Effect of Operator's Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study.

BACKGROUND AND PURPOSE: We aimed to evaluate among trained interventional neuroradiologist, whether increasing individual experience was associated with an improvement in mechanical thrombectomy (MT) procedural performance metrics. METHODS: Individual MT procedural data from 5 centers of the Endovascular Treatment in Ischemic Stroke registry and 2 additional high-volume stroke centers were pooled. Operator experience was defined for each operator as a continuous variable, cumulating the number of MT procedures performed since January 2015, as MT became standard of care or, if later than this date, since the operator started performing mechanical thrombectomies in autonomy. We tested the associations between operator's experience and procedural metrics. RESULTS: A total of 4516 procedures were included, performed by 36 operators at 7 distinct centers, with a median of 97.5 endovascular treatment procedures per operator (interquartile range, 57-170.2) over the study period. Higher operator's experience, analyzed as a continuous variable, was associated with a significantly shorter procedural duration (ß estimate, -3.98 [95% CI, -5.1 to -2.8]; P<0.001), along with local anesthesia and M1 occlusion location in multivariable models. Increasing experience was associated with better Thrombolysis in Cerebral Infarction scores (estimate, 1.02 [1-1.04]; P=0.013). CONCLUSIONS: In trained interventional neuroradiologists, increasing experience in MT is associated with significantly shorter procedural duration and better reperfusion rates, with a theoretical ceiling effect observed after around 100 procedures. These results may inform future training and practice guidelines to set minimal experience standards before autonomization, and to set-up operators' recertification processes tailored to individual case volume and prior experience.

[Stroke prevention]. / Prévention de l'AVC ischémique.

Prevention is essential to stroke management because of the high risk of recurrence. Stroke incidence is increased by known risk factors, which can be prevented. Cardiovascular prevention after stroke or TIA also includes aetiology-specific treatment, when it is known. Endovascular treatment is not indicated as a first-line treatment for atheromatous cervical or intracranial stenosis. Endovascular or surgical treatment is not indicated as first-line treatment for cervical arterial dissection because of its minor risk of stroke recurrence.

Usage of a Translated Version of Terminologia Anatomica in Brazil: An Examination of the Neurosurgical Literature

Introduction The linguistic factor may have delayed the universal adoption of the International Anatomical Terminology (IAT), which was widespread in Latin and in English only. Independent translations are possible, but they are not devoid of methodological difficulties. Objective To estimate the usage of the translated version of the Terminologia Anatomica in neurosurgical articles in Brazil. Method Consecutive national publications were checked for the correspondence of their anatomical terms to the following categories: IAT ­ Brazilian version; IAT in Latin; Nomina Anatomica ­ previous versions; incomplete terms; derivative terms; eponyms; neologisms; and others (misspellings and prosaic terms). The years 2014 and 2015 were chosen for analysis so that included articles were published at least 16 years after the publication of the original IAT (1998) and at least 13 years since the publication of the Brazilian version (2001). Results Out of a total of 183 articles analyzed, 1,132 anatomical terms were identified, referring to 334 different anatomical structures. Most of the structures were described using terms from the Brazilian version of the IAT (n » 834; 73.7%). Those that did not belong to or did not derive from any version of the IAT totaled 281 (24.8%). The remaining 17 terms (1.5%) corresponded to words derived or provided for in the Latin IAT. No association was identified between the number of authors and any category of nomenclature. Conclusion Althoughmost anatomical structures cited in Portuguese were described in accordance with the Brazilian version of the IAT, the degree of adherence was considered moderate given that about one-quarter of the terms escaped this terminology.

Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients.

BACKGROUND AND PURPOSE: Prompt recanalization of cerebral arteries in patients diagnosed with acute ischemic stroke is known to be associated with a better clinical outcome. The aim of this study was to present our initial experience regarding the efficacy and safety of the Solitaire FR as a revascularization device. METHODS: 56 consecutive patients presenting with acute ischemic stroke underwent intra-arterial therapy using the Solitaire FR revascularization device. Immediate angiographic results and early clinical outcomes are presented. RESULTS: Solitaire FR was successful in achieving recanalization in 50 out of 56 patients (89%) with a final Thrombolysis in Cerebral Infarction score ≥2b. Five out of 56 patients had procedure related complications: two asymptomatic subarachnoid hemorrhages, two thromboembolic events and one symptomatic intracranial hemorrhage (PH2). Thirty patients (53.5%) demonstrated at discharge a National Institutes of Health Stroke Scale Score of ≤1 or an improvement of at least 10 points from baseline, and 26 patients (46%) had a modified Rankin Score ≤2. CONCLUSIONS: Solitaire FR is successful in achieving a high rate of arterial recanalization with a low complication rate. The Solitaire FR is a promising thrombectomy tool with a high degree of effectiveness, safety and ease of use.

Middle longitudinal fasciculus delineation within language pathways: a diffusion tensor imaging study in human.

INTRODUCTION: The existence in the human brain of the middle longitudinal fasciculus (MdLF), initially described in the macaque monkey, is supported by diffusion tensor imaging studies. In the present work, we aim (1) to confirm that this fascicle is found constantly in control subjects with the use of DTI techniques and (2) to delineate the MdLF from the other fiber bundles that constitute the language pathways. MATERIALS AND METHODS: Tractography was realized in four right-handed healthy volunteers for the arcuate fascicle, uncinate fascicle, inferior fronto-occipital fascicle, inferior longitudinal fascicle and the middle longitudinal fascicle. The fiber tracts were characterized for their size, mean fractional anisotropy (FA), for their length, number of streamlines, and lateralization indices were calculated. RESULTS: The MdLF is found constantly and it is clearly delineated from the other fascicles that constitute the language pathways, especially the ventral pathway. It runs within the superior temporal gyrus white matter from the temporal pole, then it extends caudally in the upper part of the sagittal stratum and the posterior part of the corona radiata, to reach the inferior parietal lobule (angular gyrus). We found a leftward asymmetry for all fiber tracts when considering the mean FA. DISCUSSION: Using DTI methods, we confirm that the MdLF connects the angular gyrus and the superior temporal gyrus. On the basis of these findings, the role of the MdLF is discussed. CONCLUSION: The middle longitudinal fasciculus, connects the angular gyrus and the superior temporal gyrus and its course can be systematically differenciated from those of other fascicles composing both ventral and dorsal routes (IFOF, IFL, AF and UF).