Delayed CTP-Derived Deep Venous Outflow: A Novel Predictor of Striatocapsular Infarction after M1 Thrombectomy.

BACKGROUND AND PURPOSE: Isolated striatocapsular infarction occurs commonly in patients with ischemic stroke following M1 thrombectomy. We aimed to explore the correlation between CTP-derived parameters of deep venous outflow at presentation and subsequent striatocapsular infarction in a retrospective cohort of such patients. MATERIALS AND METHODS: TTP and peak enhancement were measured on CTP-derived time-attenuation curves of the internal cerebral and thalamostriate veins bilaterally. The difference in TTP (ΔTTP) and the relative decrease in venous enhancement between the ischemic and normal sides were calculated. NCCT performed 24 (SD, 12) hours postthrombectomy was used to determine tissue fate in the caudate head, caudate body, lentiform nucleus, and internal capsule. Striatocapsular ischemia (striatocapsular infarction-positive) was defined as infarction and striatocapsular injury as either infarction, contrast enhancement, or hemorrhagic transformation in ≥1 of these regions. A striatocapsular ischemia score was calculated (0 = no ischemic region, 1 = 1 ischemic region, 2 = ≥2 ischemic regions). RESULTS: One hundred sixteen patients were included in the analysis. Sixty-one patients had striatocapsular infarction (striatocapsular infarction-positive). The mean thalamostriate ΔTTP was 1.95 (SD, 1.9) seconds for patients positive for striatocapsular infarction and 0.79 (SD, 2.1) for patients negative for it (P = .010). Results were similar for striatocapsular injury. The mean thalamostriate ΔTTP was 0.79 (SD, 2.1), 1.68 (SD, 1.4), and 2.05 (SD, 2) for striatocapsular infarction scores of 0, 1, and 2, respectively (P = .030). CONCLUSIONS: CTP-derived thalamostriate ΔTTP is an excellent surrogate marker for striatocapsular infarction in patients post-M1 thrombectomy. The novel approach of extracting venous outflow parameters from CTP has numerous potential applications and should be further explored.

Solitaire stent for endovascular treatment of intracranial aneurysms: immediate and mid-term results in 15 patients with 17 aneurysms.

INTRODUCTION: The Solitaire stent is the first fully retractable stent for endovascular treatment (EVT) of intracranial aneurysms. The aim of this study was to evaluate its use in a prospective series with mid-term follow-up. METHODS: A retrospective review of our prospectively maintained database identified all patients treated with a Solitaire stent. Clinical charts, procedural data, angiographic results were reviewed. RESULTS: Between June 2008 and September 2009, 15 patients with 17 wide-necked or fusiform aneurysms (16 unruptured/one ruptured) were identified. EVT was successfully performed in all but one patient in whom the stent was removed because it induced flow reduction in the 1.8-mm parent artery. Among 14 treated patients, 13 had an excellent outcome and one had a good outcome. In this latter patient, the first stent could not be delivered and was changed for another one that was successfully deployed. The patient experienced a thrombo-embolic complication 6 hours after EVT and kept a slight hand paresis. In all cases but one, the stent was thus easily navigated and positioned despite a relative poor visibility. Angiographic results included eight complete occlusions, two neck remnants, and six incomplete occlusions. Six-month control in 14 aneurysms showed 13 complete occlusions and one incomplete occlusion. CONCLUSION: The Solitaire stent is useful for EVT of complex intracranial aneurysms because it is fully retractable, easy to navigate and to precisely place. However, it should be used with caution in arteries less than 2mm in diameter.