Guest Editor(s)

• Prof. Elisa F. M. Ciceri, MD

  Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Milan, Italy.

  Website | E-mail

Special Issue Introduction

The approach to neuroimaging of cerebrovascular disease was revolutionized in the early 1900s thanks to the pioneering work of Egas Moniz, who performed the first cerebral angiography via direct puncture of the carotid artery. Interventional neuroradiology was developed more recently, in the 1970s, mainly to support neurosurgery. It initially focused in the treatment of very extensive and deep vascular cerebral/spinal lesions that were deemed inoperable. In the 1980s, as coaxial microcatheters capable of navigating into the intracranial circulation became available, the so-called “flow-controlled” embolizations were dismissed. The detachable balloon technique developed by Serbinenko in Russia and later diffused by Debrun, has made it possible to perform local and accurate treatment of AV fistulas and aneurysms. However, the modern era of Neurointervention began in the following decade, with Guglielmi's controlled detachment platinum coils (GDC) and the progress of biplanar angiography equipment with DSA digital flat-panel technology, allowing 3D and pseudoTC scans.

A lower invasiveness compared to the surgical approach has since contributed to the progressive spread of endovascular treatment techniques. Thanks to improved CT and MRI neuroimaging, the availability of increasingly more performing materials, like catheters, wires and devices, the use of vasoactive and antiplatelet drugs, a better knowledge of the pathophysiology of cerebrovascular diseases and a more specific training of interventional neuroradiologist, huge progress has been made in this discipline in the last decades, to the point that it is now a direct competitor of Neurosurgery in the cerebrovascular field. The most recent challenge in Interventional Neuroradiology is undoubtedly the acute ischemic stroke, with the capability of revascularizing very distal intracranial occluded vessels and restoring the normal hemodynamic in the affected brain by mechanical thrombectomy via aspiration and / or stent-retriever techniques.

Training, equipment and devices are certainly crucial to obtaining the best results in the most complicated scenario, but only a multidisciplinary team of Neuroradiologists, Neurologists and Neurosurgeons will guarantee tailor-made treatments to the patient and his pathology, making the most updated skills, equipment and technologies available, and therefore the best treatment alternatives. The purpose of this special issue is to provide an overview of the most advanced techniques in interventional neuroradiology applied to the most frequent cerebrovascular diseases of both hemorrhagic and ischemic origin, as well as to discuss recent developments and possible alternatives, with an eye to future applications.

Keywords

Cerebrovascular disease, stroke, interventional neuroradiology, intracranial hemorrhage

Submission Deadline

15 Jan 2021

Submission Information

Articles of special issue are free of charge for article processing.
For Author Instructions, please refer to http://vpjournal.net/pages/view/author_instructions
For Online Submission, please login at https://oaemesas.com/VP/?IssueId=509
Submission Deadline: 15 Jan 2021
Contacts: Alisa Wang, Assistant Editor, Alisa@vpjournal.net

Planned Papers

Type: Original Article

Title: Functional outcomes after endovascular thrombectomy in patients with atrial fibrillation

Authors: Dennis J. Cordato, Cecilia Cappelen-Smith

Affiliations: Ingham Institute for Applied Medical Research, Sydney, 2000, Australia.

Correspondence: Dr. Dennis John,Cordato, MD, PHD, Ingham Institute for Applied Medical Research, Sydney, 2000, Australia. E-mail: Dennis.Cordato@health.nsw.gov.au

Abstract: Background: Endovascular thrombectomy (EVT) improves functional outcomes and mortality in ischemic stroke patients with large vessel occlusions (LVO). Patients with atrial fibrillation (AF) are over-represented in EVT populations, due to a high prevalence of LVO and contraindication to intravenous thrombolysis. However, the influence of AF on thrombectomy outcomes remains unclear.

Methods: A retrospective analysis of 394 prospectively collected patients who received EVT for anterior cerebral circulation (ACC) LVO at a single Australian comprehensive stroke center. This study aims to: (1) compare 90-day functional outcomes (modified Rankin Score mRS 0-2) and mortality in AF vs. non-AF patients receiving EVT; (2) compare 90-day functional outcomes and mortality in AF patients on therapeutic vs. non-therapeutic anticoagulation receiving EVT; (3) identify prognostic factors that influence outcomes in AF patients undergoing EVT.

Results: 171 of 394 (49%) EVT patients had AF. Patients with AF were significantly older, had higher CHADS₂, higher NIHSS and lower rates of thrombolysis administration. There was no significant difference in 90-day mRS (P = 0.970) or mortality (P = 0.391) between AF and non-AF groups. Similarly, there was no significant difference in 90-day mRS (P = 0.935) or mortality (P = 0.428) between AF patients on therapeutic vs. non-therapeutic anticoagulation. Advancing age and higher NIHSS were independent predictors of worse 90-day functional outcome (OR 1.045, P = 0.020; OR 1.086, P = 0.001) and mortality (OR 1.138, P < 0.001; OR 1.107, P = 0.002). Thrombolysis administration improved mortality (OR 0.215, P = 0.016) but not functional outcomes (P = 0.092).

Conclusion: AF does not significantly modify 90-day functional outcomes or mortality after EVT in patients with ACC LVO. Furthermore, therapeutic anticoagulation does not influence EVT outcomes.

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Type: Review

Title: Prevention of cardioembolic stroke in patients with atrial fibrillation: The emerging role of the left atrial appendage occlusion. Is the future now?

Authors: Giovanni Cimmino^1,2*, Francesco Loffredo^1,2,3, Emanuele Gallinoro⁴, Dario Prozzo¹, Dario Fabiani^1,2, Luigi Cante^1,2, Maurizio Cappelli Bigazzi², Paolo Golino^1,2

Affiliations: ¹Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy. ²Vanvitelli Cardiology Unit, Monaldi Hospital, Naples, Italy. ³Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy. ⁴Cardiovascular Center, OLV Clinic, Aalst, Belgium.

*Corresponding author: Prof. Giovanni Cimmino, Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, c/o Monaldi Hospital, Via L. Bianchi, 1 , 80131 Naples, Italy. E-mail: giovanni.cimmino@unicampania.it

Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia in general population, with an estimated prevalence of 1%, but it is expected to increase in the next decades, in both Europe and US, because of the rising life expectancy. It is well known that AF increases the risk of ischemic stroke, silent cerebral ischemia and related cognitive impairment. Because of the blood stasis, mostly in the left atrial appendage (LAA), thrombus formation may occur. This is particularly true in the setting of nonvalvular AF (NVAF). Previous studies have shown that over  90% of emboli related to NVAF originate from the LAA, so prevention of systemic cardioembolism is indicated. According the current guidelines, anticoagulation with Direct Oral Anticoagulants (DOACs) or Vitamin K Antagonists (VKAs), represents the standard care in AF patients to prevent stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown non-inferiority for stroke prevention while having significantly fewer bleeding complications compared to VKAs, some issues remain a matter of debate, including contraindications, side effects and adherence. An increasing number of patients cannot take anticoagulants because of high bleeding risk or the experience of life-threatening bleeding. In the last few years, a new procedure is emerging to prevent the cardioembolic stroke in the setting of patients at high bleeding risk: the percutaneous Left Atrial Appendage Occlusion (LAAO). Various devices have been developed over the last years, not all approved in Europe and with some of them still under clinical investigation. Currently available devices have shown a decreasing in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure always requires transesophageal echocardiography, anesthesia, femoral vein access and transeptal puncture. After the approval of the first device, the indication for LAAO was changed. The available literature indicates that LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation.
Giovanni Cimmino MD, PhD
Associate Professor of Cardiology
Department of Translational Medical Sciences
University of Campania "Luigi Vanvitelli"
Cardiology Unit "Vanvitelli"
Monaldi Hospital

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