disability.

The article offers information on intracranial aneurysms, its epidemiology, management, and diagnostic evaluation. It notes that 1-5% of the U.S. population suffers from intracranial aneurysms wherein most of aneurysms occur in the anterior circulation near the Circle of Willis. It mentions that ruptured aneurysms are most often co-existent with subarachnoid hemorrhage and that immediate care of the ruptured intracranial aneurysms after hemorrhage is the standard of care. Unruptured aneurysm manifestations include headache, stroke, and neurologic deficits. It states that imaging study for evaluation of intracranial aneurysms rely on its clinical presentation.

The article examines the treatment of acute ischemic stroke with intra-arterial therapy (IAT). A brief history on the significance of thombolysis and thombectomy in the management of stroke is offered. The NINDS IV trial is highlighted which evaluates the effectivness of a tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke. The interventional management of stroke (IMS) trials are outlined which investigate the combined approach of intravenous (IV) and IA tPA infusion.

The article presents a case study of a 79-year-old woman who was aphasic with right extremity hemiparesis. Her medical history included hypercholesterolemia, hypertension, type II diabetes and coronary artery disease. The importance of risk factor recognition for patients with angiographically documented hemorrhagic conversion during intra-arterial thrombolysis for stroke is also discussed.

The article offers information on the treatment alternatives, diagnostic imaging, and epidemiology of intracranial atherosclerotic disease (ICAD). It notes that ICAD is responsible for approximately 5-10% of all strokes and transient ischemic attacks (TIAs). It adds that four imaging options can be used to diagnose and characterize ICAD including conventional angiography, magnetic resonance angiography (MRA), computer tomography angiography (CTA), and transcranial Doppler (TCD). It mentions that medical therapy for ICAD would include aggressive management of hypertension, smoking cessation, and management of diabetes and hyperlipidemia.

The article discusses a study which assessed the percentage of neurointerventional devices on external markers. The researchers analyzed the devices approved by the U.S. Food and Drug Administration (FDA). The study found that 11 products of the 51 devices from manufacturers listed contain any external markers. Acute radiation side effects from high exposure rates are mentioned.

Intro: SARS-CoV-2 (COVID-19) infection is associated with acute ischemic stroke (AIS), which may be due to a prothrombotic state. Early reports have suggested high rates of reocclusion following mechanical thrombectomy (MT) with poor radiographic and clinical outcomes. We report our early experience using intra-procedural antithrombotics to address SARS-CoV-2 reocclusion. Methods: We identified 6 patients that experienced early reocclusion after MT for COVID-19-associated AIS through retrospective chart review abstracting their basic demographics, COVID-19 status, and stroke management. All these patients were treated after reocclusion with aspirin and cangrelor intra-procedurally, the latter of which was converted to ticagrelor post-procedurally. Some patients additionally received argatroban infusion intraprocedurally. Results: Mean age was 54. There were 3 post-procedural and 3 intra-procedural re-occlusions. After repeat thrombectomy and treatment with aspirin and cangrelor, those with post-procedure reocclusion did not show further reocclusion, while those with intra-procedural reocclusion showed radiographic improvement with intraprocedural cangrelor administration. Outcomes for these patients were poor, with a median mRS of 4. Two patients developed petechial hemorrhage of their stroke which was managed conservatively, and one developed a retroperitoneal hemorrhage from femoral access requiring transfusion. There were no patients who developed new parenchymal hematomas. Conclusion: COVID-19 AIS may be associated with a hypercoagulable state which risks malignant reocclusion complicating MT. We found antithrombotic treatment periprocedural cangrelor with or without argatroban transitioned to oral aspirin with ticagrelor to be a viable method for management of these patients. [ABSTRACT FROM AUTHOR]

Background and aims Baseline National Institutes of Health Stroke Scale (NIHSS) scores have frequently been used for prognostication after ischemic stroke. With the increasing utilization of acute stroke interventions, we aimed to determine whether baseline NIHSS scores are still able to reliably predict post-stroke functional outcome. Methods We retrospectively analyzed prospectively collected data from a high-volume tertiary-care center. We tested strength of association between NIHSS scores at baseline and 24 h with discharge NIHSS using Spearman correlation, and diagnostic accuracy of NIHSS scores in predicting favorable outcome at three months (defined as modified Rankin Scale 0–2) using receiver operating characteristic curve analysis with area under the curve. Results There were 1183 patients in our cohort, with median baseline NIHSS 8 (IQR 3–17), 24-h NIHSS 4 (IQR 1–11), and discharge NIHSS 2 (IQR 1–8). Correlation with discharge NIHSS was r = 0.60 for baseline NIHSS and r = 0.88 for 24-h NIHSS. Of all patients with follow-up data, 425/1037 (41%) had favorable functional outcome at three months. Receiver operating characteristic curve analysis for predicting favorable outcome showed area under the curve 0.698 (95% CI 0.664–0.732) for baseline NIHSS, 0.800 (95% CI 0.772–0.827) for 24-h NIHSS, and 0.819 (95% CI 0.793–0.845) for discharge NIHSS; 24 h and discharge NIHSS maintained robust predictive accuracy for patients receiving mechanical thrombectomy (AUC 0.846, 95% CI 0.798–0.895; AUC 0.873, 95% CI 0.832–0.914, respectively), while accuracy for baseline NIHSS decreased (AUC 0.635, 95% CI 0.566–0.704). Conclusion Baseline NIHSS scores are inferior to 24 h and discharge scores in predicting post-stroke functional outcomes, especially in patients receiving mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

Background Many factors may potentially complicate the stroke recovery process, including persistently impaired level of consciousness (LOC)—whether from residual stroke effects or from superimposed delirium. We aimed to determine the degree to which impaired LOC at hospital discharge is associated with outcomes after ischemic stroke. Methods We conducted a single-center retrospective cohort study using prospectively-collected data from 2015 to 2017, collecting total NIHSS-LOC score at discharge as well as subscores for responsiveness (LOC-R), orientation questions (LOC-Q), and command-following (LOC-C). We determined associations between LOC scores and 3-month outcome using logistic regression, with discharge location (skilled nursing facility [SNF] vs. inpatient rehabilitation) representing a pre-specified secondary outcome. Results We identified 1003 consecutive patients with ischemic stroke who survived to discharge, of whom 32% had any LOC score > 0. Total LOC score at discharge was associated with unfavorable 3-month outcome (OR 4.9 [95% CI 2.4–9.8] for LOC = 1; OR 8.0 [2.7–23.9] for LOC = 2–3; OR 6.3 [2.1–18.5] for LOC = 4–5; all patients with LOC = 6–7 had poor outcomes), as were subscores for LOC-R (OR 5.3 [1.3–21.2] for LOC-R = 1; all patients with LOC-R = 2–3 had poor outcomes) and LOC-Q (OR 4.1 [2.1–8.3] for LOC-Q = 1; OR 4.9 [1.8–13.5] for LOC-Q = 2). Total LOC score (OR 2.6 [1.3–5.3] for LOC = 1; OR 3.1 [1.2–8.2] for LOC = 2–3) and LOC-Q (OR 3.3 [1.6–6.6] for LOC-Q = 1; OR 3.4 [1.3–9.0] for LOC-Q = 2) were also associated with discharge to SNF rather than to inpatient rehabilitation. Conclusions The presence of impaired consciousness or disorientation at discharge is associated with markedly worse outcomes after ischemic stroke. Further studies are necessary to determine the separate effects of residual stroke-related LOC changes and those caused by superimposed delirium. [ABSTRACT FROM AUTHOR]

The article offers information about interventional radiology. It notes that the term interventional radiology was coined by doctor Alexander Margulis in 1967. It defines interventional radiology as a medical specialty committed to patients' clinical care in an image-guided, innovative, and minimally invasive procedure. It mentions that doctor Charles Dotter first introduced interventional radiology when he percutaneously dilated a superficial femoral artery stenosis in 1964.

Transradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention. Consecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics. A total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required. Sheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to determine whether the benefits of multiphase CTA (mCTA) over single-phase CTA (sCTA) for the detection of proximal cerebrovascular occlusions similarly extend to the distal cerebral vasculature. Methods: Four attending radiologists, two neuroradiologists and two emergency radiologists, contributed as readers to this retrospective study. For each reader, two sessions were conducted, one using sCTA and one using mCTA. During each session, the reader interpreted the studies of 104 patients who underwent imaging for suspicion of acute ischemic stroke, resulting in a total of 832 interpretations. Changes in diagnostic accuracy, time to render final decision, and reported levels of reader confidence were quantitatively assessed. Further analysis comparing the effects for neuroradiologists versus emergency radiologists was additionally conducted. Results: Using mCTA resulted in a significant 5.0% absolute increase in sensitivity (91.6% vs. 96.6%, p =.004) and an insignificant increase in specificity (99.5% vs. 99.7%, p =.39). A significant reduction in reading time (66.7 s vs. 59.6 s, p =.001) and an increase in diagnostic confidence (2.26 vs. 2.58, p <.001) were observed. Using sCTA, higher sensitivity was achieved by neuroradiologists than emergency radiologists (96.0% vs. 86.9%, p =.002); using mCTA resulted in an absolute increase in sensitivity of 0.9% (97.4%, p =.44) for neuroradiologists and 9.6% (96.5%, p <.001) for emergency radiologists, eliminating significant differences between the groups (p = 0.57). Conclusion: The use of mCTA results in increased sensitivity and negative predictive value, decreased reading time, increased diagnostic confidence, and the elimination of differences in accuracy between neuroradiologists and emergency radiologists. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article offers information on the results of clinical trials on efficacy of endovascular therapy (EVT) for acute ischemic stroke treatment. Topics discussed include quality-improvement (QI) metrics for endovascular ischemic stroke treatment, developing clinical practice guidelines and methods of treatment including angioplasty and mechanical thrombectomy.

Background Large vessel disease stroke subtype carries the highest risk of early recurrent stroke. In this study we aim to look at the association between impaired perfusion and early stroke recurrence in patients with intracranial atherosclerotic disease or total cervical carotid occlusion. Methods This is a retrospective study from a comprehensive stroke center where we included consecutive patients 18 years or older with intracranial atherosclerotic disease or total cervical carotid occlusion admitted with a diagnosis of ischemic stroke within 24 h from symptom onset with National Institute Health Stroke Scale < 15, between 1 December 2016 and 30 June 2017. Patients with (1) evidence of ≥ 50% stenosis of a large intracranial artery or total carotid artery occlusion, (2) symptoms referable to the territory of the affected artery, and (3) perfusion imaging data using the RAPID processing software were included. The primary predictor was unfavorable perfusion imaging defined as Tmax > 6 s mismatch volume (penumbra volume-infarct volume) of 15 ml or more. The outcome was recurrent cerebrovascular events at 90 days defined as worsening or new neurological symptoms in the absence of a nonvascular cause attributable to the decline, or new infarct or infarct extension in the territory of the affected artery. We used Cox proportional hazards models to determine the association between impaired perfusion and recurrent cerebrovascular events. Results Sixty-two patients met our inclusion criteria; mean age 66.4 ± 13.1 years, 64.5% male (40/62) and 50.0% (31/62) with intracranial atherosclerotic disease. When compared to patients with favorable perfusion pattern, patients with unfavorable perfusion pattern were more likely to have recurrent cerebrovascular events (55.6% (10/18) versus 9.1% (4/44), p < 0.001). This association persisted after adjusting for potential confounders (adjusted hazard ratio 10.44, 95% confidence interval 2.30-47.42, p = 0.002). Conclusion Perfusion mismatch predicts recurrent cerebrovascular events in patients with ischemic stroke due to intracranial atherosclerotic disease or total cervical carotid occlusion. Studies are needed to determine the utility of revascularization strategies in this patient population. [ABSTRACT FROM AUTHOR]

Background: Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) and stroke volume on diffusion weighted imaging (DWI); data are more limited in patients with minor stroke. We sought to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS component scores in patients with minor stroke.Methods: We included all patients with minor stroke (NIHSS 0-5) enrolled in the Stroke Warning Information and Faster Treatment study. We calculated lesion(s) volume (cm3 ) on the DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). We used nonparametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components).Results: We identified 894 patients with a discharge diagnosis of minor stroke; 709 underwent magnetic resonance imaging and 510 were DWI positive. There was a graded relationship between the NIHSS score and median DWI lesion volume in cm3 : (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, and NIHSS 5: 23.6, P < .01). The median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5, P = .025), language disorder (34.6 vs. 11.9, P < .001), and visual field impairment (185.6 vs. 11.6, P < .001). Other components of the NIHSS were not associated with lesion volume.Conclusion: In patients with minor stroke, the nature of deficit when used with the NIHSS score can improve prediction of infarct volume. This may have clinical and therapeutic implications. [ABSTRACT FROM AUTHOR]

Introduction There is very limited data on the use of MRI based perfusion imaging to select patients with acute ischemic stroke and large vessel occlusion (LVO) for intraarterial therapy beyond 6 h from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6 h from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. Methods This is a single institution (Rhode Island Hospital) retrospective study between December 1st, 2015, and July 30th, 2016 that included patients with acute ischemic stroke and proximal LVO with CT ASPECTS of 6 or more and 6–24 h from symptom onset who were assessed for mechanical embolectomy using MRI based perfusion imaging. Favorable imaging profile was defined based on prior studies as 1) DWI lesion volume (as defined as apparent diffusion coefficient < 620 × 10 –6 mm 2 /s) of 70 ml or less; 2) Penumbra volume (as defined by volume of tissue with T max > 6 s) of 15 ml or greater; 3) A mismatch ratio of 1.8 or more; and 4) Volume of tissue with perfusion lesion with T max > 10 s is < 100 ml. Good outcome was defined as a 90-day mRS ≤ 2. Results 41 patients met the inclusion criteria; 22 (53.7%) had favorable imaging profile and underwent mechanical embolectomy. The rate of good outcomes in this series was similar to that in a patient level pooled meta-analysis of the recent endovascular trials (63.6% vs. 46%, p = 0.13). None of the patients in our cohort had symptomatic intracereberal hemorrhage. Conclusions MRI perfusion based imaging may help select patients with acute ischemic stroke and proximal emergent LVO for embolectomy beyond the treatment window used in most endovascular trials. This provides compelling evidence for stroke centers to participate in ongoing trials using advanced imaging to study endovascular treatment in this patient population. [ABSTRACT FROM AUTHOR]

The field of neurointerventional (NI) surgery has developed in the context of technologic innovation. Many treatments readily provided in 2014 would have been hard to imagine as recently as 10 years ago. The reality of present day NI care is that, while providers, payors, policy makers and patients rely on evidence to guide NI decision-making, the available data are often less robust than participants might desire. In this paper we will explore the fundamentals of evidence-based clinical practice. [ABSTRACT FROM AUTHOR]

The article suggests practice standards for patients carotid artery angioplasty and stenting (CAS) and presents a reporting framework for CAS-treated patients. Topics discussed include carotid endarterectomy, treatment recommendations, and aspects of suggested reporting standards, including demographics, symptoms, and comorbidities.

The article focuses on the primary certification and requirements for neurointerventionalists under the Maintenance of Certification (MOC) program of the American Board of Medical Specialties (ABMS). Among the organizations of neurointerventionalists discussed are American Board of Neurological Surgery (ABNS), American Board of Radiology (ABR), and American Board of Psychiatry and Neurology (ABPN).

The article discusses the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery's report on vertebral augmentation. It mentions the image-guided procedures kyphoplasty and vertebroplasty which both involve the injection of cement mostly polymethylmethacrylate (PMMA) into the body. An overview of treating osteoporotic and cancer-related compression fractures through the augmentation is also presented.

Background The goal of this article is to provide expert consensus recommendations for reporting standards, terminology and definitions when reporting on neurointerventional chemotherapy administration for head and neck tumors. These criteria may be used to design clinical trials, to provide definitions for patient stratification and to permit robust analysis of published data. Methods This publication represents a consensus document by the Society for Neurointerventional Surgery. A PubMed search was conducted and included articles published in 2002-2011, with the search strategy designed to identify all studies of intra-arterial chemotherapy for tumors of neck and head. Articles were evaluated for evidence class, and recommendations were made using guidelines for evidence-based medicine proposed by a joint committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Specifically, technical methods, outcome variables and reported complications were highlighted. Results Thirty-five publications were included in the review. While most studies represent class III evidence, there was sufficient concordance to justify level 2 recommendations regarding technical methods for administration of intra-arterial chemotherapy. The data also support level 2 recommendations regarding reporting of particular outcome variables subsumed within broad categories entitled 'Procedure-related', 'Disease control' and 'Survival'. The data support recommendations for the reporting of access site-related, neurologic, head and neck, ocular, hematologic and systemic complications, and also complications related to the percutaneous access site. Conclusions Intra-arterial chemotherapy is a growing field in interventional neuroradiology. It is important to adopt uniform technical and reporting standards that will allow cross-publication comparisons and facilitate homogeneous practice standards. Published data support such standards, which are vital for the consistent evaluation of future published research. [ABSTRACT FROM AUTHOR]

The article discusses the use of coil embolization in the treatment of endovascular aneurysm. It covers the basic elements of patient selection and evaluation, pre-procedural and post-procedural assessment, follow-up, reporting standards and standards of practice as applied to the treatment method. The effectiveness of computed tomography angiography and magnetic resonance imaging (MRI) in diagnosing cerebral aneurysms is reviewed.

Background: Symptomatic intracranial atherosclerotic disease (ICAD) worldwide represents one of the most prevalent causes of stroke. When severe, studies show that it has a very high risk for recurrent stroke, highlighting the need for effective preventative strategies. The mainstay of treatment has been medical therapy and is of critical importance in all patients with this disease. Endovascular therapy is also a possible therapeutic option but much remains to be defined in terms of best techniques and patient selection. This guideline will serve as recommendations for diagnosis and endovascular treatment of patients with ICAD. Methods: A literature review was performed to extract published literature regarding ICAD, published from 2000 to 2011. Evidence was evaluated and classified according to American Heart Association (AHA)/ American Stroke Association standard. Recommendations are made based on available evidence assessed by the Standards Committee of the Society of NeuroInterventional Surgery. The assessment was based on guidelines for evidence based medicine proposed by the American Academy of Neurology (AAN), the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Results: 59 publications were identified. The SAMMPRIS study is the only prospective, randomized, controlled trial available and is given an AHA level B designation, AAN class II and CEBM level 1b. The Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial arteries (SSYLVIA) trial was a prospective, nonrandomized study with the outcome assessment made by a non-operator study neurologist, allowing an AHA level B, AAN class III and CEBM level 2. The remaining studies were uncontrolled or did not have objective outcome measurement, and are thus classified as AHA level C, AAN class IV and CEBM level 4. Conclusion: Medical management with combination aspirin and clopidogrel for 3 months and aggressive risk factor modification is the firstline therapy for patients with symptomatic ICAD. Endovascular angioplasty with or without stenting is a possible therapeutic option for selected patients with symptomatic ICAD. Further studies are necessary to define appropriate patient selection and the best therapeutic approach for various subsets of patients. [ABSTRACT FROM AUTHOR]

Background: Management of vascular tumors of the head, neck, and brain is often complex and requires a multidisciplinary approach. Peri-operative embolization of vascular tumors may help to reduce intra-operative bleeding and operative times and have thus become an integral part of the management of these tumors. Advances in catheter and non-catheter based techniques in conjunction with the growing field of neurointerventional surgery is likely to expand the number of peri-operative embolizations performed. The goal of this article is to provide consensus reporting standards and guidelines for embolization treatment of vascular head, neck, and brain tumors. Summary: This article was produced by a writing group comprised of members of the Society of Neurointerventional Surgery. A computerized literature search using the National Library of Medicine database (Pubmed) was conducted for relevant articles published between 1 January 1990 and 31 December 2010. The article summarizes the effectiveness and safety of perioperative vascular tumor embolization. In addition, this document provides consensus definitions and reporting standards as well as guidelines not intended to represent the standard of care, but rather to provide uniformity in subsequent trials and studies involving embolization of vascular head and neck as well as brain tumors. Conclusions: Peri-operative embolization of vascular head, neck, and brain tumors is an effective and safe adjuvant to surgical resection. Major complications reported in the literature are rare when these procedures are performed by operators with appropriate training and knowledge of the relevant vascular and surgical anatomy. These standards may help to standardize reporting and publication in future studies. [ABSTRACT FROM AUTHOR]

Intracranial vertebral artery (VA) dissection has three clinical presentations: ischemia, hemorrhage, and mass effect. Imaging findings of intracranial VA dissections vary according to clinical presentation. Irregular stenosis or occlusion of the VA is the most common finding in patients with posterior fossa infarction, whereas a dissecting aneurysm is the main feature in those with acute subarachnoid hemorrhage. A chronic, giant, dissecting aneurysm can cause mass effect on the brain stem or cranial nerves, as well as distal embolism. Magnetic resonance imaging is useful for detection of intramural hematomas and intimal flaps, both of which are diagnostic of VA dissection. Multidetector computed tomography angiography is increasingly used for diagnosis of VA dissection. Catheter angiography is still beneficial for evaluation of precise endoluminal morphology of the dissection before surgical or endovascular intervention. Endovascular treatment is now considered a major therapeutic option for patients with a ruptured dissecting aneurysm or a chronic dissecting aneurysm. Anticoagulation therapy is currently considered the initial treatment of choice in patients with posterior circulation ischemic symptoms. Endovascular treatment, such as stent-assisted angioplasty or coil occlusion at the dissection site, can be performed in selected patients with posterior fossa ischemic symptoms. [ABSTRACT FROM AUTHOR]

The article discusses the types, symptoms and treatment of spinal vascular malformations (SVM). The various types of SVMs include spinal dural arteriovenous malformations (AVM), juvenile spinal AVMs and perimedullary spinal AVMs. Magnetic resonance imaging (MRI) scanning, a high quality diagnostic spinal angiogram is useful to detect the presence of lesions in the AVM. The article also mentions that endovascular treatment may be administered depending on the type of AVM.