is in persons 55 to 60 years old. 11 An estimated 5 to 15 percent of cases of stroke are related to ruptured intracranial aneurysms. 12 Aneurysmal subarachnoid hemorrhage, a form of hemorrhagic stroke, has a 30-day mortality rate of 45 percent. An estimated 30 percent of survivors will have moderate-to-severe disability. 13 Little is known about the cause of intracranial aneurysms or the process by which they form, grow, and rupture, although hypertension and smoking-induced vascular changes are thought to have a major role. 3 The most common histologic finding is a decrease in the tunica media, the middle muscular layer of the artery, causing structural defects. These defects, combined with hemodynamic factors, lead to aneurysmal outpouchings at arterial branch points in the subarachnoid space at the base of the brain (Fig. 1).

Background and Purpose-We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex and transcranial Doppler (TCD) in patients with acute cerebral ischemia. We aimed to determine the yield and accuracy of NVUE to identify lesions amenable for interventional treatment (LAITs). Methods-NVUE was performed with portable carotid duplex and TCD using standardized fast-track (Ͻ15 minutes) insonation protocols. Digital subtraction angiography (DSA) was the gold standard for identifying LAIT. These lesions were defined as proximal intra-or extracranial occlusions, near-occlusions, Ն50% stenoses or thrombus in the symptomatic artery.

Background and Purpose-This study evaluated the safety and efficacy of aggressive mechanical clot disruption (AMCD) in acute stroke patients with persisting middle cerebral artery (MCA) or internal carotid artery (ICA) occlusion after thrombolytic therapy. Methods-Retrospective case series were used from a prospectively collected stroke database on consecutive acute ischemic stroke patients treated with intra-arterial (IA) thrombolytics and mechanical clot disruption during a 5-year interval.

Object. The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. Methods. Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization; and 16 underwent embolization alone. The outcomes of gait and micturition disability were analyzed. Follow up averaged 3.4 years (range 1 month–11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome. Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff—Logue Scale, was significantly improved after treatment, from 3.4 ± 1.4 (average ± standard deviation) to 2.7 ± 1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9 ± 1 to 1.6 ± 1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff—Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging—documented spinal cord edema. Conclusions. Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.

Background and Purpose-The authors report their experience using Matrix coils in the treatment of cerebral aneurysms. Methods-The outcomes of 72 consecutive patients (76 aneurysms) who underwent coiling using Matrix coils at our institution were retrospectively analyzed. Results-Seventy-four aneurysms in 70 patients were coiled using Matrix coils (ranging 3% to 100% by coil length; mean 68.8%). Two patients underwent regular platinum coil embolization after failed Matrix coil placement. Thirty-two (42%) ruptured aneurysms were acutely treated. In 46 aneurysms, Matrix composed Ͼ50% of coil length. Complete aneurysm occlusion was obtained in 13 aneurysms (17.6%), neck remnant in 30 (40.5%), and dome filling in 31 (41.9%). Procedural morbidity and mortality rates were 1.4% and 1.4%, respectively. Angiographic follow-up was obtained in 63.5% (47 of 74 aneurysms; average 12.2 months; range 0 to 34). In these 47 angiographically followed aneurysms, the overall recanalization rate was 57.4%. In aneurysms with Ͼ50% Matrix coils, 76.1% had angiographic follow-up (35 of 46), and in this group, the overall recanalization rate was 54.3% (19 of 35): 25% (1 of 4) for very small (Ͻ5 mm); 33% (4 of 12) for small-size (Ͻ10 mm)/small-neck (Ͻ4 mm); and 63% (5 of 8) for small-size/wide-neck (Ն4 mm). A total of 82% (9 of 11) recanalization occurred in large aneurysms (Ն10 to 25 mm). Ten aneurysms (21.3%; 10 of 47) underwent retreatment. Clinical follow-up was obtained in 61 (86%) patients (average 15 months; range 1 to 37): 87% of patients were Glasgow Outcome Scale 4 or 5. Conclusion-The use of Matrix coils resulted in worse recanalization rates than that reported for Guglielmi detachable bare platinum coils.