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https://www.readbyqxmd.com/read/28721332/to-stent-or-not-to-stent-a-tale-of-two-occlusions
#1
Ali S Haider, Lyndon K Lee, Tijani Osumah, Saira Alli, Umair Khan, Steven Vayalumkal, Aida Kafai Golahmadi, Richa Thakur, Phu Nguyen, Kennith F Layton
Stenting and balloon angioplasty, along with mechanical thrombectomy, have gained notability as adjunctive treatment options to intravenous tissue plasminogen activator (IV-tPA) for tandem internal carotid artery (ICA) and middle cerebral artery (MCA) occlusions (TIM occlusions). Acute ischemic strokes (AISs) secondary to TIM occlusions are associated with poor patient outcomes primarily due to low recanalization rates following intravenous thrombolysis, consequently prompting the need for more invasive recanalization efforts...
June 17, 2017: Curēus
https://www.readbyqxmd.com/read/28700481/a-multiparameter-model-predicting-in-hospital-mortality-in-malignant-cerebral-infarction
#2
Chien-Fu Chen, Ruey-Tay Lin, Hsiu-Fen Lin, A-Ching Chao
The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI.This prospective study enrolled all patients with LHI involving >50% of the middle cerebral artery (MCA) admitted to our neurological intensive care unit within 48 hours of symptom onset. Early clinical and radiographic parameters and the baseline CHADS2 score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke [double weight]) were analyzed regarding their ability to predict patient outcomes...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28695721/aortic-isthmus-shunt-dynamics-in-normal-and-complicated-monochorionic-pregnancies
#3
Viola Seravalli, Dana Block-Abraham, Cyrethia McShane, Sarah Millard, Ahmet Baschat, Jena Miller
OBJECTIVE: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. METHODS: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta (DAo), middle cerebral artery (MCA), and ductus venosus (DV), and with left and right ventricular cardiac output and stroke volume was studied. RESULTS: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin-twin-transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS+sIUGR; 8 uncomplicated)...
July 11, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/28694110/predictors-of-in-hospital-mortality-after-decompressive-hemicraniectomy-for-malignant-ischemic-stroke
#4
Saadat Kamran, Abdul Salam, Naveed Akhtar, Aymen Alboudi, Arsalan Ahmad, Rabia Khan, Rashed Nazir, Muhammad Nadeem, Jihad Inshasi, Ahmed ElSotouhy, Ghanim Al Sulaiti, Ashfaq Shuaib
OBJECTIVE: The purpose of this retrospective multicenter, pooled-data analysis was to determine the factors associated with in-hospital mortality in decompressive hemicraniectomy (DHC) for malignant middle cerebral artery (MMCA) stroke. PATIENTS AND METHODS: The authors reviewed pooled DHC database from 3 countries for patients with MMCA with hospital mortality in spite of DHC to identify factors that predicted in-hospital mortality after DHC. The identified factors were applied to the group of patients who were selected for DHC but either refused surgery and died or stabilized and did not undergo DHC...
July 7, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28693074/-analysis-of-the-correlation-between-deep-medullary-veins-and-clinical-prognosis-of-middle-cerebral-artery-stroke
#5
H Y Li, Y Duan, B Q Yang, C C Chang, N Liu, L X Zhang, S Lin
Objective: To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI). Methods: A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists...
July 4, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28691137/effective-use-of-balloon-guide-catheters-in-reducing-incidence-of-mechanical-thrombectomy-related-distal-embolization
#6
Dong Hoon Lee, Jae Hoon Sung, Sang Uk Kim, Ho Jun Yi, Jae Taek Hong, Sang Won Lee
BACKGROUND AND PURPOSE: The clinical benefit of endovascular stroke therapy has been demonstrated in several prospective randomized trials. However, in a relevant percentage of patients, mechanical thrombectomy bears the risk of causing new infarction in initially unaffected vascular territories through thrombus fragmentation and migration of clot debris. The goal of this study was to evaluate the use of the balloon guide catheter (BGC) to effectively achieve flow arrest and thrombus aspiration during the intervention to avoid distal embolization...
July 9, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28687423/an-increase-of-sigma-1-receptor-in-the-penumbra-neuron-after-acute-ischemic-stroke
#7
Xiaotian Zhang, Fangfang Wu, Yun Jiao, Tianyu Tang, Li Yang, Chunqiang Lu, Yanhong Zhang, Yuan Zhang, Ying Bai, Jie Chao, Gaojun Teng, Honghong Yao
BACKGROUND: Penumbra salvage from infarction by early reperfusion within the time window is the target of acute ischemic stroke therapies. Although the penumbral imaging is potently usable in clinic trial, additional work needs to be performed to advancing the field with better-defined, evaluated, and validated imaging measures. METHODS: Mice were subjected to permanent stroke by right middle cerebral artery (MCA) occlusion. Multimodel magnetic resonance imaging (MRI) method was assessed to define the penumbra as that brain region in which the perfusion and diffusion-weighted MR images are mismatched (perfusion-weighted imaging [PWI]-diffusion-weighted imaging [DWI] mismatch)...
July 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28685617/aerobic-exercise-prevents-rarefaction-of-pial-collaterals-and-increased-stroke-severity-that-occur-with-aging
#8
Wojciech Rzechorzek, Hua Zhang, Brian K Buckley, Kunjie Hua, Daniel Pomp, James E Faber
Variation in extent of the brain's collateral circulation is an important determinant of variation in the severity of stroke and efficacy of revascularization therapies. However, the number and diameter of pial collateral "arterioles" decrease with aging in associated with reduced eNOS and increased oxidative stress. We tested whether exercise reduces this aging-induced rarefaction. Twelve-month-old mice were randomized to sedentary or voluntary wheel-running. At 26 months' age, permanent MCA occlusion was followed 72 h later by determination of infarct volume and vascular casting after maximal dilation...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28674513/isolated-striatocapsular-infarcts-after-endovascular-treatment-of-acute-proximal-middle-cerebral-artery-occlusions-prevalence-enabling-factors-and-clinical-outcome
#9
Johannes Kaesmacher, Thomas Huber, Manuel Lehm, Claus Zimmer, Kathleen Bernkopf, Silke Wunderlich, Tobias Boeckh-Behrens, Nathan W Manning, Justus F Kleine
BACKGROUND: Striatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28665172/treatment-with-low-dose-fasudil-for-acute-ischemic-stroke-in-chronic-hypertension
#10
Siu-Lung Chan, Marilyn J Cipolla
We investigated the effect of Rho kinase inhibition on changes in cerebral blood flow (CBF), brain injury and vascular function after ischemic stroke in spontaneously hypertensive rats (SHR). Changes in core MCA and collateral perfusion were measured by a validated laser Doppler method. Animals underwent 2 h tMCAO and 2 h reperfusion. Fasudil (0.1 mg/kg, i.v.) or vehicle was given at 30 min ischemia (n = 9/group; mean (SD)). Brain injury was determined by 2,3,5-triphenyltetrazolium chloride staining...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28647416/related-factors-of-asymmetrical-vein-sign-in-acute-middle-cerebral-artery-stroke-and-correlation-with-clinical-outcome
#11
Jinchao Yu, Liming Wang, Zhenzhi Li, Shanshan Wang, Guangbin Wang
OBJECTIVE: The aim of our study was to analyze the related factors of asymmetrical cortical vein sign (ACVS) and asymmetrical medullary vein sign (AMVS) on susceptibility-weighted imaging (SWI) in patients with acute middle cerebral artery (MCA) stroke and whether their presence can be used as an independent predictor for clinical outcome. METHODS: According to the presence of ACVS and AMVS on SWI, 124 patients with acute MCA stroke within 3 days were divided into several different groups...
June 21, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28625574/rapamycin-decreased-blood-brain-barrier-permeability-in-control-but-not-in-diabetic-rats-in-early-cerebral-ischemia
#12
Oak Z Chi, Geza K Kiss, Scott J Mellender, Xia Liu, Harvey R Weiss
Diabetes causes functional and structural changes in blood-brain barrier (BBB). The mammalian target of rapamycin (mTOR) has been associated with glucose metabolism, diabetes, and altering BBB permeability. Since there is only a narrow therapeutic window (3h) for stroke victims, it is important to investigate BBB disruption in the early stage of cerebral ischemia. We compared the degree of BBB disruption in diabetic and in control rats at two hours of reperfusion after one hour of middle cerebral artery (MCA) occlusion with or without inhibition of mTOR...
July 27, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28620567/a-retrospective-cohort-study-to-assess-patient-and-physician-reported-outcome-measures-after-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-stroke
#13
Sanjay Budhdeo, Angelos G Kolias, David J Clark, Aswin Chari, Peter J Hutchinson, Elizabeth A Warburton
INTRODUCTION: Decompressive hemicraniectomy for malignant middle cerebral artery (MCA) infarction is known to reduce mortality. However, there are on-going concerns in terms of the quality of life in survivors. We aimed to examine the correlation between patient and physician reported outcome measures in decompressive hemicraniectomy. PATIENTS AND METHODS: We analyzed outcomes in 21 patients who underwent decompressive hemicraniectomy for malignant MCA infarction between September 2003 and August 2013 within a regional health system...
May 10, 2017: Curēus
https://www.readbyqxmd.com/read/28611828/heads-up-a-novel-provocative-maneuver-to-guide-acute-ischemic-stroke-management
#14
Latisha K Ali, Julius K Weng, Sidney Starkman, Jeffrey L Saver, Doojin Kim, Bruce Ovbiagele, Brian H Buck, Nerses Sanossian, Paul Vespa, Oh Young Bang, Reza Jahan, Gary R Duckwiler, Fernando Viñuela, David S Liebeskind
BACKGROUND: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. METHODS: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28608454/accelerated-atherosclerosis-in-anca-associated-vasculitis
#15
I González-Suárez, J J Ríos-Blanco, J Arpa
OBJECTIVES: Cardiovascular disease, including myocardial infarction and stroke, is a major cause of mortality in ANCA-associated vasculitis (AAV). Although AAV affects small vessels, an accelerated atherosclerosis not explained by traditional cardiovascular risk factors (CVRF) has been demonstrated. We aimed to investigate the association of atherosclerosis measured by carotid intima-media thickness (CIMT) and cerebral small vessel disease in AAV-patients. MATERIALS & METHODS: Twenty-three AAV-patients in complete remission were recruited...
June 12, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28604106/decompressive-craniectomy-for-the-treatment-of-malignant-middle-cerebral-artery-infarction
#16
Kapil Mohan Rajwani, Matthew Crocker, Barry Moynihan
INTRODUCTION: Malignant middle cerebral artery (MCA) infarction is associated with up to 80% mortality in the first week, despite maximal medical therapy. Decompressive craniectomy (DC) has been shown to improve survival rates in these patients. However, there are concerns that DC prolongs poor quality of life by increasing the number of survivors with major disability. This review will assess if DC in patients with malignant MCA infarction improves functional outcomes compared to maximal medical therapy...
June 12, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28579508/decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-stroke-south-asian-experience
#17
Saadat Kamran, Naveed Akhtar, Abdul Salam, Ayman Alboudi, Hiba Rashid, Kainat Kamran, Rabia Ali Khan, Mohsin Khalid Mirza, Arsalan Ahmed, Ahmed M A Own, Sohail Al Rukun, Jihad Inshasi, Dirk Deleu, Ghanim Al Sulaiti, Ashfaq Shuaib
BACKGROUND: The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke. METHODS: This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months...
June 1, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28549641/treatment-of-moyamoya-disease-and-unruptured-intracranial-aneurysm-in-floating-harbor-syndrome-a-case-report
#18
Daniel J Coughlin, Charles A Miller, A Jesse Schuette
BACKGROUND: This is the first report of the successful treatment of moyamoya disease (MMD) and an unruptured intracranial aneurysm in a patient with Floating-Harbor Syndrome (FHS). CASE DESCRIPTION: A 35 year-old, phenotypically syndromic woman presented with signs and symptoms consistent with ischemic stroke. MRI and catheter angiography confirmed diagnosis of moyamoya and a 6 mm basilar apex artery aneurysm (BAA). She underwent right sided craniotomy for direct and indirect revascularization by means of superficial temporal artery-middle cerebral artery (STA-MCA) bypass and encephalo-duro-arterio-synangiosis (EDAS)...
May 23, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28536522/a-high-resolution-mri-study-of-relationship-between-remodeling-patterns-and-ischemic-stroke-in-patients-with-atherosclerotic-middle-cerebral-artery-stenosis
#19
Dan-Feng Zhang, Yu-Chen Chen, Huiyou Chen, Wei-Dong Zhang, Jun Sun, Cun-Nan Mao, Wen Su, Peng Wang, Xindao Yin
Purpose: Recently, high-resolution magnetic resonance imaging (HR-MRI) has been used to depict the wall characteristics of the intracranial arteries. The aim of this study was to explain the relationship between the remodeling patterns and acute ischemic stroke in patients with atherosclerotic middle cerebral artery (MCA) stenosis using HR-MRI. Materials and Methods: From August 2015 to May 2016, we prospectively screened 33 consecutive patients with unilateral MCA stenosis using time-to-flight MR angiography, including 15 patients with symptomatic MCA stenosis and 18 patients with asymptomatic MCA stenosis...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28530158/analyzing-circle-of-willis-blood-flow-in-ischemic-stroke-patients-through-3d-stroke-arterial-flow-estimation
#20
Aichi Chien, Fernando Viñuela
Background The objective of ischemic stroke (IS) treatment is to achieve revascularization in cerebral arteries to restore blood flow. However, there is no available method to extract arterial flow data from clinical CTA images. We developed 3D Stroke Arterial Flow Estimation (SAFE), which provides blood flow data throughout the Circle of Willis based on 3D CTA and allows comparison of arterial flow distribution in the brain. Methods We implemented a newly developed 3D vascular reconstruction algorithm for clinical stroke CTA images...
January 1, 2017: Interventional Neuroradiology
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