JNIS Podcast

Current endovascular strategies for cerebral venous thrombosis

The recommendations of the report of the Society of Neurointerventional Surgery (SNIS) Standards and Guidelines Committee for endovascular strategies for cerebral venous thrombosis are discussed in this podcast. Editor-in-Chief of JNIS, Felipe de Albuquerque, talks to Justin Fraser (Department of Neurological Surgery, University of Kentucky, Lexington, USA) on behalf of the Society of NeuroInterventional Surgery.
Read the paper on the JNIS website: https://jnis.bmj.com/content/10/8/803

M2 occlusions patients may benefit from endovascular therapy

M2 occlusions can present with serious neurological deficits, resulting in large infarcts and significant morbidity and mortality. The paper discussed in this podcast concludes that patients with M2 occlusions and higher baseline deficits (NIHSS score ≥9) may benefit from endovascular therapy, thus potentially expanding the category of acute ischemic strokes amenable to intervention.
Listen to the conversation between the Editor-in-Chief of JNIS, Felipe de Albuquerque, and Ansaar Rai (Department of Interventional Neuroradiology, West Virginia University Hospital, USA), who is the co-author of “A population-based incidence of M2 strokes indicates potential expansion of large vessel occlusions amenable to endovascular therapy”. Read the Editor’s Choice paper of June 2018 on the JNIS website: jnis.bmj.com/content/10/6/510.

Balloon guide catheter use in mechanical thrombectomy linked to clinical and angiographic outcomes

The use of balloon guide catheters (BGCs) during mechanical thrombectomy for acute ischemic stroke is associated with superior clinical and angiographic outcomes, concludes a systematic review and meta-analysis recently published by JNIS and discussed in this podcast.
Waleed Brinjikji (Departments of Radiology and Neurosurgery of the Mayo Clinic, Rochester, Minnesota, USA) tells the Editor-in-Chief of the journal Felipe Albuquerque the details of his paper ‘Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis’.
Read the Editor’s Choice of April 2018: http://jnis.bmj.com/content/10/4/335

Favorable revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct

A low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke. The study discussed in this podcast evaluated the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct, concluding that revascularization therapy contributed to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.
The Editor-in-Chief of JNIS Felipe Albuquerque is joined by Vincent Costalat (Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France), who co-authored the paper: "Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke".
Read the full details of this article published in the January 2018 issue of JNIS here: http://jnis.bmj.com/content/10/1/5.

Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms

In this podcast, the Editor-in-Chief of JNIS Felipe Albuquerque speaks to Raul Nogueira (Department of Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Atlanta, Georgia, USA).
He is the co-author of the study "Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis".
Read the full paper published in the October 2017 issue of the journal also on the JNIS website: http://dx.doi.org/10.1136/neurintsurg-2016-012633.
The second article mentioned in this podcast, "Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts", can be found here: http://dx.doi.org/10.1136/neurintsurg-2017-013243.

Predictors of false-positive stroke thrombectomy transfers

Diagnosing with clinical scales or imaging? The transfer decision process of patients with large vessel occlusion (LVO) stroke to receive thrombectomy is discussed in this podcast.
The Editor-in-Chief of JNIS Felipe Albuquerque speaks to Michael Chen (Department of Neurological Surgery, Rush University Medical Center, Chicago, USA) about his co-authored study ‘Predictors of false-positive stroke thrombectomy transfers’, published in the September 2017’s issue of the JNIS.
Read the full paper on the journal's website: http://jnis.bmj.com/content/9/9/834.

Editorial: In defence of “our” stroke patients

JNIS Associate Editor Joshua Hirsch is joined by Shazam Hussain (Cerebrovascular Center, Cleveland Clinic, Ohio, USA) and David Fiorella (Department of Neurosurgery, Stony Brook University, New York, USA) to discuss the June 2017's editorial in the Journal of Neurointerventional Surgery.
In this commentary, they analyse the conclusions of the study “Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke”, published by Circulation, stating that the opinions of Drs Hopkins and Holmes “lead to unwarranted conclusions that have dangerous implications for patient care”.
The authors of the JNIS editorial comment on three major points of controversy:
(1) a disregard for training, expertise, and experience in the management of a disease that may lead to death or disability when treating physicians do not have them;
(2) a misunderstanding of the fundamental underpinnings of stroke physiology and anatomy;
(3) a false association between a real problem (undeveloped systems of care) and a spurious assumption (ie, that there are not enough physicians trained to perform intracranial MT). We examine these concerns below.
The editorial “In defense of our patients” was written on behalf of the Society of NeuroInterventional Surgery, the Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, and the Society of Vascular and Interventional Neurology.
Read the full article on the JNIS website: jnis.bmj.com/content/9/6/525.

Long term experience using the ADAPT technique for the treatment of acute ischemic stroke

The direct aspiration first pass technique (ADAPT) has been introduced as a simple and fast method for achieving good angiographic and clinical outcomes using large bore aspiration catheters for the treatment of acute ischemic stroke (AIS). A study recently published in JNIS by Dr Turk et al. conclude that ADAPT is an effective method to achieve good clinical and angiographic outcomes, and serves as a useful firstline method for revascularization.
In this podcast, The Editor-in-Chief of JNIS Felipe Albuquerque and Aquilla Turk discuss the details of this single center's long term experience with ADAPT. The paper “Long term experience using the ADAPT technique for the treatment of acute ischemic stroke” can be found on the JNIS website (http://jnis.bmj.com/content/9/5/437) and on the May 2017's edition of the journal.
Read the other study mentioned in this podcast, "The ‘pit-crew’ model for improving door-to-needle times in endovascular stroke therapy: a Six-Sigma project", here: http://jnis.bmj.com/content/8/5/447.

Implications of limiting mechanical thrombectomy to patients with ELVO meeting top tier evidence

The impact of recent guidelines for endovascular management of emergent large vessel occlusion (ELVO) awarding top tier evidence to the same selective criteria in recent trials is discussed in this podcast.
The Editor-in-Chief of JNIS Felipe Albuquerque talks to the two main authors of the study, "Implications of limiting mechanical thrombectomy to patients with emergent large vessel occlusion meeting top tier evidence criteria". Rohini Bhole and Adam Arthur (University of Tennessee Health Sciences Center) explain how guideline adherence impacted treatment numbers and outcomes in a cohort of patients from a comprehensive stroke centre.
Read the full paper: http://jnis.bmj.com/content/9/3/225.

MACRA 2.0

In this podcast about the healthcare policy, Associate Editor of JNIS and Chair of the SNIS Health Care policy and Economic committee Josh Hirsch is joined by co-authors Andrew Rosenkrantz, from the Department of Radiology, NYU Langone Medical Center, and by Gregory Nicola, from the Hackensack Radiology Group, to discuss MACRA Quality Payment Program episodic care payments, costs of care and implications to neurointerventional specialists.
In times of change in the American Administration, the group reflects on what elements of the MACRA/QPP will remain and which might change or even disappear.
Read the related articles:
http://jnis.bmj.com/content/early/2016/12/01/neurintsurg-2016-012885
http://jnis.bmj.com/content/early/2016/11/24/neurintsurg-2016-012845