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Papers by Christopher P Kellner

BMJ case reports, Jan 6, 2014

A 14-year-old boy with Loeys-Dietz syndrome (LDS) had an acute neurologic decline 6 days after a ... more A 14-year-old boy with Loeys-Dietz syndrome (LDS) had an acute neurologic decline 6 days after a subarachnoid hemorrhage. Cerebral angiography at presentation did not show an aneurysmal source of the hemorrhage. However, on post-bleed day 6 the patient experienced an acutely worsening headache and subsequently lost consciousness. Head CT showed new subarachnoid blood and repeat angiography demonstrated a basilar tip aneurysm. Endovascular coil embolization was performed and his neurologic status improved postoperatively until post-bleed day 9 when he became unresponsive. A CT angiogram demonstrated severe proximal vasospasm. After an unsuccessful attempt to treat the vasospasm medically, the patient was transported to the neurointerventional suite for intra-arterial vasodilator treatment, which also failed to ameliorate the vasospasm. The endovascular surgeons were then faced with the conundrum of attempting a high-risk cerebral angioplasty in a pediatric patient with LDS or returni...

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, Jan 29, 2017

As neurointerventionalists aim to treat occlusions in the ever more distal vasculature, off-label... more As neurointerventionalists aim to treat occlusions in the ever more distal vasculature, off-label catheters (OLCs) have been adapted for aspiration thrombectomy. This may not be without its attendant risks. Recently issued, a letter from the FDA cautioned providers against using OLCs as substitutes for FDA-cleared aspiration thrombectomy catheters, especially in the distal vasculature. In light of this, we evaluated the efficacy and safety of OLCs used for aspiration thrombectomy in the distal vasculature at our institution. We retrospectively queried all patients who underwent thrombectomy at our institution between January 1, 2016 and March 1, 2017. Patients were screened for: (1) occlusion location in the distal vasculature (M2 or more distal) and (2) direct thrombus aspiration attempt with an OLC. Demographic, clinical, and procedural data were recorded. Eight patients were included for analysis (Table 1). The median admission NIHSS was 17 (IQR 13-23.3). Occlusion locations incl...

Brain Sciences, 2013

Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a maj... more Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction. In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

Journal of neurosurgery. Pediatrics, 2012

A rteriovenous malformations are one of the major causes of stroke in children. 1,4-6 Because int... more A rteriovenous malformations are one of the major causes of stroke in children. 1,4-6 Because intracerebral hemorrhage is the most devastating as well as the most common clinical presentation (46%-87%) in children with AVMs, there is a strong interest in establishing treatment strategies that could prevent or reduce both the initial hemorrhage and possible rebleeding. 7,9,11,14,15,17 Aneurysms separate and distinct from the circle of Willis are commonly found located adjacent to or within AVMs, and are typically classified as either arterial, intranidal, or venous in location. 21,22 The nature of these AVM-associated aneurysms has been partially investigated in adults. 3,18,19,24,25 Although the data are mixed, the preponderance of data suggests that the presence of an aneurysm may be an independent risk factor for hemorrhage in adults with AVMs. 12,13,16,19,22,24,26 For this reason, most adults with ruptured AVMs undergo prompt cerebral angiography with endovascular treatment of AVMassociated aneurysms. In children, however, conventional cerebral angiography and treatment are often performed in a delayed fashion, in part because the nature of AVMassociated aneurysms is generally unknown. Because pe

BMJ case reports, Jan 6, 2014

A 14-year-old boy with Loeys-Dietz syndrome (LDS) had an acute neurologic decline 6 days after a ... more A 14-year-old boy with Loeys-Dietz syndrome (LDS) had an acute neurologic decline 6 days after a subarachnoid hemorrhage. Cerebral angiography at presentation did not show an aneurysmal source of the hemorrhage. However, on post-bleed day 6 the patient experienced an acutely worsening headache and subsequently lost consciousness. Head CT showed new subarachnoid blood and repeat angiography demonstrated a basilar tip aneurysm. Endovascular coil embolization was performed and his neurologic status improved postoperatively until post-bleed day 9 when he became unresponsive. A CT angiogram demonstrated severe proximal vasospasm. After an unsuccessful attempt to treat the vasospasm medically, the patient was transported to the neurointerventional suite for intra-arterial vasodilator treatment, which also failed to ameliorate the vasospasm. The endovascular surgeons were then faced with the conundrum of attempting a high-risk cerebral angioplasty in a pediatric patient with LDS or returni...

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, Jan 29, 2017

As neurointerventionalists aim to treat occlusions in the ever more distal vasculature, off-label... more As neurointerventionalists aim to treat occlusions in the ever more distal vasculature, off-label catheters (OLCs) have been adapted for aspiration thrombectomy. This may not be without its attendant risks. Recently issued, a letter from the FDA cautioned providers against using OLCs as substitutes for FDA-cleared aspiration thrombectomy catheters, especially in the distal vasculature. In light of this, we evaluated the efficacy and safety of OLCs used for aspiration thrombectomy in the distal vasculature at our institution. We retrospectively queried all patients who underwent thrombectomy at our institution between January 1, 2016 and March 1, 2017. Patients were screened for: (1) occlusion location in the distal vasculature (M2 or more distal) and (2) direct thrombus aspiration attempt with an OLC. Demographic, clinical, and procedural data were recorded. Eight patients were included for analysis (Table 1). The median admission NIHSS was 17 (IQR 13-23.3). Occlusion locations incl...

Brain Sciences, 2013

Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a maj... more Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction. In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.

Journal of neurosurgery. Pediatrics, 2012

A rteriovenous malformations are one of the major causes of stroke in children. 1,4-6 Because int... more A rteriovenous malformations are one of the major causes of stroke in children. 1,4-6 Because intracerebral hemorrhage is the most devastating as well as the most common clinical presentation (46%-87%) in children with AVMs, there is a strong interest in establishing treatment strategies that could prevent or reduce both the initial hemorrhage and possible rebleeding. 7,9,11,14,15,17 Aneurysms separate and distinct from the circle of Willis are commonly found located adjacent to or within AVMs, and are typically classified as either arterial, intranidal, or venous in location. 21,22 The nature of these AVM-associated aneurysms has been partially investigated in adults. 3,18,19,24,25 Although the data are mixed, the preponderance of data suggests that the presence of an aneurysm may be an independent risk factor for hemorrhage in adults with AVMs. 12,13,16,19,22,24,26 For this reason, most adults with ruptured AVMs undergo prompt cerebral angiography with endovascular treatment of AVMassociated aneurysms. In children, however, conventional cerebral angiography and treatment are often performed in a delayed fashion, in part because the nature of AVMassociated aneurysms is generally unknown. Because pe