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David Hasan, Mario Zanaty, Robert M. Starke, Elias Atallah, Nohra Chalouhi, Pascal Jabbour, Amit Singla, Waldo R. Guerrero, Daichi Nakagawa, Edgar A. Samaniego, Nnenna Mbabuike, Rabih G. Tawk, Adnan H. Siddiqui, Elad I. Levy, Roberta L. Novakovic, Jonathan White, Clemens M. Schirmer, Thomas G. Brott, Hussain Shallwani, and L. Nelson Hopkins

I schemic stroke is the fifth leading cause of disability and death in the United States. 17 The overall risk of stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. 9 , 14 , 15 This has been theoretically attributed to ipsilateral compromised cerebral perfusion. 11 The management of chronic or subacute ICA occlusions has been clinically challenging. Carotid endarterectomy and superficial temporal artery–middle cerebral artery (MCA) bypass have been studied in high

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Mario Zanaty, Susanna Howard, Jorge A. Roa, Carlos M. Alvarez, David K. Kung, David J. McCarthy, Edgar A. Samaniego, Daichi Nakagawa, Robert M. Starke, Kaustubh Limaye, Sami Al Kasab, Nohra Chalouhi, Pascal Jabbour, James Torner, Daniel Tranel, and David Hasan

T he annual risk of stroke from a chronically occluded internal carotid artery (COICA) reaches around 5%–7% despite current optimized medical management. 21 , 27 , 28 In addition, patients with COICA have been shown to suffer cognitive impairment, 1 , 8 and even mild cognitive impairment significantly reduces the quality of life of such patients. 12 , 30 These factors emphasize the importance of identifying the candidates who will have better functional outcomes with surgical intervention than with medical management alone as well as the most appropriate

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Robert M. Starke, Ricardo J. Komotar, and E. Sander Connolly

M oyamoya disease is a chronic cerebrovascular disorder defined by progressive occlusion of the intracranial vessels. The stenosis begins with the intracranial carotid arteries and can progress to involve the anterior, middle, and posterior cerebral arteries. As these arteries gradually stenose, a collateral network of capillaries develops at the base of the brain, producing the characteristic reticulate appearance (“puff of smoke”) on angiography. In Asian populations, moyamoya disease has a well-defined phenotype. The disease has a bimodal age of

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Gregory W. Basil, Annelise C. Sprau, Robert M. Starke, Allan D. Levi, and Michael Y. Wang

may help avoid early cervical fusions. 2 However, it is critical to recognize that because these approaches rely on percutaneous techniques, they do not allow for direct identification and protection of critical anatomical structures. Indeed, access to the disc space often relies on the surgeon using his or her fingers to press downwards against the spine and develop a safe corridor between the esophagus and carotid artery. 1 , 3 Although the reported rate of complications of this procedure is low, there have been notable reports of potentially devastating

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Badih Daou, Christine Hammer, Nohra Chalouhi, Robert M. Starke, Pascal Jabbour, Robert H. Rosenwasser, and Stavropoula Tjoumakaris

, history of diabetes, history of trauma, aneurysm location, involved segment of the internal carotid artery (according to the Bouthillier classification) or vertebral artery, intracranial versus extracranial location, aneurysm shape (saccular or fusiform), and aneurysm size. Statistical Analysis Data are presented as the mean and range for continuous variables, and as the frequency for categorical variables. Analysis was carried out using the unpaired t-test, chi-square, and Fisher exact tests. The assessment of the means of more than 2 groups was carried out by

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Matthew C. Garrett, Ricardo J. Komotar, Maxwell B. Merkow, Robert M. Starke, Marc L. Otten, and E. Sander Connolly

published. The entrance criteria included: 1) a history of TIAs or 1 or more minor or completed strokes in the carotid distribution; and 2) the presence of at least 1 of several atherosclerotic angiographic lesions, such as stenosis or occlusion of the trunk or major branches before the bi- or trifurcation of the MCA, stenosis of the internal carotid artery at or above the C-2 vertebral body, or occlusion of the internal carotid artery. The study included 1377 patients who were randomized to surgical or medical therapy. The study hypothesis was that there would be a one

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Samir Sur, Brian Snelling, Priyank Khandelwal, Justin M. Caplan, Eric C. Peterson, Robert M. Starke, and Dileep R. Yavagal

importance. 14 Direct cervical carotid artery puncture, transbrachial, and transradial approaches have been described in this setting, but previous reports have typically focused on these nontraditional approaches as rescue measures after failed transfemoral attempts. 5 , 6 , 13 , 16 Further, experience with the transradial approach is often confined to posterior circulation access, and this approach with use of modern stent retriever technology has yet to be reported. At our institution, we have increasingly employed a transradial technique to access both anterior

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Scott D. Wait, Adib A. Abla, Brendan D. Killory, Robert M. Starke, Robert F. Spetzler, and Peter Nakaji

C lopidogrel is used for the primary and secondary prevention of ischemic events in patients with coronary and/or cerebrovascular arterial disease. Carotid endarterectomy is the gold standard for severe carotid artery stenosis requiring surgical treatment. 1–3 Most patients presenting for surgery take one or more APAs including clopidogrel. No consensus exists regarding the preoperative use of clopidogrel. When combined with aspirin, APAs are more effective than aspirin alone and have a greater perioperative risk profile for bleeding. 4 , 5 Postoperative

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Robert M. Starke, Brian J. Williams, Claire Hiles, James H. Nguyen, Mohamed Y. Elsharkawy, and Jason P. Sheehan

seen in 23 patients (57.5%), carotid artery encasement in 21 (52.5%), and carotid artery occlusion in 3 (7.5%). The mean duration of clinical follow-up was 83 months, and 11 patients (27.5%) experienced new or worsening cranial nerve deficits that were mostly mild and did not negatively impact their daily functioning. The mean duration of imaging follow-up was 76 months, and 7 patients (17.5%) had lesions demonstrating growth. The authors state that there was a poor correlation between clinical and radiographic findings, noting that 6 (54.5%) of the 11 patients with

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Kenneth C. Liu, Robert M. Starke, Christopher R. Durst, Tony R. Wang, Dale Ding, R. Webster Crowley, and Steven A. Newman

-weighted ( right ) MR images showing distension of the perioptic subarachnoid spaces and an empty sella. B: Cerebral angiography. Anteroposterior (AP) ( left ) and lateral ( right ) views of a right internal carotid artery (ICA) injection in the venous phase showing prominent focal stenosis of the right transverse sinus ( solid arrows ) and stenosis of the left transverse sinus, with diminished flows ( dashed arrow ). C: Cerebral venography. AP view of a superior sagittal sinus injection, performed during venous manometry, which showed a trans-stenosis pressure