[9] The major strength of the study is that we confirmed the HMCAS using CT angiography. We did not show that treatment made a difference to the rate of resolution. However, the decision to treat patients was governed by the clinical presentation and not the length of thrombus. Further, we observed that the estimated thrombus burden, detected by length or volume was highly predictive of HMCAS resolution. This is consistent with prior observations showing that the thrombus location and extent is related to recanalization rates and outcomes.[10] NCCT brain is the first modality of choice to image patients with acute stroke due to its

speed of acquisition, cost effectiveness, and wide availability. HMCAS on baseline scans in patient with acute ischemic stroke are easily recognized with good interrater agreement,[11] high specificity,[12] and

its length can Idasanutlin nmr be easily measured without selleck compound the need for sophisticated tools. Use of volume estimation of HMCAS is helpful but requires more sophisticated image analysis. In the SITS-ISTR register, the hyperdense sign disappeared in 48% patients at follow-up with IV tPA and these patients showed more rapid neurological improvement and had a better 3-month functional outcome[6] Although this observation of disappearance of HMCAS is consistent with ours, it may be confounded by baseline differences in the patient population and the stroke severity or by measurement error since CT angiography was not done to confirm a HMCAS. This study is limited by its modest size and retrospective nature. Second, there are technical limitations of accurately measuring the HMCAS on conventional 5 mm NCCT and we infer that one reason for the poor sensitivity of the HMCAS on NCCT is the slice thickness and other technical factors. Infrequent disappearance of HMCAS

>10mm with intravenous tPA suggests additional need for more advanced vascular imaging like CT angiography and digital subtraction angiography followed by need for ancillary endovascular therapy in this group, a concept which is Alanine-glyoxylate transaminase currently being directly tested in the THERAPY trial using the Penumbra Stroke system.[13] “
“Posterior cerebral artery aneurysms are treatment challenge for the neurosurgeon. Parent artery occlusion, trapping and bypass have been the classic treatment options for aneurysms in this location. With the introduction of newer embolic agents such as Onyx®, endovascular intervention is now a viable therapy for these aneurysms. We report the case of a 60-year-old man who presented with a symptomatic, though unruptured, fusiform left posterior cerebral artery aneurysm. Given the distal location of this dominant sided aneurysm, post-operative visual deficits and aphasia were a concern if parent vessel occlusion were to be performed. Therefore, an endovascular reconstruction using Onyx HD-500 and two closed-cell stents was performed.