The initial experience with the Embotrap III stent-retriever in a real world setting.

MATERIALS AND METHODS: We performed a retrospective review of our prospectively maintained database to identify all patients treated with the Embotrap 3 stent-retriever between January 2021 and January 2022. We recorded the baseline demographics, NIHSS, ASPECT score and clot characteristics, first pass and final eTICI scores, complications and 90 day mRS. RESULTS: One hundred and ten patients met the inclusion criteria, average age 69 ± 14 years, 50% were male (n = 55). The median NIHSS at presentation was 18 (range 3-30) and 58.2% received IV tPA prior to MT. The median ASPECT score on plain CT was 8 with average clot length 20.2 ± 14.8 mm (n = 93). The first pass effect (FPE) was seen in 41.8% of cases with modified FPE seen in 59.1%. A 24-hour CT scan (n = 97) showed median ASPECTs of 7. 43.8% of patients achieve mRS ≤ 2 at 90-day mRS (n = 64). CONCLUSION: The Embotrap 3 stent-retriever has a high rate of FPE and final recanalization in this real world cohort of patients.

The Q and A-The MIVI Q Catheters for Aspiration Thrombectomy-Initial Experience from London.

BACKGROUND: Aspiration thrombectomy is a widely accepted treatment option for large vessel occlusion (LVO). The MIVI aspiration system has a novel design to maximize the lumen size. We present the results of our initial experience with this innovative aspiration thrombectomy system. MATERIALS AND METHODS: Retrospectively, we reviewed our database to find all cases of LVO treated with the MIVI Q system (February 2019 and July 2020). In addition, we recorded the baseline demographics, NIHSS, ASPECT, mTICI scores, procedural time, complications, and 90 day mRS. RESULTS: Herein, we identified 25 patients with an average age of 65.3 ± 19.3 years (range 19-89), majority of whom were female (n = 14, 56%). The average NIHSS was 16.9 ± 6.7 (range 6-30), and the average CT ASPECT was 7.9 ± 1.4 (range 5-10). The most common clot location was the M1 segment of the MCA (n = 16, 64%). Four of the patients had tandem lesions (16%). The average clot length was 21.7 ± 31 mm (range 2-130 mm). Of the 23 cases where the Q catheter reached the proximal clot face, mTICI ≥ 2b was achieved on the first pass in 11 cases (44%), and at the end of the 'Q aspiration' only the procedures with 16 patients achieved mTICI ≥ 2b recanalization (64%). Stent-retrievers were used in 13 cases (52%). At the end of the procedure, 24 patients (96%) achieved mTICI ≥ 2b with 18 patients (72%) achieving mTICI ≥ 2c. The average number of passes with the Q catheter, including when it was used for SOLUMBRA, was 2.1 ± 2.2 (range 1-10). The mean procedure time was 69 ± 32 mins (range 7-116 mins). No complications were associated with the MIVI Q. CONCLUSIONS: The MIVI aspiration system is a novel technology with regards to aspiration mechanical thrombectomy. The system is easy to use with early results comparable to other large-bore catheter systems. However, further studies are needed.

Vessel wall enhancement of a ruptured intra-nidal aneurysm in a brain arteriovenous malformation.

Ruptured arteriovenous malformations are a frequently encountered pathology with significant associated morbidity and mortality. Identifying and securing the rupture point is mandatory; however, this can often be difficult. Black blood vessel wall magnetic resonance imaging is a promising technique for identifying ruptured saccular aneurysms and has been used in cases of multiple aneurysms. Here we describe a case of using this imaging technique to identify the rupture point in a ruptured arteriovenous malformation with histopathological correlation.

Dural masses: meningiomas and their mimics.

Meningiomas are the most common dural tumour. They are regularly being seen as an incidental finding on brain imaging and treated conservatively. However, there are many other dural masses which mimic their appearances, including primary neoplastic processes, metastases, granulomatous diseases and infection. While some of these are rare, others such as metastases and tuberculosis arise relatively frequently in practice. Although not pathognomonic, key features which increase the probability of a lesion being a meningioma include intralesional calcifications, skull hyperostosis, local dural enhancement and increased perfusion. It is important to have an awareness of these entities as well as their main imaging findings, as they have a wide range of prognoses and differing management strategies. This review outlines several of the most important mimics along with their imaging findings on both standard and advanced techniques with key features which may be used to help differentiate them from meningiomas.

New vistas in clinical practice: susceptibility-weighted imaging.

Susceptibility-weighted imaging (SWI) is a recently developed magnetic resonance imaging (MRI) technique where image contrast represents 'magnetic susceptibility effects'-a natural property of tissues. The applications of SWI are rapidly increasing, with much work being carried out to determine the usefulness of the technique in multiple disease states. Current clinical applications of the technique include detection of microbleeds, subarachnoid hemorrhage (SAH), ferromagnetic deposition in neurodegenerative disease, and characterization of cerebral tumors.