Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis.

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH. METHODS: Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. RESULTS: We included 5 trials totaling 1981 patients; 83 patients started treatment<6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83-2.51); for 6 to 12 hours 1.03 (0.65-1.63), for 12 to 24 hours 0.84 (0.65-1.09), and for >24 hours 1.06 (0.87-1.31), and for DCI, <6 hours 1.76 (0.68-4.58), for 6 to 12 hours 2.09 (0.99-4.39), for 12 to 24 hours 0.80 (0.56-1.16), and for >24 hours 1.08 (0.88-1.32). CONCLUSIONS: This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.

Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion.

BACKGROUND AND PURPOSE: Patients with stroke unsuitable for IV thrombolysis may be considered for endovascular revascularization, particularly when baseline imaging suggests proximal cerebral vessel occlusion associated with minimal established infarction. This retrospective review describes the use of a self-expanding retrievable intracranial stent (Solitaire AB) for thrombectomy in acute ischemic stroke. MATERIALS AND METHODS: Twenty-six consecutive patients with stroke treated endovascularly by using the Solitaire stent were identified, followed by detailed review of data extracted from their imaging and clinical records. RESULTS: Recanalization (TIMI grade ≥2) was achieved with Solitaire thrombectomy as the single treatment technique in 16 patients and in combination with urokinase or the Penumbra device in 9 of the remaining 10 patients. Two patients had symptomatic intracranial hemorrhage. A favorable clinical outcome (mRS score of ≤2) was seen in 3 of 5 patients with MCA occlusion, 6 of 11 (55%) patients with ICA occlusion, and 2 of 10 patients with BA occlusion. CONCLUSIONS: Mechanical thrombectomy by using the Solitaire stent appears to be safe and is capable of achieving a high rate of recanalization and favorable clinical outcomes in patients presenting with proximal cerebral vessel occlusion.

Accuracy and interobserver reliability of three-dimensional rotational angiography versus mathematical models for volumetric measurement of intracranial aneurysms.

We aimed to compare the inter-rater reliability relating to the volumetric measurement of intracranial aneurysms obtained with three-dimensional rotational angiography (3D-RA) compared with two commonly used mathematical models. Ten randomly selected aneurysms were measured by 3 independent assessors using 3D-RA and 2 mathematical models for the calculation of an ellipsoid: Equation (1), Vab=4/3pi x (a/2)x(b/2)x(a + b/4); and Equation (2), Vabc=(4/3)pi x (a/2)x(b/2)x(c/2). The inter-rater reliability for each method was: 3D-RA, 0.99; Vabc, 0.90; and Vab, 0.89. The 95% confidence interval for the mean difference between 3D-RA and Vabc was not significantly different, whereas there was a significant difference between 3D-RA and Vab. Vab gave consistently higher estimates than 3D-RA. This was especially true for aneurysms with larger volumes. The use of 3D-RA to undertake volumetric measurements of intra-cranial aneurysms is both valid and reproducible for different assessors.