JNIS Podcast

Endovascular treatment for large vessel stroke

With advances in device design, patient selection paradigms and other elements of treatment, the neuroendovascular approach to acute ischemic stroke has made great strides forward.
In this podcast, Dr Joshua Hirsch interviews Dr Brijesh Mehta on how the implementation of operational improvements can meaningfully impact patient outcomes.
Dr Mehta is a neuroInterventional surgeon at the Memorial Neuroscience Institute in south Florida, where he directs the Comprehensive Stroke Center and Neurointensive Care Unit.
These articles published in the JNIS might be of interest to people who enjoy this podcast:
Applying the Lean management philosophy to NeuroInterventional radiology http://goo.gl/c0x5Zl
Establishing operational stability—developing human infrastructure http://goo.gl/623WtS
‘Time’ for success http://goo.gl/rgJ0U7

ASPECTS decay during inter-facility transfer predicts patient outcomes

Pretreatment Alberta Stroke Program Early CT Scores (ASPECTS) is associated with clinical outcomes. The rate of decline between subsequent images, however, may be more predictive of outcomes as it integrates time and physiology.
A paper published in the January issue of JNIS retrospectively looked at patients transferred from six primary stroke centers and treated with intra-arterial therapy (IAT). They found patients with faster rates of ASPECTS decay during inter-facility transfers are associated with worse clinical outcomes.
Rob Tarr discusses the work with co-author Rishi Gupta, Wellstar Neurosurgery, Marietta, USA.
Read the full paper:
http://jnis.bmj.com/content/7/1/22.full

Unruptured intracranial aneurysms conservatively followed with serial CT angiography

Could morphology and growth predict rupture?
Despite several landmark studies, the natural history of unruptured intracranial aneurysms (UIA) remains uncertain.
Rob Tarr talks to William Mehan, Division of Neuroradiology, Massachusetts General Hospital, about his paper which aimed to identify or confirm factors predictive of rupture of UIA being observed conservatively with serial CT angiography in a North American patient population.
Read the full paper (for free): http://jnis.bmj.com/content/6/10/761.full

Admission neutrophil–lymphocyte ratio predicts 90 day outcome after endovascular stroke therapy

Immune dysregulation influences outcome following acute ischemic stroke (AIS). Admission white blood cell counts are routinely obtained, making the neutrophil–lymphocyte ratio (NLR) a readily available biomarker of the immune response to stroke.
With colleagues Taura Barr, WVU Prevention Research Center, One Medical Center Drive, sought to identify the relationship between NLR and 90 day AIS outcome. Rob Tarr asks her what they found.
Read the full paper:
http://goo.gl/nGXmYO

Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions

Symptomatic subacute/chronic large artery intracranial occlusive disease represents a common medical dilemma. A recent JNIS paper reports a multicenter experience of endovascular recanalization of intracranial atherosclerotic occlusions refractory to medical therapy.
Robb Tarr talks to co-author Raul Nogueira, Department of Neurology, Marcus Stroke and Neuroscience Center/Grady Memorial Hospital/Emory University.
Read the full paper: http://jnis.bmj.com/content/6/9/645.full

Safety and predictors of aneurysm retreatment for remnant intracranial aneurysm

Aneurysmal subarachnoid hemorrhage (SAH) is a rare but devastating form of stroke. Endovascular therapy has been criticized for its higher rate of recanalization and retreatment. The safety and predictors of retreatment are unknown.
A recent study in JNIS reports the clinical outcomes, imaging outcomes and predictors for aneurysm retreatment after initial endovascular embolization.
Rob Tarr speaks with co-author Dr Osama Zaidat, Vascular and Interventional Neurology/Department of Neurology, Medical College of Wisconsin/Froedtert Hospital.
Read the full paper:
Safety and predictors of aneurysm retreatment for remnant intracranial aneurysm after initial endovascular embolization http://jnis.bmj.com/content/6/7/490.full

Affordable care 2014: A tale of two boards

The Patient Protection and Affordable Care Act (ACA) became law on 23 March 2010. As part of the law, two independent boards were established. The Patient-Centered Outcomes Research Institute embodies national aspirations for employing comparative effectiveness research in healthcare decision-making, and the Independent Payment Advisory Board is focused on the need for a group of impartial experts to establish anticipatable growth rates for Medicare. Approximately 4 years after the bill was passed into law, these independent boards are at very different points in their life cycles. In this podcast, Josh Hirsch, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Geraldine McGinty, Department of Radiology, Weill Cornell Medical College, New York, and Richard Duszak, Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, give us a status update.Read the related article: http://goo.gl/mNRI8g

Flat detector derived parenchymal blood volume maps to estimate cerebral blood volume

Newer flat panel angiographic detector (FD) systems have the capability to generate parenchymal blood volume (PBV) maps. The ability to generate these maps in the angiographic suite has the potential to markedly expedite the triage and treatment of patients with acute ischemic stroke. David Fiorella, Department of Neurological Surgery, Stony Brook University Medical Center, NY, and colleagues, have compared FP-PBV maps with cerebral blood volume (CBV) maps derived using standard dynamic CT perfusion (CTP) in a population of patients with stroke.Rob Tarr asks him what they found.Read the full paper: http://jnis.bmj.com/content/6/6/451.full

Current Procedural Terminology

US physicians nearly universally use the CPT coding system. This code set communicates medical, procedural, surgical and diagnostic services and is a critical component of describing the work we do.Drs. Josh Hirsch, Jackie Bello and Raymond Tu are actively involved in the world of physician reimbursement through their associations with the Relative-Value Update Committee (RUC) and Current Procedural Terminology (CPT) committees. In this podcast they discuss the role CPT plays in physician reimbursement and its interplay with the RUC and Centers for Medicare & Medicaid Services (CMS). The JNIS article being discussed is:Current procedural terminology; a primer http://goo.gl/TIhC8NListen to Dr Hirsch's previous podcast on component coding and the RUC: http://goo.gl/KcEbk4

The ADAPT technique in the clinic: A direct aspiration first pass technique for stroke thrombectomy

The development of new revascularization devices has improved recanalization rates and time but not clinical outcomes. In a paper in May's JNIS, Aquilla Turk, Department of Radiology, Medical University of South Carolina, ad colleagues, report their initial results with a new technique utilizing a direct aspiration first pass technique with a large bore aspiration catheter as the primary method for vessel recanalization.Rob Tarr discusses the findings with Dr Turk and also Marc Chimowitz, Department of Neurosciences, Medical University of South Carolina, who has written an accompanying editorial.Read the articles:Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy http://goo.gl/H1MQqbGame changer for endovascular treatment of acute ischemic stroke? http://goo.gl/JFkDM0