77 e-Letters

  • Aspiration with distal filter protection: an effective management for carotid floating thrombus

    To the editor,

    Giragani S et al. (published online 25 January 2017) described a remarkable case of recurrent transient ischemic attacks (TIA) due to carotid free floating thrombus. They successfully used stentriever with distal filter protection in retrieving the thrombus.

    Here we share a similar case of TIA with right common carotid artery (CCA) floating thrombus that was effectively managed with distal filter protection and aspiration. A 48-year-male with recurrent ischemic symptoms detected to have right CCA long segment floating thrombus (approximately 4.5 cm) extending upto right proximal external carotid artery.* Under general anaesthesia through right femoral route long sheath guiding catheter (Neuron Max 6F088; Penumbra, Inc. Alameda, USA) was placed in right proximal CCA. After parking the filter device (Spider FX 6mm; eV3, Plymouth, Minnesota, USA) at distal cervical segment, thrombus was aspirated using penumbra system (5MAX ACE, 132 cm; Penumbra, Inc. Alameda, USA).* Final check angiography showed 80 % reduction in clot burden .*

    Placing the filter protection device in the distal cervical segment does not protect thrombus migration to ECA, although it primarily prevent intracranial shower. In our index case thrombus fragment migrated to ECA, although it did not cause any neurological deficit. These cases highlight a novel technique to treat free floating thrombus.

    *Representative image available.

  • Transcranial antegrade approach for the treatment of dural sinus thrombosis

    With interest, I read this article and the authors' claim that their technique has not been previously described. A cursory search using PubMed would have shown that we described this approach almost 30 years ago:

    Treatment of dural sinus thrombosis with local urokinase infusion. Case report. Scott JA, Pascuzzi RM, Hall PV, Becker GJ. J Neurosurg. 1988 Feb;68(2):284-7.

  • Re: Letter to the Editor
    Felipe C. Albuquerque

    We appreciate the letter in response to our study and would like to offer the following. First and foremost, it is obvious the authors of the letter feel that this study is an indictment of chiropractic care or spinal manipulation. To the neurosurgical and neurointerventional community, it should be clear that this study downplays any potential causality between chiropractic care and extracranial vessel dissection, as the study...

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  • Letter to the Editor
    Peter Tuchin

    To the editor,

    We would like to raise some issues regarding the Moon et al article "Stroke prevention by endovascular treatment of carotid and vertebral artery dissections", recently published in Neurointerventional Surgery.1 We commend the authors for conducting research in the important area of cervical artery dissection. Their study confirms that cervical artery dissection is a very rare condition, with the...

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  • Comment on “Delayed enhancing lesions after coil embolization of aneurysms: clinical experience and benchtop analyses”

    We read with interest the article entitled: “Delayed enhancing lesions after coil embolization of aneurysms: clinical experience and benchtop analyses” by Oh et al [1]. This interesting case series deals with a recently described complication of intracranial endovascular procedures [2–8]: delayed enhancing lesions (DELs), also known as NICE (non-ischemic cerebral enhancing) lesions [8]. This rare complication consists in delayed appearance of cortical leptomeningeal enhancement associated with vasogenic subcortical edema [8]. The authors describe 3 more cases, in addition to the 19 previously reported [8]. We congratulate the authors for their efforts to understand the mechanism of this rare complication by performing benchtop tests.
    Numerous hypotheses have been proposed to explain this complication.
    First, an allergic reaction to nickel has been suggested [4,7]. In a series we recently published in Neuroradiology [8], we did not find any allergic reaction to the devices used for the embolization of the patients who presented NICE lesions. The fact that, in the series of Oh et al [1], none of the three patients had an allergic background, seems to confirm the absence of any relationship between these lesions and allergy.
    The second hypothesis is a reaction to foreign bodies (catheter coating) released during the embolization. We do believe that, according to our experience [8] and to the data of the literature [2,3,5,6], these lesions are more likely to...

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  • Re:Comment on The Medina Embolic Device: early clinical experience from a single center
    Marta Aguilar Perez

    We would like to thank our colleagues for reading our publication and for the thorough review of the paper. We greatly look forward to reading their own experience and believe that it will add substantially to the literature on this new and interesting device.

    At the outset we would like to make it clear that we stand by our initial comment in saying that we believe the combination of a MED and other devices,...

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  • Thrombectomy in low NIHSS stroke - a diagnostic and therapeutic challenge
    Anselm Angermaier

    We read with great interest the article of Haussen et al. 1 outlining the problem of identifying patients with minor stroke symptoms (low NIHSS) despite proximal vessel occlusion who should undergo thrombectomy. Intension-to-treat analysis showed significantly higher reduction of stroke severity in the primary thrombectomy group compared to the medical group. But more interestingly, per-protocol analysis revealed a high propo...

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  • Use of flat panal angio CT for navigation through a stent
    Gerhard Schroth

    Thank you for your technical considerations regarding stent in stent placement without hooking the first stent.

    Use of 3 D Roadmap may be helpful. Moreover, following passage of the microwire, reconstructions of a second flat panel angioCT with the microwire in place clearly outlines the relationship between the microwire and the struts of the first stent, especially if reconstructions perpendicular to the orientati...

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  • Trying to catch the "ghost ischemic core": CT perfusion versus DWI
    Nicola Morelli

    Dear Editor, We read with great interest the original article by Boned S. et al. (1) which demonstrates that CT perfusion (CTP) may overestimate the final infarct core, especially in the early time window. Interestingly, the authors introduce the "ghost infarct core" concept in ischemic stroke, referring to that particular condition where the final infarct core at follow up imaging may be smaller than the one observed on...

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  • Comment on The Medina Embolic Device: early clinical experience from a single center
    Frederic Clarencon

    Frederic Clarencon, MD, PhD 1, 2, Nader-Antoine Sourour, MD 1 *

    1. Department of Interventional Neuroradiology. Pitie-Salpetriere Hospital.

    APHP. Paris France. 2. Paris VI University Pierre et Marie Curie. Paris. France

    * Corresponding author

    We read with great interest the case series entitled: "The Medina Embolic Device: early clinical experience from a single center" by Aguilar Per...

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