BACKGROUND AND PURPOSE: FD technology enables reconstructive repair of otherwise difficult-totreat intracranial aneurysms. These stentlike devices may induce progressive aneurysm thrombosis without additional implants and may initiate complete reverse vessel remodeling. The associated vascular biologic processes are as yet only partially understood.

Background 'Silent' cerebral infarction and stroke are complications of transcatheter aortic valve implantation (TAVI). Objective To assess the occurrence of cerebral infarction, identify predictive risk factors and examine the impact on patient health-related quality of life (HRQoL). Methods Cerebral diffusion weighted MRI of 31 patients with aortic stenosis undergoing CoreValve TAVI was carried out. HRQoL was assessed at baseline and at 30 days by SF-12v2 and EQ5D questionnaires. Results New cerebral infarcts occurred in 24/31 patients (77%) and stroke in 2 (6%). Stroke was associated with a greater number and volume of cerebral infarcts. Age (r¼0.37, p¼0.042), severity of atheroma (arch and descending aorta; r¼0.91, p<0.001, r¼0.69, p¼0.001, respectively) and catheterisation time (r¼0.45, p¼0.02) were predictors of the number of new cerebral infarcts. HRQoL improved overall: SF-12v2 physical component summary increased significantly (32.466.2 vs 36.567.2; p¼0.03) with no significant change in mental component summary (43.5611.7 vs 43.1614.3; p¼0.85). The EQ5D score and Visual Analogue Scale showed no significant change (0.5660.26 vs 0.5960.31; p¼0.70, and 54.2619 vs 58.2624; p¼0.43). Conclusion Multiple small cerebral infarcts occurred in 77% of patients with TAVI. The majority of infarcts were 'silent' with clinical stroke being associated with a both higher infarct number and volume. Increased age and the severity of aortic arch atheroma were independent risk factors for the development of new cerebral infarcts. Overall HRQoL improved and there was no association between the number of new cerebral infarcts and altered health status.

Background and Purpose— A single-center prospective randomized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome. Methods— Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grades 2, 3, 4, and 3+4 were randomized to either the study group of standard therapy plus insertion of a lumbar drain or the control group of standard therapy alone. The primary outcome measure was the prevalence of delayed ischemic neurological deficit. Results— Two hundred ten patients with aneurysmal subarachnoid hemorrhage (166 female, 44 male; median age, 54 years; interquartile range, 45–62 years) were recruited into the control (n=105) and study (n=105) groups of the trial. World Federation of Neurological Surgeons grade was: 1 (n=139), 2 (n=60), and 3 (n=11); Fisher grade was: 2 (n=87), 3 (n=85), and 4 (n=38). The prevalence of delayed ischemic neurological deficit was 35.2% and 21.0% in the control and study groups, respectively ( P =0.021). The prevalence of a modified Rankin Scale score of 4, 5, or 6 at Day 10 and 6 months, respectively, was 62.5% and 18.6% in the control group and 44.8% and 19.8% in the study group ( P =0.009 and 0.83, respectively). Conclusions— Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage. Clinical Trial Registration— URL: www.clinicaltrials.gov . Unique identifier: NCT00842049.

No abstract

Duplication of the vertebral artery is rare. We report two cases in which it was an incidental finding. In the first, duplication of the right vertebral artery was demonstrated by magnetic resonance angiography (MRA) and conventional angiography. The second patient had duplication of the right vertebral artery demonstrated by MRA. We discuss the origin of this abnormality, its radiological implications and its potential clinical significance are discussed.

No abstract

T ranscatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis is an alternative to medical therapy or surgical aortic valve replacement (SAVR) in those at high surgical risk.1 TAVI has been shown to reduce mortality and improve patient symptoms and healthrelated quality of life (HRQoL).2,3 Although TAVI seems cost-effective when compared with SAVR, embolic cerebral infarction remains a concern because of its frequency and the associated morbidity, mortality, and healthcare costs. 4 This will be increasingly important if TAVI is considered for lower risk or younger patient populations.Previous work has shown that embolic cerebral infarction occurs after both TAVI and SAVR, with the majority remaining subclinical.3,5-9 The incidence of cerebral emboli seems to be greater post TAVI, with no significant difference between the access routes (transfemoral versus transapical) or valve types (Medtronic CoreValve versus Edwards Sapien). 8 The clinical consequences of these silent infarcts and identification of risk factors are yet to be fully established. Two studies have assessed basic cerebral function using a mini-mental state examination pre and post TAVI, demonstrating no significant change at 3 months. 5,6 We Background-Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. Methods and Results-Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied.

Executive committeeA Algra, A Compter (trial coordinator), L J Kappelle (coprincipal investigator), W J Schonewille, and H B van der Worp (co-principal investigator). Data safety monitoring board M L Bots (chair, epidemiologist), L Defreyne (radiologist), and P J Koudstaal (neurologist). Outcome assessment committees E J van Dijk (neurologist), C J Frijns (neurologist), J Hofmeijer (neurologist), M A van Buchem (radiologist), D R Rutgers (radiologist), B K Velthuis (radiologist), and T D Witkamp (radiologist).