eLetters

93 e-Letters

  • 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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  • 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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  • No thromboembolic complications after Pipeline Embolization Device with Shield Technology treatment: the possible role of aneurysm size

    To the editor,

    With great interest we read the recent paper by Martinez-Galdámez et al. regarding the periprocedural outcomes and early safety after placement of a Pipeline Embolization Device with Shield Technology (PEDshield) (1). Evaluation of new endovascular devices, such as PEDshield, is of the utmost importance to give future users a chance to objectively review possible benefits for their clinical practice.

    In the study of Martinez-Galdámez et al. 76% of the target aneurysms were small (< 10 mm). It is known that small aneurysms are associated with a lower probability of thromboembolisms and ischemic stroke after flow diverter treatment than large and giant aneurysms (2,3). The size of the treated aneurysms, and not the PEDshield, might therefore explain the lack of thromboembolic complications reported in the study of Martinez-Galdámez et al. Selection bias might thus have led to the conclusion that the early safety of the PEDshield device is warranted.

    Furthermore, it is hard to understand why only 21 out of 50 patients (42%) underwent platelet reactivity testing, especially since the primary outcome measure focused on identifying thromboembolic complications in the territory supplied by the treated artery. To make matters worse: when platelet reactivity tests revealed the presence of hyporesponders, anti-platelet therapy was left unchanged in most cases. If thromboembolic complications do occur in the 6-month and 1-year follow-up of this...

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  • 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.

  • Social Media Metrics: A New Way of Measuring Scientific Impact
    Andres M Lozano

    We read with great interest the article by Fargen et al(1), which reports the Journal of Neurointerventional Surgery (JNIS) experience in social media. The journal recently implemented a three-pronged social media strategy, along with the hiring of dedicated social media staffing, to enhance their online viewership. Since implementing this marketing approach, JNIS has had significantly more website accessions to their pe...

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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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  • 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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  • Letter by Parthasarathy et al. regarding article, "Unwanted detachment of the Solitaire device during mechanical thrombectomy in acute ischemic stroke ".
    Vipul Gupta

    Letter by Parthasarathy et al. regarding article, "Unwanted detachment of the Solitaire device during mechanical thrombectomy in acute ischemic stroke ".

    Rajsrinivas Parthasarathy MRCP (UK) Neurology, Vipul Gupta MD, Gaurav Goel MD DM

    Department of Neurointerventional surgery, Institute of Neuroscience, Medanta, the Medicity, Gurgaon, India.

    Title word count: 14

    Word Count: Abstract: 1...

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