JNIS Podcast

In this podcast Dr Robert Tarr talks to Dr Matt Gounis and his team Dr Juyu Chueh and Dr Srinivasan Vedantham about their editors choice paper. In this podcast they discuss their methodology and the drawbacks of this kind of study. Full paper >> http://jnis.bmj.com/content/7/9/676.full

In this podcast Dr Robert Tarr speaks to Dr Ali Seifi about his recent paper that was selected as editors choice. This podcast covers the differences in mortality and patient outcome between endovascular coiling and surgical clipping and discusses possible chances for a future aneurysm registry. Full paper >> http://jnis.bmj.com/content/7/10/728.full?sid=16c2199c-8711-4039-aab9-aa10a1496033

Bias and peer review are of universal importance to all those that produce scholarly work. Fiona Godlee and Rob Tarr, editors in chief of The BMJ and JNIS respectively, share their insights and experience on these highly topical issues with Joshua Hirsch. Read the related paper: http://jnis.bmj.com/content/early/2015/04/17/neurintsurg-2015-011781.full

The system of healthcare delivery in the United States is in the midst of a meaningful transition. Traditional fee for service paradigms are moving towards what has been termed value-based approaches. Doctors Joshua HIrsch, Geraldine Mcginty and Greg Nicola examine recent developments and discuss how specialist can participate and help lead that transition. Listeners to the podcast might enjoy rea...

On Dec 17th 2014, the NEJM published the results of MR CLEAN; a Dutch study comparing patients treated with intra-arterial thrombolysis to those of a medically managed cohort. The design of this trial was ingenious; focusing attention on patients who appeared to have failed intravenous thrombolysis. The IAT managed group performed quite favorably with respect to this control group. Three associate...

With advances in device design, patient selection paradigms and other elements of treatment, the neuroendovascular approach to acute ischemic stroke has made great strides forward. In this podcast, Dr Joshua Hirsch interviews Dr Brijesh Mehta on how the implementation of operational improvements can meaningfully impact patient outcomes. Dr Mehta is a neuroInterventional surgeon at the Memorial Neu...

Pretreatment Alberta Stroke Program Early CT Scores (ASPECTS) is associated with clinical outcomes. The rate of decline between subsequent images, however, may be more predictive of outcomes as it integrates time and physiology. A paper published in the January issue of JNIS retrospectively looked at patients transferred from six primary stroke centers and treated with intra-arterial therapy (IAT)...

Could morphology and growth predict rupture? Despite several landmark studies, the natural history of unruptured intracranial aneurysms (UIA) remains uncertain. Rob Tarr talks to William Mehan, Division of Neuroradiology, Massachusetts General Hospital, about his paper which aimed to identify or confirm factors predictive of rupture of UIA being observed conservatively with serial CT angiography i...

Immune dysregulation influences outcome following acute ischemic stroke (AIS). Admission white blood cell counts are routinely obtained, making the neutrophil–lymphocyte ratio (NLR) a readily available biomarker of the immune response to stroke. With colleagues Taura Barr, WVU Prevention Research Center, One Medical Center Drive, sought to identify the relationship between NLR and 90 day AIS outco...

Symptomatic subacute/chronic large artery intracranial occlusive disease represents a common medical dilemma. A recent JNIS paper reports a multicenter experience of endovascular recanalization of intracranial atherosclerotic occlusions refractory to medical therapy. Robb Tarr talks to co-author Raul Nogueira, Department of Neurology, Marcus Stroke and Neuroscience Center/Grady Memorial Hospital/E...

Aneurysmal subarachnoid hemorrhage (SAH) is a rare but devastating form of stroke. Endovascular therapy has been criticized for its higher rate of recanalization and retreatment. The safety and predictors of retreatment are unknown. A recent study in JNIS reports the clinical outcomes, imaging outcomes and predictors for aneurysm retreatment after initial endovascular embolization. Rob Tarr speaks...

The Patient Protection and Affordable Care Act (ACA) became law on 23 March 2010. As part of the law, two independent boards were established. The Patient-Centered Outcomes Research Institute embodies national aspirations for employing comparative effectiveness research in healthcare decision-making, and the Independent Payment Advisory Board is focused on the need for a group of impartial experts...

Newer flat panel angiographic detector (FD) systems have the capability to generate parenchymal blood volume (PBV) maps. The ability to generate these maps in the angiographic suite has the potential to markedly expedite the triage and treatment of patients with acute ischemic stroke. David Fiorella, Department of Neurological Surgery, Stony Brook University Medical Center, NY, and colleagues, hav...

US physicians nearly universally use the CPT coding system. This code set communicates medical, procedural, surgical and diagnostic services and is a critical component of describing the work we do. Drs. Josh Hirsch, Jackie Bello and Raymond Tu are actively involved in the world of physician reimbursement through their associations with the Relative-Value Update Committee (RUC) and Current Procedu...

The development of new revascularization devices has improved recanalization rates and time but not clinical outcomes. In a paper in May's JNIS, Aquilla Turk, Department of Radiology, Medical University of South Carolina, ad colleagues, report their initial results with a new technique utilizing a direct aspiration first pass technique with a large bore aspiration catheter as the primary method fo...

Drs. Hirsch, Meyers and Jayaraman discuss the evolving and at times complex role of Evidence Based Medicine (EBM) in contemporary neurointerventional practice. The discussants contrast EBM with Comparative Effectiveness Research and the role it plays in coverage decisions. The podcast directly links to the following articles: http://www.ncbi.nlm.nih.gov/pubmed/24578482?dopt=Abstract General consid...

The difference in the relationship between the size of intracranial aneurysms (IAs) and their risk of rupture in patients with singe IAs versus those with multiple IAs is unclear. A recent JNIS paper retrospectively analysed the size of ruptured IAs (RIAs) in patients with single and multiple IAs, in order to study this relationship further. JNIS editor Rob Tarr spoke to author Bharathi Jagadeesan...

The efficacy of hypothermia as a neuroprotectant has yet to be demonstrated in acute ischemic stroke. Researchers at Emory University School of Medicine conducted a phase I pilot study to assess the feasibility and safety of performing intravascular hypothermia after definitive intra-arterial reperfusion therapy (IAT), and in this podcast co-author Rishi Gupta tells Rob Tarr what they found. Read...

JNIS editor-in-chief Rob Tarr talks to Mike Froehler, Department of Neurology, University of Iowa Hospital, about his paper which revealed the hyperdense vessel sign on CT in acute ischemic stroke was strongly predictive of successful recanalization using the Merci device. Read the full paper here: http://goo.gl/D7klFb

Nearly annually, US healthcare providers face a significant downward revision to their Medicare fee schedule secondary to the application of the sustainable growth rate formula. Recent developments raise the possibility that this unsustainable situation might soon change; for the better. Drs Josh Hirsch, David Rosman and Raymond Liu review the sustainable growth rate and discuss how it works. In c...

JNIS editor Rob Tarr talks to Darren Orbach, Department of Neurointerventional Radiology, Children's Hospital Boston, about his recent editor's choice paper: Angioarchitectural features associated with hemorrhagic presentation in pediatric cerebral arteriovenous malformation.

Drs Josh Hirsch, Bill Donovan and Zeke Silva are actively involved in the world of physician reimbursement through their volunteer associations with organizations like the ACR, ASNR and the RUC, amongst others. This podcast is suitable for beginners or aficionados as the physician discussions will range from the history of the RUC to nuances of the erosion of component coding. The authors will use...

Rob Tarr, JNIS editor, talks to Jennifer Frontera, Neurosurgery, Mount Sinai School of Medicine, about her study showing aneurysm coiling followed by ICH evacuation is a viable alternative to clipping and ICH evacuation, for subarachnoid hemorrhage with intracerebral hematoma. See also: Management of subarachnoid hemorrhage with intracerebral hematoma: clipping and clot evacuation versus coil embo...

JNIS editor Rob Tarr talks to Kyle Fargen, Department of Neurosurgery, University of Florida, about his pilot study looking at simulator based angiography education, and the potential of the technique. See also: Simulator based angiography education in neurosurgery: results of a pilot educational program http://bit.ly/TMPoOC

JNIS editor Rob Tarr talks to Aquilla Turk (Medical University of South Carolina) about his study into CT perfusion-guided patient selection for endovascular treatment of ischemic stroke, which has shown it is safe and effective. See also: CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective http://bit.ly/Oti4yf