Welcome to EJMINT

Welcome to EJMINT, the eJournal of the European Society of Minimally Invasive Neurological Therapy. We look forward to receiving your submissions, so please explore the site and review your manuscript options. Once you have a manuscript prepared for publication in Journal style, visit ejmint.editorialmanager.com and upload your article for review.

Welcome to EJMINT

an international, peer-reviewed journal that publishes original research articles, technical notes, editorials & commentary in the field of Minimally Invasive Neurological Therapy.

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Latest Original Papers

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EJMINT Original Article, 2017: 1707000407 (14th February 2017)

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Correlation between imaging markers and clinical and radiological outcome in hyperacute stroke patients undergoing thrombectomy
Nicholas O Wroe, Robert P Palin, Tufail Patankar, et al
EJMINT Original Article, 2017: 1707000407 (14th February 2017)

Copyright © 2017 EJMINT


Correlation between imaging markers and clinical and radiological outcome in hyperacute stroke patients undergoing thrombectomy

EJMINT Original Article, 2017: 1707000407 (14th February 2017)
Nicholas O Wroe, Robert P Palin, Tufail Patankar, Alastair Bailey, Mark Igra, Tony Goddard
Abstract
INTRODUCTION: To determine whether imaging biomarkers in medicine or clinical characteristics could be used to predict recanalisation and 90-day outcomes in stroke patients undergoing mechanical thrombectomy. METHODS: Forty-three patients undergoing mechanical thrombectomy between 2009 and 2015 were included for analysis. Non-contrast CT (NCCT) determined clot density in Hounsfield Units (HU) and volume, along with Alberta Stroke Program Early CT Score (ASPECTS) on admission and at 24 h. CT angiography (CTA) yielded clot length, clot burden score (CBS) and collateral score (CS). Intraoperative fluoroscopy was used to determine thrombolysis in cerebral infarction (TICI) scores pre- and post-treatment. The principle outcome measure was the modified Rankin Scale (mRS) at 90 days. RESULTS: The only biomarker in the acute phase that predicted 90-day mRS was admission ASPECTS (p=0.0186). Non-significant trends towards positive outcome were seen with low clot volume (p=0.45), shorter clot length (p=0.33) and favourable collateral score (2 or 3, p=0.319). There was no association between outcome and clot density (p=0.67) or CBS (p=0.792). None of the biomarkers significantly predicted successful recanalisation. CONCLUSIONS: ASPECTS can be used to predict 90-day-mRS and thus outcomes in hyperacute stroke patients.
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EJMINT Original Article, 2015: 1543000269 (22nd October 2015)

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Pharmacogenomic approach to Clopidogrel resistance in patients with stent-assisted endovascular treatment of non-ruptured intracranial aneurysms
Zdravka Poljakovic, Svjetlana Šupe, Josip Ljevak, et al
EJMINT Original Article, 2015: 1543000269 (22nd October 2015)

Copyright © 2015 EJMINT


Pharmacogenomic approach to Clopidogrel resistance in patients with stent-assisted endovascular treatment of non-ruptured intracranial aneurysms

EJMINT Original Article, 2015: 1543000269 (22nd October 2015)
Zdravka Poljakovic, Svjetlana Šupe, Josip Ljevak, David Ozretić, Magdalena Krbot-Skorić, Nada Božina, Antonela Bazina, Vesna Matijević, Domagoj Alvir, Katarina Starčević, Marko Radoš
Abstract
INTRODUCTION: Antiplatelet premedication policy for patients scheduled for endovascular treatment of stent-assisted coiling has become routine practice to avoid thrombotic complications. However, clopidogrel resistance remains a serious clinical challenge in predicting and preventing thrombotic complications. Measuring platelet activity is still an uncertain method for predicting clinical outcome and pharmacogenetic testing has not yet been proven as useful and cost-effective in clinical practice. We aimed to compare CYP2C19 polymorphism and MDR1 variances with point-of-care aggregometry test results in clopidogrel premedicated patients with non-ruptured intracranial aneurysms who were scheduled for stent-assisted endovascular treatment. METHODS: We designed a prospective study for our patient cohort with planned elective endovascular treatment. All patients were premedicated for the endovascular intervention with oral dual antiagregation therapy. In selected patients we analysed and compared demographic data, localisation of the aneurysm, endovascular material used, results of genetic analysis, results of the ADPtests for clopidogrel, dosing regimen for clopidogrel and incidence of angiographic and/or clinical complications. We compared and statistically analysed correlation between pharmacogenetic findings, aggregometry results and complication rates. RESULTS: We did not find a correlation between pharmacogenetic finding and aggregometry results. However, there was a statisticaly significant correlation between pharmacogenetic polymorphism of CYP2C19 and complication rate and a trend showing correlation between MDR1 variations and aggregometry results. CONCLUSION: CYP2C19 polymorphism as well as transport MDR1 activity are, according to our results, parameters which could be helpful in predicting possible complications and choosing another therapeutic approach in certain patient groups.
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EJMINT Original Article, 2015: 1523000262 (4th June 2015)

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Current TeleStroke systems enhance IV thrombolysis after acute stroke but may delay access to endovascular procedures
Marc Ribo, Natalia Perez de la Ossa, Pere Cardona, et al
EJMINT Original Article, 2015: 1523000262 (4th June 2015)

Copyright © 2015 EJMINT


Current TeleStroke systems enhance IV thrombolysis after acute stroke but may delay access to endovascular procedures

EJMINT Original Article, 2015: 1523000262 (4th June 2015)
Marc Ribo, Natalia Perez de la Ossa, Pere Cardona, Sònia Abilleira
Abstract
INTRODUCTION: Telestroke systems as known today used currently recommend imply transfer of patients with acute strokes to Community Hospitals (CommH) that cannot offer endovascular procedures (EVT). The primary benefit of this policy relies on the fact that intravenous ( tissue plasminogen activator (iv-tPA) one, may be offered earlier and two, unnecessary transfers to Comprehensive Stroke Centers (CSC) can be avoided. However, this strategy may generate time delays in potential EVT candidates. This study aimed to quantify the potential benefits and disadvantages of this strategy.

 METHODS: From March 2013 to March 2014, 533 teleconsults were centrally attended by stroke neurologists in the Catalan telestroke system that covers 105 CommH. We defined criteria to identify potential EVT candidates ion the f-field or in the CommH after teleconsultation (clinical and radiological).

 RESULTS: 
Eighty-four patients (15.7 %) could have been identified on-in the field before arrival to CommH as potential EVT candidates. Once at the CommH, of these 84 patients, 60 (71 %) were still potential EVT candidates after CT-scan and teleconsultation. Of these 84 patients, only 27 (32 %) received iv-TPA in the CommH; however 68 (80 %) were still emergently transferred to CSC, where only 13(19 %) finally received EVT. The median time from CommH-door to groin puncture was 216 min vVs CSC-door to groin 152 min for primary CSC admissions (p<0.01).
 CONCLUSIONS: 
Present telestroke systems offer safe and timely iv-tPA treatment to eligible patients but may induce a considerable time loss in EVT candidates. Only a third1/3 of the on-field potential EVT candidates benefit from admission in a CommH when being treated with iv-tPA, while more than three quarters 3/4 will still be transferred to the CSC.
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EJMINT Original Article, 2015: 1506000254 (2nd February 2015)

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The impact of first and second generation Hydrogel Coil Technology on Cerebral Aneurysm Treatment: A single practice experience
Lotfi Hacein-Bey, Bahram Varjavand
EJMINT Original Article, 2015: 1506000254 (2nd February 2015)

Copyright © 2015 EJMINT


The impact of first and second generation Hydrogel Coil Technology on Cerebral Aneurysm Treatment: A single practice experience

EJMINT Original Article, 2015: 1506000254 (2nd February 2015)
Lotfi Hacein-Bey, Bahram Varjavand
Abstract
INTRODUCTION: Bare platinum coils have demonstrated safety and efficacy in the treatment of intracranial aneurysms; however, a persistent and important limitation occurs in the form of delayed recanalisation. The authors report their multiple-hospital, single-practice experience with the use of first and second-generation hydrogel coils for the treatment of ruptured and unruptured cerebral aneurysms. METHODS: During a period of 44 months, 101 consecutive patients with 104 ruptured or unruptured intracranial aneurysms were treated by a two-physician team covering several hospitals. Hydrogel coils, both first (Hydrocoil®) and second (HydroFrame®, HydroFill® and HydroSoft®) generation, were exclusively used in this patient cohort. Retrospective analysis of clinical and angiographic data was performed. RESULTS: Procedural morbidity and mortality were 5 % and 0 % respectively. No patient developed hydrocephalus or aseptic meningitis. The rates of immediate post-procedure total occlusion were 94 %, of neck remnants 6 % and incomplete occlusion 0 %. Long-term (>12 months) angiographic follow-up was obtained in 95 patients (94 %). No recanalisations were observed in any of those patients, whether treated with stent-assisted coiling, balloon assisted coiling or with coils only, including patients who had presented with recurrent, recanalised aneurysms. CONCLUSION: In our patient population, the safety profile of Hydrogel coils was found to be similar to that of non-coated platinum coils. Moreover, significantly improved obliteration rates, both early and delayed, were observed in our patient population, possibly from enhanced long-standing separation of the intra-aneurysmal environment from the parent artery. Presented at the LINC (Live Interventional Neuroradiology Conference) Houston 2012 Meeting, December 12, 2012, Houston, TX
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EJMINT Original Article, 2014: 1449000234 (2nd December 2014)

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Intra-arterial therapy for basilar artery thrombosis: the role of machine learning in outcome prediction
H Asadi, R Dowling, B Yan, et al
EJMINT Original Article, 2014: 1449000234 (2nd December 2014)

Copyright © 2014 EJMINT


Intra-arterial therapy for basilar artery thrombosis: the role of machine learning in outcome prediction

EJMINT Original Article, 2014: 1449000234 (2nd December 2014)
H Asadi, R Dowling, B Yan, P Mitchell
Abstract
INTRODUCTION: Although only 10% of strokes are due to involvement of the posterior circulation, they can be associated with a very poor prognosis. Therefore, accurately predicting stroke outcome from a set of variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. In this study, our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute posterior circulation ischaemic stroke. METHODS: We conducted a retrospective analysis of a prospectively collected database of acute posterior circulation ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB® and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes, as defined by 30 day mRS. RESULTS: We included 50 consecutive acute posterior circulation ischaemic stroke patients treated by endovascular technique. All the available demographic, procedural and clinical factors were included in the machine. The final confusion matrix of the neural network, demonstrated an overall congruency of ~90% between the target and output classes, with a relatively favourable overall receiving operative characteristic. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.432 (SD: ±0.584). CONCLUSION: Consistent with the findings for anterior circulation, we showed promising accuracy of outcome prediction in posterior circulation strokes, suggesting that a robust machine learning system can potentially help in prognostication of acute posterior circulation stroke.

Latest Technical Notes

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EJMINT Technical Note, 2016: 1615000406 (13th April 2016)

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Proximal Penumbra Pump Aspiration in Carotid Stenting
Pervinder Bhogal, Vamsi Gontu, Patrick A Brouwer
EJMINT Technical Note, 2016: 1615000406 (13th April 2016)


Proximal Penumbra Pump Aspiration in Carotid Stenting

EJMINT Technical Note, 2016: 1615000406 (13th April 2016)
Pervinder Bhogal, Vamsi Gontu, Patrick A Brouwer
Abstract
There is a lack of consensus on indications for carotid stenting in the field of neurointervention, despite the widespread use of this intervention for a variety of reasons including inoperability. A number of publications have addressed the use of distal protection devices, and have concluded that these devices do not benefit the (imaging) outcome of patients. A potential explanation may be that the devices used are not adequately functioning or that the passage through the stenosed portion in itself carries risk. Furthermore, the use of proximal protection devices has to date resulted in highly complicated procedures and involves very expensive equipment. We describe two cases in which a proximal protection and aspiration with the Penumbra pump was utilized with only limited minimal modification to the usual procedure.
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EJMINT Technical Note, 2015: 1538000263 (17th September 2015)

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Endovascular approach to a type IV-C spinal pial fistula associating coils and glue
Luciano Manzato, Ricardo Vanzin, Nério Azambuja, et al
EJMINT Technical Note, 2015: 1538000263 (17th September 2015)

Copyright © 2015 EJMINT


Endovascular approach to a type IV-C spinal pial fistula associating coils and glue

EJMINT Technical Note, 2015: 1538000263 (17th September 2015)
Luciano Manzato, Ricardo Vanzin, Nério Azambuja, Alex Roman, Paulo Mesquita Filho
Abstract
Spinal pial arteriovenous fistulas (SPAVFs) are rare superficial intradural vascular malformations consisting of a direct shunt between spinal cord arteries and veins. More recently, the treatment choices for this pathology have gained alternative tools, and endovascular treatment in particular have consistently gained traction as one of the most efficient choices of treatment. Surgery has proven challenging, as the anterior localisation of the shunt predisposes spinal cord manipulation and, therefore, inherent oedema and in some cases ischaemic post-operative changes in the spinal cord tissue. Surgery has increasingly been reserved for cases in which the first option of endovascular treatment is not feasible. We report a case of a type IVc SPAVF that was treated with the association of coils and glue.
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EJMINT Technical Note, 2014: 1451000251 (17th December 2014)

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Recanalisation And Stenting Of The Straight Sinus
Juha-Pekka Pienimäki, Veikko Kähärä
EJMINT Technical Note, 2014: 1451000251 (17th December 2014)

Copyright © 2014 EJMINT


Recanalisation And Stenting Of The Straight Sinus

EJMINT Technical Note, 2014: 1451000251 (17th December 2014)
Juha-Pekka Pienimäki, Veikko Kähärä
Abstract
We report a case of a 54-year-old man with an occluded straight sinus and dural AV-fistula. The patient was treated with PTA dilatation and stenting of the occluded straight sinus. A review of literature revealed no similar therapy has to date been described.

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EJMINT Technical Note, 2014: 1451000248 (17th December 2014)

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Management of trapped microwire during femoral arterial access in a pediatric patient
Danielle Eckart Sorte, Lauren Baker, Sally Bitzer, et al
EJMINT Technical Note, 2014: 1451000248 (17th December 2014)

Copyright © 2014 EJMINT


Management of trapped microwire during femoral arterial access in a pediatric patient

EJMINT Technical Note, 2014: 1451000248 (17th December 2014)
Danielle Eckart Sorte, Lauren Baker, Sally Bitzer, John D Coulson, Monica Pearl
Abstract
Femoral arterial access complications (e.g., arteriovenous fistula, pseudoaneurysm, vessel dissection, haematoma and vasospasm) are not uncommon and are likely underreported in the pediatric population. We present a case of severe vasospasm with microwire entrapment during attempted femoral arterial access in a 20-month-old. Successful microwire removal was achieved after systemic administration of nitroglycerin using a combination of pharmacological techniques that benefited from close collaboration between the interventional neuroradiology, pediatric interventional cardiology and anaesthesia teams.
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EJMINT Technical Note, 2014: 1451000242 (17th December 2014)

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High Speed Mechanical Thrombectomy: Complete Arterial Recanalisation before the End of rt-PA Thrombolysis
Benjamin Gory, Roberto Riva, Rotem Sivan-Hoffman, et al
EJMINT Technical Note, 2014: 1451000242 (17th December 2014)

Copyright © 2014 EJMINT


High Speed Mechanical Thrombectomy: Complete Arterial Recanalisation before the End of rt-PA Thrombolysis

EJMINT Technical Note, 2014: 1451000242 (17th December 2014)
Benjamin Gory, Roberto Riva, Rotem Sivan-Hoffman, Islam Eldesouky, Francis Turjman
Abstract
Early and complete recanalisation is the main goal to achieve in acute ischaemic stroke from arterial occlusion. Although intravenous (IV) thrombolysis is the standard therapy, its efficacy is limited in the setting of proximal arterial occlusion; however, systemic thrombolysis and endovascular therapy presents similar safety outcomes. Mechanical thrombectomy with the latest generation stent-retrievers allows a fast and a complete arterial recanalisation. We report a case of a patient with an acute basilar artery occlusion treated by a combined therapy (IV thrombolysis and mechanical thrombectomy). A complete recanalisation was rapidly obtained during the mechanical thrombectomy procedure, prior to termination of the IV thrombolysis. Early and complete recanalisation is the main goal to achieve in acute ischaemic stroke with arterial occlusion [1]. Intravenous (IV) thrombolysis is the standard therapy; however endovascular mechanical thrombectomy using stent-retrievers has been recently shown to provide fast, complete recanalisation [2]. We report here a case of a patient with an acute basilar artery occlusion, treated by a combined therapy (IV thrombolysis and mechanical thrombectomy). Complete recanalisation had been rapidly obtained during the mechanical thrombectomy procedure, prior to termination of the IV thrombolysis. A 56-year-old man developed an acute right hemiplegia and anarthria during a stenting procedure of a post-radiotherapy left extracranial internal carotid stenosis. Time of onset of symptoms was 16:15, and the patient was admitted to our stroke center at 18:20. NIH Stroke Scale (NIHSS) score on admission was 19 (right hemiplegia, anaesthesia, ophthalmoparesis and anarthria). An MRI was performed at 18:38 revealing a left latero-pontine infarct distal to an acute basilar artery occlusion. Due to the location of the occlusion, a combined therapy was initiated. First bolus dose of rt-PA (10 % dose, 5 mg) was administrated at 19:00 (165 min after the deficit onset). The femoral artery was punctured at 19:15 under local anaesthesia. Angiogram proved the persistence of a complete occlusion, 15 min after the first bolus of IV thrombolysis. The microcatheter was navigated and positioned in the right P1 posterior cerebral artery at 19:26. A Solitaire FR stent 4 x 20 mm was deployed at 19:40 and a complete recanalisation was observed at 19:46 (211 min after stroke onset, 31 min after femoral puncture and 46 min after initiation of rt-PA infusion). The IV thrombolysis ended at 20:00. The NIHSS score was 4 at 20:00 and 1 the next day.

Latest Editorials

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EJMINT Editorial, 2016: 1607000288 (18th February 2016)

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Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document
American Academy of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS), Lavine SD, Cockroft K, et al
EJMINT Editorial, 2016: 1607000288 (18th February 2016)

This document is being simultaneously co-published by Interventional Neuroradiology, American Journal of Neuroradiology, Journal of Interventional Neurology, EJMINT, Journal of Neuroendovascular Therapy, Journal of NeuroInterventional Surgery, Neuroradiology and Neurosurgery.


Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document

EJMINT Editorial, 2016: 1607000288 (18th February 2016)
American Academy of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS), American Society of Neuroradiology (ASNR), Asian Australasian Federation of Interventional and Therapeutic Neuroradiology (AAFITN), Australian and New Zealand Society of Neuroradiology - Conjoint Committee for Recognition of Training in Interventional Neuroradiology (CCINR) representing the RANZCR (ANZSNR), ANZAN and NSA, Canadian Interventional Neuro Group (CING), European Society of Neuroradiology (ESNR), European Society of Minimally Invasive Neurological Therapy (ESMINT), Japanese Society for Neuroendovascular therapy (JSNET), Sociedad Ibero Latino Americana de Neuroradiologica (SILAN), Society of NeuroInterventional Surgery (SNIS), Society of Vascular and Interventional Neurology (SVIN), World Federation of Interventional and Therapeutic Neuroradiology (WFITN)

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EJMINT Editorial, 2013: 1335000120 (29th August 2013)

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The ESMINT and ESNR statement regarding trials evaluating the endovascular treatment at the acute stage of ischemic stroke
Laurent Pierot, Michael Söderman, Martin Bendszus, et al
EJMINT Editorial, 2013: 1335000120 (29th August 2013)

Copyright © 2013 EJMINT


The ESMINT and ESNR statement regarding trials evaluating the endovascular treatment at the acute stage of ischemic stroke

EJMINT Editorial, 2013: 1335000120 (29th August 2013)
Laurent Pierot, Michael Söderman, Martin Bendszus, Philip M White, Mario Muto, Francis Turjman, Salvatore Mangiafico, Jan Gralla, Jens Fiehler, István Szikora, Christophe Cognard

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EJMINT Editorial, 2013: 1327000117 (4th July 2013)

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ESMINT statement regarding the UEMS Training Charter for Interventional Neuroradiology
Christophe Cognard, István Szikora
EJMINT Editorial, 2013: 1327000117 (4th July 2013)

Copyright © 2013 EJMINT


ESMINT statement regarding the UEMS Training Charter for Interventional Neuroradiology

EJMINT Editorial, 2013: 1327000117 (4th July 2013)
Christophe Cognard, István Szikora

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EJMINT Editorial, 2012: 1204000018 (23rd January 2012)

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A new European Training Charter in Interventional Neuroradiology - INR
Olof Flodmark, Remy Demuth, Bernd Richling, et al
EJMINT Editorial, 2012: 1204000018 (23rd January 2012)

Copyright © 2012 EJMINT


A new European Training Charter in Interventional Neuroradiology - INR

EJMINT Editorial, 2012: 1204000018 (23rd January 2012)
Olof Flodmark, Remy Demuth, Bernd Richling, Wolfgang Grisold, Laurent Pierot

Latest Invited Reviews

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EJMINT Invited Review, 2014: 1419000139 (8th May 2014)

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Role, safety, and efficacy of WEB flow disruption: a review
Laurent Pierot, Anil Gholkar, Laurent Spelle, et al
EJMINT Invited Review, 2014: 1419000139 (8th May 2014)

Copyright © 2014 EJMINT


Role, safety, and efficacy of WEB flow disruption: a review

EJMINT Invited Review, 2014: 1419000139 (8th May 2014)
Laurent Pierot, Anil Gholkar, Laurent Spelle, Thomas Liebig, Christophe Cognard, István Szikora
Abstract
For many years, endovascular treatment has been the first line treatment for both ruptured and unruptured aneurysms. [1-4] However aneurysms with a complex anatomy (fusiform aneurysms, wide-neck aneurysms, large and giant aneurysms) are in some cases untreatable or difficult to treat with standard coiling. For this reason, more complex endovascular techniques have been developed, such as balloon-assisted coiling, stent-assisted coiling, and flow diversion.
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EJMINT Invited Review, 2012: 1238000077 (21st September 2012)

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Thrombectomy for Acute Ischemic Stroke Treatment: A Review
Pasquale Mordasini, Christoph Zubler, Gerhard Schroth, et al
EJMINT Invited Review, 2012: 1238000077 (21st September 2012)


Thrombectomy for Acute Ischemic Stroke Treatment: A Review

EJMINT Invited Review, 2012: 1238000077 (21st September 2012)
Pasquale Mordasini, Christoph Zubler, Gerhard Schroth, Jan Gralla
Abstract
Mechanical treatment approaches for acute ischemic stroke treatment aim for fast and efficient reperfusion with short procedure times and high recanalisation rates, thus extending the treatment window. We review the current literature on mechanical thrombectomy for the treatment of acute ischemic stroke.
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