Introduction: Cranio-Cervical Artery Dissection (CeAD) is a relatively common cause of cerebrovas... more Introduction: Cranio-Cervical Artery Dissection (CeAD) is a relatively common cause of cerebrovascular event in young subjects for which no clear treatment strategy is established. We evaluated the incidence of major adverse cardiovascular events (MACE) in CeAD patients treated with and without stent placement. Methods: COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) is a single high-volume center prospective longitudinal registry that enrolled consecutive CeAD patients over a 2-year period. Patients were ≥18 years of age with confirmed extra- or intracranial CeAD on imaging. Enrolled participants were followed for 1-year evaluating MACE as the primary end-point. Results: One-hundred eleven patients were enrolled (age 53 ± 15.9, 56% Caucasian, 50% male, BMI 28.9 ± 9.2). Grade 1, 2, 3, and 4 blunt vascular injury noted in 16%, 33%, 19%, and 32%, respectively. Forty-percent of dissections were due to known trauma. A predisposing factor was noted ...
B ased on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured... more B ased on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured cerebral aneurysms is associated with the lowest immediate morbidity and mortality rates compared to other treatment options. 1,2 Whenever anatomy permits, coiling is the preferred method for repair. Unfortunately, not all cerebral aneurysms are suitable for coiling, and the best treatment for aneurysms that cannot be coiled remains unclear. Adjunctive techniques such as surgical clipping, balloon remodeling, 3 use of two microcatheters, 4 and intracranial stents 5 can increase the likelihood of aneurysm thrombosis and parent vessel patency. The goal of this article is to describe our current practice using intracranial stents in appropriately selected patients with subarachnoid hemorrhage (SAH) as a result of aneurysm rupture. the use of intracranial stents and coils to treat patients with SAH from cerebral aneurysms has been extremely helpful in the following clinical situations: • Fu...
OBJECTIVE Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images o... more OBJECTIVE Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. METHODS Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by a electrocardiography (ECG) - triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback was registered with fluoroscopy and evaluated for error and clinical usability. RESULTS A total of 32 landmarks were identified w...
Sensing, modeling, and neuromodulation technologies are profoundly advancing the practice of epil... more Sensing, modeling, and neuromodulation technologies are profoundly advancing the practice of epilepsy surgery. Chronically implanted neural monitoring technologies developed for seizure termination and seizure prediction have each been found to be useful in unintended applications, specifically for the planning of resective surgery. We review and summarize the use of chronic monitoring in an unanticipated context in which it was found to be invaluable in the planning of surgery; this was observed in a pivotal study of a seizure detection and termination system. Monitoring of patients chronically in their normal ambulatory setting, as facilitated by this technology, allows unperturbed assessment of patients while on outpatient medication regimens and without the time and space constraints imposed by cost and infection risk inherent in subacute inpatient invasive monitoring. Five patients in the NeuroPace US pivotal trial underwent resective surgery which was subsequent to and enabled by chronic recordings from the implanted monitoring system. These resective surgeries were independent from the primary intended function of the implanted neural monitoring device. Chronic monitoring facilitated greater anatomical localization of the sources and allowed for a deeper understanding of the dynamic network behavior of interconnected seizure foci, thereby facilitating a substantially more sophisticated approach to resective surgery. In the NeuroPace trial, monitoring and analysis of chronic unlimited recording electrocorticography (CURE) from chronically implanted subdural and depth electrodes facilitated planning of resective surgery that resulted in near or complete seizure freedom in 4 patients. This series suggests that chronic recording of electrocorticographic signals is a therapeutic modality meritorious of further investigation. Note: This was analysis and study was performed on patients previously enrolled in the NeuroPace® RNS® Ststem Pivotal trial: http://clinicaltrials.gov/show/NCT00572195
Based on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured ... more Based on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured cerebral aneurysms is associated with the lowest immediate morbidity and mortality rates compared to other treatment options.1, 2 Whenever anatomy permits, coiling is the preferred method for repair. Unfortunately, not all cerebral aneurysms are suitable for coiling, and the best treatment for aneurysms that cannot be coiled remains unclear. Adjunctive techniques such as surgical clipping, balloon remodeling,3 use of two microcatheters,4 and intracranial stents 5 can increase the likelihood of aneurysm thrombosis and parent vessel patency. The goal of this article is to describe our current practice using intracranial stents in appropriately selected patients with subarachnoid hemorrhage (SAH) as a result of aneurysm rupture.
OBJECTIVE The calcium channel blocker nicardipine (NC) is effective for acute control of hyperten... more OBJECTIVE The calcium channel blocker nicardipine (NC) is effective for acute control of hypertension. However, efficacy and safety in neurosurgical patients have not been evaluated. We sought to compare NC with the most commonly used agent, sodium nitroprusside (SNP), in patients with subarachnoid or intracerebral hemorrhage. METHODS We performed a prospective randomized comparison of the safety and efficacy of NC and SNP in patients with subarachnoid or intracerebral hemorrhage. We assessed the number of dose adjustments per patient day, proportion of time within set blood pressure parameters, use of additional medications for blood pressure control, clinical outcome, and drug-related complications. RESULTS Two hundred patients were screened and 163 patients were randomized, including 89 in the SNP group and 74 in the NC group. In 107 patients, intravenous blood pressure control was started; 60 of these patients received SNP and 47 received NC. When analyzed by intent to treat, pa...
Object Neural cell transplantation has been proposed as a treatment after stroke. The purpose of ... more Object Neural cell transplantation has been proposed as a treatment after stroke. The purpose of this study was to establish if human neural stem cells (HNSCs) could survive in the nonhuman primate brain after an ischemic event. Methods Three adult cynomolgus monkeys received a unilateral occlusion of the M1 segment of the right middle cerebral artery (MCA). One week later each animal received five magnetic resonance (MR) image–guided stereotactic intracerebral injections of HNSC neurospheres labeled with bromodeoxyuridine (BrdU) in the areas surrounding the ischemic lesion as defined in T1- and T2-weighted images. On the day of transplantation and throughout the study the monkeys received oral cyclosporine (10 mg/kg twice a day), and plasma levels were monitored routinely. The animals were killed at 45, 75, or 105 days after transplantation. Magnetic resonance images revealed a cortical and subcortical infarction in the MCA distribution area. Postmortem morphological brain analyses...
Many channels and carriers associate with auxiliary subunits which modify their activities and fa... more Many channels and carriers associate with auxiliary subunits which modify their activities and facilitate biogenesis. Advances in genome sequencing as well as biochemical, molecular genetic, and physiological experimentation have allowed for the discovery of many transport auxiliary subunits. Recent interests in the pharmacology of the calcium auxiliary subunits prompted a large amount of effort in deciphering their specific role in the conductance of calcium ions. In this review, we evaluate the functions of the ‘extra’ subunits of the voltage-gated calcium channels in animals as an example of auxiliary subunits of transporters in general. We discuss the functional data available for each of these subunits, present phylogenetic analyses, and discuss their potential evolutionary origins. Our analyses also reveal novel homologues of these subunits which might be of interest to the community.
Results of recent genome-sequencing projects together with advances in biochemical, molecular gen... more Results of recent genome-sequencing projects together with advances in biochemical, molecular genetic and physiological experimentation have allowed discovery of many transport auxiliary subunits. These subunits facilitate the proper movement of substrates across cell membranes. Mutations of any of these subunits can cause catastrophic effects to the transport mechanism and cause certain genetic diseases. Auxiliary subunits of ion channels are of particular interest because of their potential to diversify the transport properties of the principal subunits. Furthermore, ion channel auxiliary subunits may function in the capacity of enhancing surface expression, allowing gating, and providing chaperone-like activities. As a result of their evolutionary histories, these proteins can be grouped exclusively by phylogenetic techniques. Many of these families are found to be restricted to a single kingdom of life while others seem to be ubiquitous. Here we report the results of systematic ...
Introduction: Cranio-Cervical Artery Dissection (CeAD) is a relatively common cause of cerebrovas... more Introduction: Cranio-Cervical Artery Dissection (CeAD) is a relatively common cause of cerebrovascular event in young subjects for which no clear treatment strategy is established. We evaluated the incidence of major adverse cardiovascular events (MACE) in CeAD patients treated with and without stent placement. Methods: COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) is a single high-volume center prospective longitudinal registry that enrolled consecutive CeAD patients over a 2-year period. Patients were ≥18 years of age with confirmed extra- or intracranial CeAD on imaging. Enrolled participants were followed for 1-year evaluating MACE as the primary end-point. Results: One-hundred eleven patients were enrolled (age 53 ± 15.9, 56% Caucasian, 50% male, BMI 28.9 ± 9.2). Grade 1, 2, 3, and 4 blunt vascular injury noted in 16%, 33%, 19%, and 32%, respectively. Forty-percent of dissections were due to known trauma. A predisposing factor was noted ...
B ased on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured... more B ased on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured cerebral aneurysms is associated with the lowest immediate morbidity and mortality rates compared to other treatment options. 1,2 Whenever anatomy permits, coiling is the preferred method for repair. Unfortunately, not all cerebral aneurysms are suitable for coiling, and the best treatment for aneurysms that cannot be coiled remains unclear. Adjunctive techniques such as surgical clipping, balloon remodeling, 3 use of two microcatheters, 4 and intracranial stents 5 can increase the likelihood of aneurysm thrombosis and parent vessel patency. The goal of this article is to describe our current practice using intracranial stents in appropriately selected patients with subarachnoid hemorrhage (SAH) as a result of aneurysm rupture. the use of intracranial stents and coils to treat patients with SAH from cerebral aneurysms has been extremely helpful in the following clinical situations: • Fu...
OBJECTIVE Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images o... more OBJECTIVE Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. METHODS Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by a electrocardiography (ECG) - triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback was registered with fluoroscopy and evaluated for error and clinical usability. RESULTS A total of 32 landmarks were identified w...
Sensing, modeling, and neuromodulation technologies are profoundly advancing the practice of epil... more Sensing, modeling, and neuromodulation technologies are profoundly advancing the practice of epilepsy surgery. Chronically implanted neural monitoring technologies developed for seizure termination and seizure prediction have each been found to be useful in unintended applications, specifically for the planning of resective surgery. We review and summarize the use of chronic monitoring in an unanticipated context in which it was found to be invaluable in the planning of surgery; this was observed in a pivotal study of a seizure detection and termination system. Monitoring of patients chronically in their normal ambulatory setting, as facilitated by this technology, allows unperturbed assessment of patients while on outpatient medication regimens and without the time and space constraints imposed by cost and infection risk inherent in subacute inpatient invasive monitoring. Five patients in the NeuroPace US pivotal trial underwent resective surgery which was subsequent to and enabled by chronic recordings from the implanted monitoring system. These resective surgeries were independent from the primary intended function of the implanted neural monitoring device. Chronic monitoring facilitated greater anatomical localization of the sources and allowed for a deeper understanding of the dynamic network behavior of interconnected seizure foci, thereby facilitating a substantially more sophisticated approach to resective surgery. In the NeuroPace trial, monitoring and analysis of chronic unlimited recording electrocorticography (CURE) from chronically implanted subdural and depth electrodes facilitated planning of resective surgery that resulted in near or complete seizure freedom in 4 patients. This series suggests that chronic recording of electrocorticographic signals is a therapeutic modality meritorious of further investigation. Note: This was analysis and study was performed on patients previously enrolled in the NeuroPace® RNS® Ststem Pivotal trial: http://clinicaltrials.gov/show/NCT00572195
Based on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured ... more Based on findings from the International Subarachnoid Aneurysm Trial (ISAT), coiling of ruptured cerebral aneurysms is associated with the lowest immediate morbidity and mortality rates compared to other treatment options.1, 2 Whenever anatomy permits, coiling is the preferred method for repair. Unfortunately, not all cerebral aneurysms are suitable for coiling, and the best treatment for aneurysms that cannot be coiled remains unclear. Adjunctive techniques such as surgical clipping, balloon remodeling,3 use of two microcatheters,4 and intracranial stents 5 can increase the likelihood of aneurysm thrombosis and parent vessel patency. The goal of this article is to describe our current practice using intracranial stents in appropriately selected patients with subarachnoid hemorrhage (SAH) as a result of aneurysm rupture.
OBJECTIVE The calcium channel blocker nicardipine (NC) is effective for acute control of hyperten... more OBJECTIVE The calcium channel blocker nicardipine (NC) is effective for acute control of hypertension. However, efficacy and safety in neurosurgical patients have not been evaluated. We sought to compare NC with the most commonly used agent, sodium nitroprusside (SNP), in patients with subarachnoid or intracerebral hemorrhage. METHODS We performed a prospective randomized comparison of the safety and efficacy of NC and SNP in patients with subarachnoid or intracerebral hemorrhage. We assessed the number of dose adjustments per patient day, proportion of time within set blood pressure parameters, use of additional medications for blood pressure control, clinical outcome, and drug-related complications. RESULTS Two hundred patients were screened and 163 patients were randomized, including 89 in the SNP group and 74 in the NC group. In 107 patients, intravenous blood pressure control was started; 60 of these patients received SNP and 47 received NC. When analyzed by intent to treat, pa...
Object Neural cell transplantation has been proposed as a treatment after stroke. The purpose of ... more Object Neural cell transplantation has been proposed as a treatment after stroke. The purpose of this study was to establish if human neural stem cells (HNSCs) could survive in the nonhuman primate brain after an ischemic event. Methods Three adult cynomolgus monkeys received a unilateral occlusion of the M1 segment of the right middle cerebral artery (MCA). One week later each animal received five magnetic resonance (MR) image–guided stereotactic intracerebral injections of HNSC neurospheres labeled with bromodeoxyuridine (BrdU) in the areas surrounding the ischemic lesion as defined in T1- and T2-weighted images. On the day of transplantation and throughout the study the monkeys received oral cyclosporine (10 mg/kg twice a day), and plasma levels were monitored routinely. The animals were killed at 45, 75, or 105 days after transplantation. Magnetic resonance images revealed a cortical and subcortical infarction in the MCA distribution area. Postmortem morphological brain analyses...
Many channels and carriers associate with auxiliary subunits which modify their activities and fa... more Many channels and carriers associate with auxiliary subunits which modify their activities and facilitate biogenesis. Advances in genome sequencing as well as biochemical, molecular genetic, and physiological experimentation have allowed for the discovery of many transport auxiliary subunits. Recent interests in the pharmacology of the calcium auxiliary subunits prompted a large amount of effort in deciphering their specific role in the conductance of calcium ions. In this review, we evaluate the functions of the ‘extra’ subunits of the voltage-gated calcium channels in animals as an example of auxiliary subunits of transporters in general. We discuss the functional data available for each of these subunits, present phylogenetic analyses, and discuss their potential evolutionary origins. Our analyses also reveal novel homologues of these subunits which might be of interest to the community.
Results of recent genome-sequencing projects together with advances in biochemical, molecular gen... more Results of recent genome-sequencing projects together with advances in biochemical, molecular genetic and physiological experimentation have allowed discovery of many transport auxiliary subunits. These subunits facilitate the proper movement of substrates across cell membranes. Mutations of any of these subunits can cause catastrophic effects to the transport mechanism and cause certain genetic diseases. Auxiliary subunits of ion channels are of particular interest because of their potential to diversify the transport properties of the principal subunits. Furthermore, ion channel auxiliary subunits may function in the capacity of enhancing surface expression, allowing gating, and providing chaperone-like activities. As a result of their evolutionary histories, these proteins can be grouped exclusively by phylogenetic techniques. Many of these families are found to be restricted to a single kingdom of life while others seem to be ubiquitous. Here we report the results of systematic ...
Uploads