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Background: Mechanical thrombectomy failure (MTF) occurs in approximately 15% of cases., Objective: To investigate factors that predict MTF., Methods: This was a retrospective review of prospectively collected data from the Stroke Thrombectomy and Aneurysm Registry. Patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) were included. Patients were categorized by mechanical thrombectomy success (MTS) (≥mTICI 2b) or MTF (

Concussion is an important cause of morbidity in young student athletes. The prevention, accurate diagnosis, and prompt management of concussions require that players, parents, coaches, and medical personnel are accurately educated on current concussion data and guidelines. All states have laws that mandate concussion education for high school athletes. There is currently no uniform educational program to disseminate information to student athletes regarding concussions. This article highlights a few nationally recognized educational programs that aim to accurately and effectively inform all members of the athletic, academic, and medical communities about the importance and urgency of concussion.

Background and Importance: Purely intraorbital arteriovenous fistulas (AVFs), which are rare vascular malformations that clinically mimic carotid-cavernous fistulas (CCFs), involve a fistula from the ophthalmic artery to 1 of the draining ophthalmic veins. We describe a case of an intraorbital AVF treated with transvenous endovascular coil embolization via the inferior petrosal sinus (IPS) route and review the literature on this rare entity., Clinical Presentation: An 81-year-old woman sought treatment after 7 days of progressive left-sided visual acuity loss, chemosis, and lateral rectus palsy. Magnetic resonance imaging demonstrated dilated vascularity in the left orbit raising suspicions for a CCF. Cerebral angiography showed a purely intraorbital AVF with a fistula between the left ophthalmic artery and superior ophthalmic vein (SOV). Transvenous selective catheterization of the fistula was performed by successfully navigating the ipsilateral IPS to the cavernous sinus and SOV. The fistula was then embolized using detachable coils. The patient was discharged the next day. Three weeks after embolization, her ocular symptoms and findings had resolved., Conclusion: Intraorbital AVFs are a rare type of AVF that can be treated by direct surgical ligation, transarterial embolization, or transvenous embolization. We successfully navigated the IPS, which is frequently stenotic or occluded secondary to chronically increased fistulous drainage, and utilized this route to embolize the fistula with detachable coils.

Background: Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, comprising 0.5% to 3% of intracranial aneurysms. Because their anatomic location relative to the PICA origin is variable, several endovascular techniques are used in their management., Objective: To evaluate and discuss endovascular techniques for the treatment of PICA aneurysms., Methods: We analyzed our prospectively maintained database to identify PICA aneurysms treated over a 12-year period from 1999 to 2011., Results: Twenty patients were assessed angiographically for endovascular treatment. Treatment was successfully performed in 17, but 3 were deemed unsuitable and were referred for surgery. Patients ranged in age from 15 to 82 years (mean, 60.5); 85% (17/20) were women. Thirteen (65%) presented with subarachnoid hemorrhage, and 3 (15%) had been previously treated surgically. Although the aneurysms were located at the PICA origin in 13 (65%), their involvement with the PICA and vertebral artery was variable. Some arose distinctly from the origin, and others incorporated the PICA itself. Five patients were treated for distal PICA aneurysms. Treatment techniques included direct coiling, vertebral artery balloon remodeling with coiling, PICA balloon remodeling with coiling, and parent vessel sacrifice of PICA with either coiling or glue embolization. Complete occlusion was initially achieved in 11 of 17 patients. Of the 6 remaining patients, 3 improved to complete occlusion at follow-up, 2 underwent re-treatment, and 1 remained stable. No patient experienced posttreatment hemorrhage., Conclusion: A variety of endovascular techniques are required for the management of PICA aneurysms. Specific techniques vary according to the location of the aneurysm in relation to the PICA origin, distal course of the artery, and the vertebral artery., Abbreviations: BRAT, Barrow Ruptured Aneurysm TrialmRS, modified Rankin scorenBCA, n-butyl cyanoacrylatePICA, posterior inferior cerebellar arterySAH, subarachnoid hemorrhageVA, vertebral artery.