Safety and predictors of aneurysm retreatment for remnant intracranial aneurysm after initial endovascular embolization http://jnis.bmj.com/content/6/7/490.full

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 to establish anticipatable growth rates for Medicare.

Approximately 4 years after the bill was passed into law, these independent boards are at very different points in their life cycles.

In this podcast, Josh Hirsch, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Geraldine McGinty, Department of Radiology, Weill Cornell Medical College, New York, and Richard Duszak, Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, give us a status update.

Read the related article: http://goo.gl/mNRI8g

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, have compared FP-PBV maps with cerebral blood volume (CBV) maps derived using standard dynamic CT perfusion (CTP) in a population of patients with stroke.

Rob Tarr asks him what they found.

Read the full paper: http://jnis.bmj.com/content/6/6/451.full

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 Procedural Terminology (CPT) committees.

In this podcast they discuss the role CPT plays in physician reimbursement and its interplay with the RUC and Centers for Medicare & Medicaid Services (CMS).

The JNIS article being discussed is:

Current procedural terminology; a primer http://goo.gl/TIhC8N

Listen to Dr Hirsch's previous podcast on component coding and the RUC: http://goo.gl/KcEbk4

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 for vessel recanalization.

Rob Tarr discusses the findings with Dr Turk and also Marc Chimowitz, Department of Neurosciences, Medical University of South Carolina, who has written an accompanying editorial.

Read the articles:

Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy http://goo.gl/H1MQqb

Game changer for endovascular treatment of acute ischemic stroke? http://goo.gl/JFkDM0

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 considerations:

http://www.ncbi.nlm.nih.gov/pubmed/22166819

http://jnis.bmj.com/content/4/1/11.long

Why standards:

http://www.ncbi.nlm.nih.gov/pubmed/21994097

http://jnis.bmj.com/content/1/1/5.long

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, Department of Radiology, University of Minnesota, about the outcome.

Read the paper here: http://goo.gl/EKHMyf

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 the full paper:

Endovascular Reperfusion and Cooling in Cerebral Acute Ischemia (ReCCLAIM I) http://goo.gl/yiNQKk

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 closing out the podcast, they review the circumstances that are potentially leading to an end of this historic challenge.