Intra-arterial thrombolysis and thrombectomy for acute ischemic stroke: technique and results.

Endovascular intraarterial (IA) strategies have emerged as important treatment options for patients with acute ischemic stroke who are ineligible for intravenous (IV) tissue plasminogen activator (tPA) or in whom such therapy has failed. The goal of this article is to provide a comprehensive review of percutaneous IA endovascular techniques aimed at revascularization in the setting of acute ischemic stroke from IA thrombolysis, mechanical thrombectomy, and primary intracranial stenting to retrievable-stent technology. For each modality, we focus on the existing clinical data, including our institutional experience and techniques.

Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia.

BACKGROUND: The mechanism of the adrenergic atrial tachyarrhythmia is unclear. We hypothesize that the ligament of Marshall (LOM) is sensitive to adrenergic stimulation and may serve as a source of the adrenergic atrial tachyarrhythmia. METHODS AND RESULTS: We performed computerized mapping studies in isolated-perfused canine left atrial tissues from normal dogs (n=9) and from dogs with chronic atrial fibrillation (AF) induced by 10 to 41 weeks of rapid pacing (n=3). Before isoproterenol, spontaneous activity occurred in only one normal tissue (cycle length, CL >1300 ms). During isoproterenol infusion, automatic rhythm was induced in both normal tissues (CL=578+/-172 ms) and AF tissues (CL=255+/-29 ms, P<0.05). The origin of spontaneous activity was mapped to the LOM. In the AF tissues, but not the normal tissues, we observed the transition from rapid automatic activity to multiple wavelet AF. Ablation of the LOM terminated the spontaneous activity and prevented AF. Immunocytochemical studies of the LOM revealed muscle tracts surrounded by tyrosine hydroxylase-positive (sympathetic) nerves. CONCLUSIONS: We conclude that the LOM is richly innervated by sympathetic nerves and serves as a source of isoproterenol-sensitive focal automatic activity in normal canine atrium. The sensitivity to isoproterenol is upregulated after long-term rapid pacing and may contribute to the development of AF in this model.

Asymmetric magnetization reversal in exchange-biased hysteresis loops

Polarized neutron reflectometry is used to probe the in-plane projection of the net-magnetization vector M--> of polycrystalline Fe films exchange coupled to twinned (110) MnF (2) or FeF (2) antiferromagnetic (AF) layers. The magnetization reversal mechanism depends upon the orientation of the cooling field with respect to the twinned microstructure of the AF, and whether the applied field is increased to (or decreased from) a positive saturating field; i.e. , the magnetization reversal is asymmetric. The reversal of the sample magnetization from one saturated state to the other occurs via either domain wall motion or magnetization rotation on opposite sides of the same hysteresis loop.

The sodium-calcium ion membrane exchanger: physiologic significance and pharmacologic implications.

The Na(+)-Ca2+ exchanger is a non-ATP-dependent protein that, under steady-state conditions, extrudes Ca2+ from the interior of the cell into the extracellular space via facilitated transport. The activity of the exchanger seems to be reduced in myocardial ischemia, leading to increased intracellular Ca2+ in the ischemic heart, which can result in arrhythmia, myocardial stunning, and necrosis. In contrast, congestive heart failure and myocardial hypertrophy are associated with increased exchanger activity and a decreased inotropic state. Pharmacologic agents are being developed to modulate sodium ion levels in the cell, which could enhance or reduce sodium-calcium exchange as needed in various pathophysiologic states. At this time there are no available drugs that act specifically on the Na(+)-Ca2+ exchanger itself. The exchanger has been cloned, and inhibitory peptides of the exchanger may soon be available for possible use in treatment of congestive heart failure.

Use of the Outreach Distal Access Catheter for microcatheter stabilization during intracranial arteriovenous malformation embolization.

The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.

Two-stage magnetization reversal in exchange biased bilayers.

MnF(2)/Fe bilayers exhibit asymmetric magnetization reversal that occurs by coherent rotation on one side of the loop and by nucleation and propagation of domain walls on the other side of the loop. Here, we show by polarized neutron reflectometry, magnetization, and magnetotransport measurements that for samples with good crystalline "quality" the rotation is a two-stage process, due to coherent rotation to a stable state perpendicular to the cooling field direction. The result is remarkably asymmetrically shaped hysteresis loops.