Jacques Dion
Emory University, Radiology and Imaging Sciences, Faculty Member
Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS). To establish the effect of the procedural time on the clinical outcomes of patients with AIS. Data from all consecutive patients who... more
Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS). To establish the effect of the procedural time on the clinical outcomes of patients with AIS. Data from all consecutive patients who underwent mechanical thrombectomy between September 2010 and July 2012 were analysed retrospectively. The variable of interest was procedural time (defined as time from groin puncture to final recanalization time). Outcome measures included the rates of symptomatic intracranial hemorrhage (sICH, defined as any parenchymal hematoma-eg, PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale 0-2) at 90 days. The cohort included 242 patients with a mean age of 65.5±14.2 and median baseline National Institutes of Health Stroke Scale score 20. 51% of the patients were female. The mean procedure time was significantly shorter in patients with a good outcome (86.7 vs 73.1 min, respectively, p=0.0228). P...
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BackgroundAneurysmal subarachnoid hemorrhage is a potentially devastating condition, and among the first priorities of treatment is aneurysm occlusion to prevent re-hemorrhage. An emerging strategy to treat patients whose aneurysms are... more
BackgroundAneurysmal subarachnoid hemorrhage is a potentially devastating condition, and among the first priorities of treatment is aneurysm occlusion to prevent re-hemorrhage. An emerging strategy to treat patients whose aneurysms are not ideal for surgical or endovascular treatment is subtotal coiling followed by flow diversion in the recovery phase or ‘plug and pipe’. However, data regarding the safety and efficacy of this strategy are lacking.MethodsA retrospective cohort study was performed to evaluate the efficacy and safety of ‘plug and pipe’. All patients with a ruptured intracranial aneurysm intentionally, subtotally treated by coiling in the acute stage followed by flow diversion after recovery, were included. The primary outcome was re-hemorrhage. Secondary outcomes included aneurysm occlusion and functional status. Complications were reviewed.Results22 patients were included. No patient suffered a re-hemorrhage, either in the interval between coiling and flow diversion o...
BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus... more
BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<...
Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. To examine the safety and effectiveness of PCA aneurysm flow... more
Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared. Ten PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. ...
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Fusiform dilatation of the internal carotid artery (FDICA) is a well-described radiographic finding following resection of childhood craniopharyngioma (CP). A 39-year-old woman with right-sided FDICA was successfully treated for lesion... more
Fusiform dilatation of the internal carotid artery (FDICA) is a well-described radiographic finding following resection of childhood craniopharyngioma (CP). A 39-year-old woman with right-sided FDICA was successfully treated for lesion enlargement with endovascular flow diversion, which has not been described in the literature.
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Administration of ε-aminocaproic acid (εACA), as adjuvant therapy following incompletely embolized cranial dural arteriovenous (dAVFs) and direct carotid artery to cavernous sinus fistulae (CCFs), is a strategy to promote post-procedural... more
Administration of ε-aminocaproic acid (εACA), as adjuvant therapy following incompletely embolized cranial dural arteriovenous (dAVFs) and direct carotid artery to cavernous sinus fistulae (CCFs), is a strategy to promote post-procedural thrombosis. However, the efficacy of εACA to treat incompletely obliterated dAVFs and CCFs has not been published. The purpose of this study was to determine if administration of εACA following incomplete embolization of cranial dAVFs or CCFs was associated with an increased likelihood of cure on follow-up imaging compared with patients not given adjuvant εACA. A retrospective cohort study was performed. All patients who underwent treatment of a dAVF or CCF at our institution between 1998 and 2016 were reviewed (n=262). Patients with residual shunting following the first attempted endovascular embolization were included in the analysis (n=52). The study groups were those treated with εACA following incomplete obliteration of the fistula and those wh...
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Multiple intracranial aneurysms (IAs) have never been reported in a patient with Gaucher disease (GD). A 69-year-old-female with type I GD presented with a left sixth nerve palsy due to a large posterior inferior cerebellar artery (PICA)... more
Multiple intracranial aneurysms (IAs) have never been reported in a patient with Gaucher disease (GD). A 69-year-old-female with type I GD presented with a left sixth nerve palsy due to a large posterior inferior cerebellar artery (PICA) aneurysm. Cerebral angiography demonstrated fifteen unruptured IAs (UIAs).
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... 1S Moskowitz, 1F Hui, 1R Gupta, 1P Rasmussen, 1T Masaryk, 2A Wahkloo, 3A Schuette, 3C Cawley, 3J Dion. ... 009 PRESERVATION OF OPHTHALMIC ARTERY ARISING FROM ANEURYSM BODY DURING ENDOVASCULAR COIL OCCLUSION E Murphy, J Pryor. ...
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Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated... more
Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant. To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms. A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms. Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and ...
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Carotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist. A database of all patients whose... more
Carotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist. A database of all patients whose aneurysms were treated with the PED since its approval by the Food and Drug Administration in 2011 was retrospectively reviewed. Demographic information, aneurysm characteristics, treatment technique, antiplatelet regimen, and follow-up data were collected. A literature review of all papers that describe PED treatment of CCA was then completed. A total of 44 patients with 45 CCAs were identified (38 women, 6 men). The mean age was 59.9±9.0 years. The mean maximal aneurysm diameter was 15.9±6.9 mm (mean neck 7.1±3.6 mm). A single PED was deployed in 32 patients, with two PEDs deployed in 10 patients and three PEDs in 3 patients. Adjunctive coiling was performed in 3 patients. Mean follow-up duration based on final imaging (MR angiography or digital su...
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BackgroundThe off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.ObjectiveTo report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline... more
BackgroundThe off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.ObjectiveTo report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED).MethodsThe neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis.ResultsTwenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in ...
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The diagnosis and management of a 28-year-old obese woman who presented with neck pain, headache, and rapidly progressive visual loss is discussed here. Results of her initial general examination were normal. Thorough medical follow-up... more
The diagnosis and management of a 28-year-old obese woman who presented with neck pain, headache, and rapidly progressive visual loss is discussed here. Results of her initial general examination were normal. Thorough medical follow-up resulted in a rare diagnosis.
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To describe the technique of percutaneous, infraocular embolization of indirect carotid-cavernous fistulas (CCFs) and analyze the results in a small clinical series. A retrospective case series of 4 patients treated at Emory University... more
To describe the technique of percutaneous, infraocular embolization of indirect carotid-cavernous fistulas (CCFs) and analyze the results in a small clinical series. A retrospective case series of 4 patients treated at Emory University Hospital. Four patients with indirect CCFs and limited transvenous access were successfully treated with transcutaneous, infraocular embolization of the recipient cavernous sinus via the ipsilateral superior orbital fissure. Main outcome measures were clinical examination findings and cerebral angiography. All patients had either preservation or improvement in final visual outcome. One patient required early retreatment because of clot lysis and reopening of a secondary, iatrogenic direct CCF. Two patients suffered early postprocedural orbital hemorrhage requiring treatment with lateral canthotomy and inferior cantholysis. Based these findings, percutaneous, infraocular, trans-superior orbital fissure embolization of CCFs is a viable alternative in patients with refractory fistulas failing management with more conventional techniques. Orbital hemorrhage is a significant risk, and availability of an ophthalmologist skilled in the management of this complication is imperative.
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To determine whether new hydrophilic microcatheter coatings exhibit characteristics that diminish the chance of permanent endovascular glue adhesion during liquid acrylic embolization. Common hydrophilic and nonhydrophilic microcatheters... more
To determine whether new hydrophilic microcatheter coatings exhibit characteristics that diminish the chance of permanent endovascular glue adhesion during liquid acrylic embolization. Common hydrophilic and nonhydrophilic microcatheters (both flow-directed and over-the-wire) used in neurointerventional procedures were evaluated in vitro for liquid acrylic (Histoacryl and Avacryl)-to-catheter bond strength, catheter endovascular friction, and catheter stretch (tensile strength). Sufficient test repetitions were acquired to achieve statistical significance. The bond strength between hydrophilically coated catheters and NBCA was significantly weaker than between nonhydrophilic catheters and NBCA. Hydrophilic catheter coating reduced dynamic endovascular friction by 30% to 35%. All flow-directed catheters exhibited considerably more stretch (less tensile strength) and therefore were more prone to fracture during withdrawal than over-the-wire systems. Histoacryl bonded to both hydrophil...
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In this report, a case of anomalous internal carotid artery looping into the orbital apex is presented. The patient was a 41-year-old man with sudden onset headache, suggestive of aneurysmal subarachnoid hemorrhage (SAH). Imaging with CT... more
In this report, a case of anomalous internal carotid artery looping into the orbital apex is presented. The patient was a 41-year-old man with sudden onset headache, suggestive of aneurysmal subarachnoid hemorrhage (SAH). Imaging with CT demonstrated a perimesencephalic distribution of blood. Cerebral angiography confirmed non-aneurysmal, perimesencephalic SAH, but incidentally noted an anomalous left internal carotid artery with a course into the orbital cone. This is the only known example of this anatomic variation. Potential embryological explanations are discussed.
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This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an 1RB approved protocol as... more
This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an 1RB approved protocol as part of the endovascular treatment of 11 patients with arteriovenous fistulae of internal carotid, external carotid, or vertebral vessels. The patient population included four patients with dural arteriovenous fistulae, three patients with direct carotid cavernous fistulae, three patients with vein of Galen malformations, and one patient with a vertebral artery - vertebral vein fistula. In six of the 11 patients the AVF were completely occluded. Fistula occlusion occurred in two patients immediately, in three patients in a delayed fashion (three days to nine months) and in one patient the fistula was closed immediately, reopened spontaneously, and then reoccluded at a second procedure 17 months later. In five patients the fistula was incompletely occl...
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Liquid N-butyl cyanoacrylate (n-BCA) use for the treatment of arteriovenous malformations (AVM) in the brain has become part of medical practice. However, no study has led to the Food and Drug Administration's approval of n-BCA for... more
Liquid N-butyl cyanoacrylate (n-BCA) use for the treatment of arteriovenous malformations (AVM) in the brain has become part of medical practice. However, no study has led to the Food and Drug Administration's approval of n-BCA for intravascular use. The purpose of this study was to verify the effectiveness and safety of an n-BCA/Tantalum Powder/Ethiodized Oil mixture, compared with conventional treatment (Trufill polyvinyl alcohol [PVA]) for preoperative embolization of cerebral AVM. Between October 15, 1996, and March 24, 1999, 104 patients at 13 centers were prospectively randomized to undergo embolization using an n-BCA/Tantalum Powder/Ethiodol mixture or Trufill PVA. The pre-embolization therapy goals were determined in terms of the number of pedicles to be embolized and the percent of nidus reduction expected. Embolization results were evaluated by a central laboratory. Subsequent surgical resection data were recorded. Safety evaluation data included recording device compl...
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Percutaneous vertebroplasty is an innovative and successful approach to the treatment of painful osteoporotic compression fractures refractory to medical therapy. We encourage all neuroradiologists to take an active interest in bringing... more
Percutaneous vertebroplasty is an innovative and successful approach to the treatment of painful osteoporotic compression fractures refractory to medical therapy. We encourage all neuroradiologists to take an active interest in bringing this exciting technology to their patients and their practices.
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1. Diagn Imaging (San Franc). 1997 Sep;19(9):68, 71-2. Vertebroplasty relieves osteoporosis pain. Jensen ME, Dion JE. University of Virginia, Charlottesville, USA. PMID: 10170162 [PubMed - indexed for MEDLINE]. MeSH Terms. ...
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We describe a case of dural arteriovenous fistula (DAVF) presenting with subarachnoid hemorrhage (SAH). The diagnosis of DAVF was based on spinal angiography. A review of the literature revealed that five of 13 previously reported DAVFs... more
We describe a case of dural arteriovenous fistula (DAVF) presenting with subarachnoid hemorrhage (SAH). The diagnosis of DAVF was based on spinal angiography. A review of the literature revealed that five of 13 previously reported DAVFs of the cervical spine were accompanied by SAH. SAH has not been observed in DAVFs involving other segments of the spinal canal.
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New medical devices are subject to a regulatory scheme designed to ensure safety and effectiveness that is administered by the United States Food and Drug Administration (FDA). Gaining approval to market a device for a specific clinical... more
New medical devices are subject to a regulatory scheme designed to ensure safety and effectiveness that is administered by the United States Food and Drug Administration (FDA). Gaining approval to market a device for a specific clinical indication may be time-...
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We calculated the incremental cost-utility ratio for Guglielmi detachable coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures. Decision tree and Markov... more
We calculated the incremental cost-utility ratio for Guglielmi detachable coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures. Decision tree and Markov analyses that employ cohort simulation were applied to determine the incremental cost-utility ratio of GDC embolization versus no therapy for unruptured cerebral aneurysms. Clinical values required as input data were estimated from the literature for the following variables: relative frequencies of complete aneurysmal occlusion, partial aneurysmal occlusion, and attempted coiling (no coils detached); morbidity and mortality of GDC embolization; frequency, morbidity, and mortality of spontaneous aneurysmal rupture in untreated and GDC-embolized aneurysms; annual rate of recanalization of GDC-embolized aneurysms; quality of life when knowingly living with untreated or GDG-embolized aneurysms and of living with fixed neurologic deficit; costs of GDC em...
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To assess in a swine model the in vivo thrombogenicity of various microcatheters and guiding catheters as a function of catheter material, catheter coating, and duration of implantation. Microcatheters (Tracker 18 and Fastracker 18,... more
To assess in a swine model the in vivo thrombogenicity of various microcatheters and guiding catheters as a function of catheter material, catheter coating, and duration of implantation. Microcatheters (Tracker 18 and Fastracker 18, Target Therapeutics, Fremont, Calif; Magic 1.8, Balt, Montmorency, France; and Transit, Cordis Endovascular Systems, Miami Lakes, Fla) were placed through 6F guiding catheters (Fasguide, Target Therapeutics, and Envoy, Cordis Endovascular Systems) into the common carotid arteries of swine for 30 minutes (short term), 90 minutes (medium term), and 35 days (long term). Guiding catheters were implanted for 5 hours. At the end of the implantation periods the catheters were retracted and fixed for scanning electron microscopy. The surface of the Fastracker microcatheter was devoid of debris after both short- and medium-term implantation. The Tracker microcatheter had minimal accumulation of cellular elements whereas the Transit microcatheter showed moderate a...
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To determine the frequency of the computed tomographic (CT) pattern of nonaneurysmal perimesencephalic subarachnoid hemorrhage in the setting of ruptured posterior fossa aneurysms. Four neuroradiologists independently and retrospectively... more
To determine the frequency of the computed tomographic (CT) pattern of nonaneurysmal perimesencephalic subarachnoid hemorrhage in the setting of ruptured posterior fossa aneurysms. Four neuroradiologists independently and retrospectively reviewed cranial CT scans of 169 patients with ruptured vertebrobasilar aneurysms (44 cases of posteroinferior cerebellar artery aneurysm, 20 cases of superior cerebellar artery aneurysm, and 105 cases of basilar-tip aneurysm). The mean frequency of nonaneurysmal perimesencephalic pattern of subarachnoid hemorrhage in ruptured vertebrobasilar aneurysms was 7.1% (48 of 676 readings) among the four readers. The mean frequency of aneurysms with the pattern of hemorrhage for each location was as follows: basilar tip, 9.8% (41 of 420 readings); superior cerebellar artery, 5.0% (four of 80 readings); and posteroinferior cerebellar artery, 0%. In 75% (six of eight) of the cases in which the CT pattern of hemorrhage was deemed compatible by all readers with...
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This article discusses embolization of brain arteriovenous malformations prior to stereotactic surgery. The rationale and goals of treatment are presented. Patient selection, embolization techniques, complications, and postprocedure... more
This article discusses embolization of brain arteriovenous malformations prior to stereotactic surgery. The rationale and goals of treatment are presented. Patient selection, embolization techniques, complications, and postprocedure management are reviewed.
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Five cases of ipsilateral pupillary dilatation that developed during local intraarterial infusion of papaverine are reported. All patients were being treated for symptomatic vasospasm secondary to subarachnoid hemorrhage. In each case,... more
Five cases of ipsilateral pupillary dilatation that developed during local intraarterial infusion of papaverine are reported. All patients were being treated for symptomatic vasospasm secondary to subarachnoid hemorrhage. In each case, the tip of the infusion catheter was positioned in the internal carotid artery in close proximity to the ostium of the ophthalmic artery. Pupillary dilatation in all patients readily resolved after termination of the infusion.
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This report describes three patients who experienced transient neurologic events associated with intraarterial papaverine infusion in the vertebrobasilar system. Two of these involved respiratory depression and underscore the need for... more
This report describes three patients who experienced transient neurologic events associated with intraarterial papaverine infusion in the vertebrobasilar system. Two of these involved respiratory depression and underscore the need for careful monitoring and, when required, cardiopulmonary support.
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To elucidate, in light of reports of complications associated with intraarterial infusion of papaverine hydrochloride, the known propensity of papaverine hydrochloride to form precipitate in combination with other solutions or... more
To elucidate, in light of reports of complications associated with intraarterial infusion of papaverine hydrochloride, the known propensity of papaverine hydrochloride to form precipitate in combination with other solutions or pharmaceuticals. Initially simulating a situation experienced during an intraarterial papaverine infusion for cerebral vasospasm, we mixed various concentrations of papaverine with serum, nonheparinized and heparinized saline, and nonionic contrast material. Papaverine in concentrations of 0.3% (300 mg/100 mL of normal saline) or greater formed a precipitate when mixed with human serum (blood). The precipitate crystals were 50 to 100 microns in size and could be returned to solution simply by the addition of more serum. Crystal emboli are a possible transient cause of complications experienced during treatment of vasospasm with its attendant altered flow dynamics.
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A 35-year-old man, injured in an automobile accident was found to have a subarachnoid-mediastinal fistula that mimicked a ruptured aorta. Of 16 reported cases of traumatic subarachnoid-mediastinal fistula, this is only the third in which... more
A 35-year-old man, injured in an automobile accident was found to have a subarachnoid-mediastinal fistula that mimicked a ruptured aorta. Of 16 reported cases of traumatic subarachnoid-mediastinal fistula, this is only the third in which the fistulous communication was with the extrapleural space only. The possibility of subarachnoid-mediastinal fistula, although rare, should be entertained in injuries to the thoracocervical spine when neurologic symptoms are present.
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Summary: Occlusion of an internal carotid artery stent was identified immediately post placement in a patient who had restenosis after prior angioplasty. An IV dose of abciximab was administered, and serial angiograms were performed. This... more
Summary: Occlusion of an internal carotid artery stent was identified immediately post placement in a patient who had restenosis after prior angioplasty. An IV dose of abciximab was administered, and serial angiograms were performed. This resulted in partial resolution of the thrombus at 10 minutes and complete resolution at 20 minutes. Acute thrombosis is a potential complication of arterial angioplasty