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Badih Daou, Edison P. Valle-Giler, Nohra Chalouhi, Robert M. Starke, Stavropoula Tjoumakaris, David Hasan, Robert H. Rosenwasser, Ryan Hebert and Pascal Jabbour

W ith the advancements in endovascular techniques, an increasing number of cerebral aneurysms are being managed using this approach. Flow diversion using the Pipeline Embolization Device (PED) has become a popular method for the management of cerebral aneurysms. In 2011, the PED (Covidien) was approved by the US FDA for the treatment of large and giant wide-neck aneurysms in the internal carotid artery (ICA), from the petrous to the superior hypophyseal segments. Since then, several reports have highlighted the safety and efficacy of the PED in the

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Ricardo Segal, Peter J. Jannetta, Sidney K. Wolfson Jr., Manuel Dujovny and Eugene E. Cook

. 8 Finally, decompression of the ventrolateral medulla on the left side adjacent to the entry zone of the ninth and 10th cranial nerves has been correlated with relief from arterial hypertension. 4 Despite these significant clinical data, no experimental evidence is available to demonstrate the physiological and structural effects of pulsatile vascular loop compression on the central nervous system. A self-contained double-balloon device was designed to function as an artificial artery pulsating with the heart. This device simulates those naturally occurring

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Gregor Durner, Yigit Özpeynirci, Bernd Schmitz, Christian Rainer Wirtz, Ralph König and Andrej Pala

O ver the past few decades, great advances have been made in the treatment of cerebral aneurysms. In this field, coiling has become a common alternative to surgical clipping. 10 The Woven EndoBridge (WEB; Sequent Medical) device is one of the latest innovations added to the armamentarium of endovascular treatment (EVT) devices, especially for wide-neck bifurcation aneurysms. The WEB device was introduced in 2011, 5 , 7 and recent studies have confirmed its feasibility and safety. 6 , 13 Occlusion rates up to 81.1% have been reported in short-term studies. 9

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Kate A. Hentschel, Badih Daou, Nohra Chalouhi, Robert M. Starke, Shannon Clark, Ashish Gandhe, Pascal Jabbour, Robert Rosenwasser and Stavropoula Tjoumakaris

D espite recent cerebrovascular advances, ischemic stroke remains a leading cause of morbidity and mortality. The goal of acute ischemic stroke (AIS) interventions is to obtain arterial recanalization and cerebral reperfusion. Over the past decade, 4 mechanical thrombectomy devices have obtained US Food and Drug Administration approval for the treatment of AIS as the sole intervention or as an adjunct to intravenous tissue plasminogen activator (tPA). The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) and Penumbra Pivotal Stroke trials suggested

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Erez Nossek, David J. Chalif, Shamik Chakraborty, Kim Lombardo, Karen S. Black and Avi Setton

F low-diverter devices were originally reported to modify and redirect flow as a treatment option for wide-neck aneurysms. 1 , 2 , 10 , 14–16 , 26 The Pipeline Embolization Device (PED; ev3 Neurovascular) has been approved specifically to treat large, wide-neck proximal internal carotid artery (ICA) aneurysms at the cavernous ICA and ophthalmic artery segments as a sole device. 1 , 16 There are few published descriptions of the concurrent use of PEDs and coils. 8 , 21 , 24 A detailed and specific description of this technique, as well as its benefits

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Georgios A. Maragkos, Luis C. Ascanio, Mohamed M. Salem, Sricharan Gopakumar, Santiago Gomez-Paz, Alejandro Enriquez-Marulanda, Abhi Jain, Clemens M. Schirmer, Paul M. Foreman, Christoph J. Griessenauer, Peter Kan, Christopher S. Ogilvy and Ajith J. Thomas

T he Pipeline embolization device (PED; Covidien) is a well-established first-line endovascular treatment option for select patients with intracranial aneurysms. 15 The PED is a woven flow-diverting stent, which is deployed endovascularly in the parent artery and diverts blood flow away from the aneurysm. Over time, endothelialization occurs across the neck of the aneurysm and the lesion is completely excluded from the systemic circulation. 12 Previous studies have shown that once an aneurysm is occluded, it is extremely unlikely to recur or rupture. 9 The

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Emilio Lozupone, Mariangela Piano, Luca Valvassori, Luca Quilici, Guglielmo Pero, Emiliano Visconti and Edoardo Boccardi

T he main objective of the treatment of ruptured aneurysms is to avoid rebleeding. This objective can be achieved either by endovascular techniques or by open neurosurgery. However, in certain cases of ruptured aneurysms, such as blood blister–like aneurysms (BBAs) or dissecting aneurysms, surgery can be technically challenging. 1 In the last few years, the flow diverter device (FDD) has become an important tool in the management of unruptured aneurysms, especially in wide-neck, dissecting, or fusiform aneurysms. 1 , 6 , 11 , 16 Many papers report the

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David W. Newell, James M. Schuster and Anthony M. Avellino

incorporated the parent vessel. The aneurysms were treated using primary aneurysm excision accompanied by surgical anastomosis of the proximal and distal portions of the vessel, which was performed with the aid of a vascular microanastomotic device (The Coupler; Medical Companies Alliance, Birmingham, AL). Illustrative Cases Case 1 History and Examination This 60-year-old woman presented with a history of a syncopal episode. Imaging studies identified a large fusiform aneurysm on the distal MCA. The cause of the patient's syncope was not determined. Her family

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Georgios A. Maragkos, Rouzbeh Motiei-Langroudi, Aristotelis S. Filippidis and Efstathios Papavassiliou

P rogestins are frequently used in various formulations for female contraception. The association of progestins with increased intracranial pressure (ICP) in the form of idiopathic intracranial hypertension (IIH), also known as “pseudotumor cerebri,” has been demonstrated. 3 , 5 However, there has never been proof of an association between progestins and hydrocephalus. Levonorgestrel-releasing intrauterine devices (LIUDs) were originally thought to release progestins only locally in the uterus, decreasing systemic absorption and related side effects, 8 but it

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Cheerag D. Upadhyaya, Jau-Ching Wu, Gregory Trost, Regis W. Haid, Vincent C. Traynelis, Bobby Tay, Domagoj Coric and Praveen V. Mummaneni

these trials participated in this analysis. The coauthors had access to unpublished as well as published summary data from each of these trials. We obtained unpublished, original summary data from each of the trials to complete our analysis. Statistics were calculated utilizing fixed effects and random effects assumptions to calculate a pooled RR for categorical variables and WMD for continuous variables. A random effects model typically yields a more conservative effect estimate. Given that the trials were studying different devices, we thought it prudent to use