JNIS Podcast

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

Decreasing procedure times with a standardized approach to ELVO cases. Welcoming JNIS new editor

In this introductory podcast of Felipe Albuquerque, the new Editor-in-Chief of JNIS talks with Ryan McTaggart, who co-authored the study, "Decreasing procedure times with a standardized approach to emergent large vessel occlusion (ELVO) cases".
The study was run at the single comprehensive stroke center at the Rhode Island Hospital and concluded that a standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times.
Read the full paper at the JNIS website: http://jnis.bmj.com/content/9/1/2.

Analysis of vertebral augmentation practice patterns update. The farewell to JNIS editor Robert Tarr

In this farewell podcast of the JNIS Editor-in-Chief, Robert Tarr talks vertebral augmentation practice with Associate Editor Joshua Hirsch and Ronil Chandra.
Dr J A Hirsch, from the Massachusetts General Hospital, Harvard Medical School, USA, and Dr R V Chandra, from the Interventional Neuroradiology Service, Monash University, Melbourne, Australia, are the leading authors of the study "Analysis of vertebral augmentation practice patterns: A 2016 update", published in the December 2016 print edition of JNIS.
Read the full article here: http://jnis.bmj.com/content/8/12/1299.

Type of general anesthesia effects on endovascular management of acute ischemic stroke

In this podcast, Andrew Kofke, from the Departments of Anesthesiology and Critical Care and Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA, reveals the details of his JNIS Editor's Choice paper published in the November 2016 issue.
The study concludes that anesthetic techniques and associated physiology used in endovascular management of acute ischemic stroke (EMAIS) are not homogeneous, making any statements about the effects of generic general anesthesia in stroke ambiguous.
In "Anesthetic variation and potential impact of anesthetics used during endovascular management of acute ischemic stroke" the authors also conclude that the type of general anesthesia may affect the outcome after EMAIS.
Read the full details here:
http://jnis.bmj.com/content/early/2015/11/27/neurintsurg-2015-011998.full.pdf.

Posterior cranial fossa arteriovenous malformations are more prone to feeder vessel aneurysms

In this podcast, the Editor-in-Chief of JNIS, Robert Tarr, is joined by Ali Alaraj, the corresponding author of the study, "Increased prevalence and rupture status of feeder vessel aneurysms in posterior fossa arteriovenous malformations".
Dr Alaraj, from the Department of Neurosurgery, Neuropsychiatric Institute University of Illinois, Chicago, USA, explains why are posterior cranial fossa arteriovenous malformations (AVMs) more prone to developing associated aneurysms, specifically feeder vessel aneurysms. Feeder vessel aneurysms are more likely to be the source of hemorrhage in the posterior fossa. As such, they may be the most appropriate targets for initial and prompt control by embolization or surgery due to their elevated threat.
Read the full paper here: http://jnis.bmj.com/content/8/10/1021.full.

The low-profile visualized intraluminal support device use on wide-necked intracranial aneurysms

In this podcast, the Editor-in-Chief of JNIS, Robert Tarr, is joined by David Fiorella, the corresponding author of the study, "Final results of the US humanitarian device exemption study of the low-profile visualized intraluminal support (LVIS) device".
Dr Fiorella, from the Department of Neurological Surgery, Stony Brook University Medical Center, New York, concludes that the LVIS device facilitates coil embolization of wide-necked intracranial aneurysms with high rates of technical success. The process also granted an excellent safety profile, and very high rates of complete and near-complete occlusion at follow-up.
Read the full paper here: http://jnis.bmj.com/content/early/2015/09/21/neurintsurg-2015-011937.full

GRAFT reduces potential flow diverter malapposition and occasional acute thrombus formation

In this podcast, Dr Robert Tarr interviews Dr Matthew Gounis and Dr Ajit Puri on their latest study, "Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT".
GRAFT is a semi-automated image post-processing software, which uses intuitive two-dimensional representations of wall apposition from either high-resolution contrast-enhanced cone-beam CT (VasoCT) or intravascular optical coherence tomography (OCT) images.
The technique brings great prospects of reducing stroke-related complications when treating intracranial aneurysms. It delivers quantitative and visually convenient representations of potential flow diverter malapposition and occasional acute thrombus formation.
The paper, published on the August 2016 issue of JNIS, can be read here: http://jnis.bmj.com/content/8/8/847.full.