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Background Medium vessel occlusions (MeVOs) comprise a large proportion of all stroke events. We performed a multicenter study of MIVI Q catheters, a novel design that optimizes suction forces without an increase in lumen diameter, for the treatment of MeVOs, aiming to evaluate its efficacy and safety. Methods Databases of two US and two UK centers were retrospectively reviewed for MeVO patients (M2- M3, anterior cerebral artery (ACA), or posterior cerebral artery (PCA)) treated with Q catheters. Outcomes were assessed as successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2b), first pass effect (FPE), and modified FPE (mFPE) as single pass achieving mTICI ≥2c and mTICI≥2b, respectively, and 90 day modified Rankin Scale (mRS) score. Results 69 patients were included (median age 71 years, IQR 56--82.5; 52.2% men). Median National Institutes of Health Stroke Scale (NIHSS) score at admission was 14, and Alberta Stroke Program Early CT Score (ASPECTS) was 9. Primary (without large vessel occlusion (LVO)) and secondary (with LVO) MeVOs represented 47.8% and 52.2% of cases, respectively. Q catheters used were Q3 (47.8%), Q4 (33.3%), Q5 (10.1%), and Q6 (8.7%). mTICI≥2b was achieved in 92.8% of patients, with FPE in 47.8%, and mFPE in 68.1%. Two (2.9%) intraprocedural complications (symptomatic intracranial hemorrhage) occurred. 50% (27/54) achieved an mRS score of ≤2 at the 90 day follow-up. The median NIHSS at admission was significantly higher in secondary than in primary MeVOs (19.5 vs 12, P=0.009). The rate of mRS ≤2 at 90 days was significantly higher in primary than in secondary MeVOs (77.3% vs 31.3%, P=0.002). Conclusions Treatment of MeVO patients with Q catheters resulted in optimal angiographic and clinical outcomes. Although angiographic results were similar between primary and secondary MeVOs, the former had less severe presenting NIHSS and better outcomes at 90 days than the latter. [ABSTRACT FROM AUTHOR]

Background The management of intracranial aneurysm (IA) is challenging. Clinicians often rely on varied and intuitively disparate ways of evaluating rupture risk that may only partially take into account complex hemodynamic and morphologic factors. We developed a prototype of a clinically oriented, streamlined, computational platform, AView, for rapid assessment of hemodynamics and morphometrics in clinical settings. To show the potential clinical utility of AView, we report our initial multicenter experience highlighting the possible advantages of morphologic and hemodynamic analysis of IAs. Methods AView software was deployed across 8 medical centers (6 in the United States, 2 in Japan). Eight clinicians were trained and used the AView software between September 2012 and January 2013. Results We present 12 illustrative cases that show the potential clinical utility of AView. For all, morphology and hemodynamics, flow visualization, and rupture resemblance score (a surrogate for rupture risk) were provided. In 3 cases, AView could confirm the clinicians' decision to treat; in 3 cases, it could suggest which aneurysms may be at greater risk among multiple aneurysms; in 5 cases, AView could provide additional information for use during treatment decisions for ambiguous situations. In one stent-assisted coiling case, flow visualization predicted that the intuitive choice for stent placement could have resulted in sacrifice of an anterior cerebral artery due to blockage by coils and led clinicians to reconsider treatment plans. Conclusions AView has the potential to confirm decisions to treat IAs, suggest which among multiple aneurysms to treat, and guide treatment decisions. Furthermore, the flow visualization it affords can inform aneurysm treatment planning and potentially avoid poor outcomes. [ABSTRACT FROM AUTHOR]

Wide-necked cerebral aneurysms often require complex treatment strategies for optimal treatment. As the surgeon's arsenal continues to expand, consideration of all potential applications of available devices is important. The Woven EndoBridge (WEB) device (MicroVention-Terumo, Aliso Viejo, California) capitalizes on flow disruption to promote thrombosis and is Food and Drug Administration (FDA) approved for saccular wide-necked bifurcation aneurysms located at the middle cerebral artery bifurcation, internal carotid artery (ICA) terminus, anterior communicating artery complex, and basilar apex. In this video, we demonstrate an off-label use of the WEB to treat a wide-necked type II1 ophthalmic artery aneurysm, highlighting the importance of correct device sizing. The patient is a 74-yr-old woman with a family history of aneurysms. Her aneurysm was found incidentally after a minor trauma. Observation and various treatment options were considered. The patient preferred to avoid open surgical intervention and dual antiplatelet therapy. Endoluminal flow diversion for types II and III ophthalmic artery aneurysms has relatively low occlusion rates and a higher incidence of visual field deficits.1 A WEB device can be an excellent alternative to treat these aneurysms. A biaxial system was used to selectively catheterize the supraclinoid internal carotid artery and then the aneurysm, and optimal flow diversion was achieved. The patient did well and was discharged home the next day on aspirin alone. Six-month angiography showed near-occlusion of the aneurysm and ophthalmic artery patency. The neck remnant will be followed up with repeat angiography in 6 mo. The patient gave informed consent for the procedure and video recording. Institutional review board approval was deemed unnecessary. Video ©University at Buffalo Neurosurgery, 2019. With permission., (Copyright © 2020 by the Congress of Neurological Surgeons.)

Prof. Mahmut Gazi Yasargil was born in Lice, Diyarbakır, Turkey in 1925. He started to medicine education in Friedrich Schiller University of Jena. Because of the World War-II, he continued his education in University of Basel, Sweden. He worked with Prof. Krayenbühl in Department of Neurosurgery on cerebral angiography. In 1953, he discovered orbital venography and superior sagittal sinus thrombosis. He took 3D photos of brain and modelled venous and arterial vessels of brain. In 1957, he published first book about vertebral and basilar arteries. In 1957, he went to USA to learn stereotaxic surgery from Prof. Mundiger and Prof. Hassler. In 1958 and 1965, he published books about "aneurysm and arteriovenous malformation" and "cerebral angiography". He learned microsurgery techniques on animals in USA. After returning to Sweden, he done first brain by-pass surgery in 1967 and organized microneurosurgery courses. In 1971, he invented his own microscopy, still widely used in micro-brain surgery. Leyla retractor, Yasargil aneurysm clips, scissors, aspirator and forceps were made with his own design. In 1974, tumors originated from ear nerve, in 1976, skull base meningioma were operated successfully by him. He made a breakthrough in epilepsy surgery without excluding a whole lobe. He wrote his most popular book series microneurosurgery between 1984-1996. In 1993, he retired in Zurich. In the following 20 years he worked actively in USA in Little Rock- Arkansas. Laboratory and Education Center established in the name of Prof. Yaşargil and his wife. He came back to Turkey in 2013 to Yeditepe University. [ABSTRACT FROM AUTHOR]