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Endovascular and stroke

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https://www.readbyqxmd.com/read/29343588/modeling-the-impact-of-interhospital-transfer-network-design-on-stroke-outcomes-in-a-large-city
#1
Neal S Parikh, Abhinaba Chatterjee, Iván Díaz, Ankur Pandya, Alexander E Merkler, Gino Gialdini, Benjamin R Kummer, Saad A Mir, Michael P Lerario, Matthew E Fink, Babak B Navi, Hooman Kamel
BACKGROUND AND PURPOSE: We sought to model the effects of interhospital transfer network design on endovascular therapy eligibility and clinical outcomes of stroke because of large-vessel occlusion for the residents of a large city. METHODS: We modeled 3 transfer network designs for New York City. In model A, patients were transferred from spoke hospitals to the closest hub hospitals with endovascular capabilities irrespective of hospital affiliation. In model B, which was considered the base case, patients were transferred to the closest affiliated hub hospitals...
January 17, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29343137/hybrid-aortic-arch-and-frozen-elephant-trunk-reconstruction-bridging-the-gap-between-conventional-and-total-endovascular-arch-repair
#2
Sabin J Bozso, Abigail White, Jeevan Nagendran, Michael C Moon, Michael W A Chu
Novel endovascular techniques hope to offer patients aortic arch repair with reduced morbidity compared to conventional arch surgery; however, current endovascular strategies remain challenged by the proximal seal zone, higher stroke rates, long-term durability and select anatomy. Hybrid arch repair offers patients a less invasive alternative that can treat more distal aorta than conventional arch repair yet still be performed via standard sternotomy. Areas Covered: This review will discuss the current evidence and future development of hybrid aortic arch and frozen elephant trunk reconstruction...
January 18, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29340574/effect-of-general-anesthesia-and-conscious-sedation-during-endovascular-therapy-on-infarct-growth-and-clinical-outcomes-in-acute-ischemic-stroke-a-randomized-clinical-trial
#3
Claus Z Simonsen, Albert J Yoo, Leif H Sørensen, Niels Juul, Søren P Johnsen, Grethe Andersen, Mads Rasmussen
Importance: Endovascular therapy (EVT) is the standard of care for select patients who had a stroke caused by a large vessel occlusion in the anterior circulation, but there is uncertainty regarding the optimal anesthetic approach during EVT. Observational studies suggest that general anesthesia (GA) is associated with worse outcomes compared with conscious sedation (CS). Objective: To examine the effect of type of anesthesia during EVT on infarct growth and clinical outcome...
January 16, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29338866/the-repair-of-a-type-ia-endoleak-following-thoracic-endovascular-aortic-repair-using-a-stented-elephant-trunk-procedure
#4
Rui-Dong Qi, Jun-Ming Zhu, Yong-Min Liu, Lei Chen, Cheng-Nan Li, Xiao-Yan Xing, Li-Zhong Sun
BACKGROUND: Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. METHODS: From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure...
December 14, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29338750/reperfusion-therapy-in-acute-ischemic-stroke-dawn-of-a-new-era
#5
REVIEW
Sonu Bhaskar, Peter Stanwell, Dennis Cordato, John Attia, Christopher Levi
Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed...
January 16, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29336360/early-neurological-deterioration-after-recanalization-treatment-in-patients-with-acute-ischemic-stroke-a-retrospective-study
#6
Ying-Bo Zhang, Ying-Ying Su, Yan-Bo He, Yi-Fei Liu, Gang Liu, Lin-Lin Fan
BACKGROUND: Early neurological deterioration (END) is a prominent issue after recanalization treatment. However, few studies have reported the characteristics of END after endovascular treatment (EVT) as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator (IV rt-PA) and EVT of acute ischemic stroke, and identified risk factors for END. METHODS: Medical records of patients who received recanalization treatment between January 1, 2014, and December 31, 2015 were reviewed...
January 20, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29335886/effect-of-actual-age-on-outcome-at-discharge-in-patients-by-surgical-clipping-and-endovascular-coiling-for-ruptured-cerebral-aneurysm-in-japan
#7
Fusao Ikawa, Masaru Abiko, Daizo Ishii, Jyumpei Ohshita, Takahito Okazaki, Shigeyuki Sakamoto, Shotai Kobayashi, Kaoru Kurisu
The Japanese population features the highest rate of elderly individuals worldwide. However, the difference of actual age indication for surgical clipping (SC) and endovascular coiling (EC) has never reported. We clarified the effect of actual age on poor outcome at discharge in patients by each treatment for ruptured cerebral aneurysm according to the Japanese Stroke Data Bank. A total of 3593 patients with ruptured saccular cerebral aneurysm were treated by SC and/or EC between 2000 and 2013. The effect of actual age on poor outcome (modified Rankin scale [mRS] score > 2) at discharge was evaluated by the cutoff age using receiver operating characteristic analysis for each treatment...
January 15, 2018: Neurosurgical Review
https://www.readbyqxmd.com/read/29333567/predictors-for-intracranial-hemorrhage-following-intravenous-thrombolysis-in-posterior-circulation-stroke
#8
Dorňák Tomáš, Král Michal, Sedláčková Zuzana, Šaňák Daniel, Čecháková Eva, Divišová Petra, Zapletalová Jana, Kaňovský Petr
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90...
January 15, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29331206/mechanical-thrombectomy-determining-the-proportion-of-eligible-acute-ischemic-stroke-patients-in-the-cohort-of-single-academic-stroke-center
#9
Marcin Wiącek, Rafał Kaczorowski, Bartosz Sieczkowski, Natalia Kanas, Halina Bartosik-Psujek
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. METHODS: We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016)...
December 26, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29329730/mechanical-thrombectomy-in-acute-ischaemic-stroke-a-review-of-the-different-techniques
#10
REVIEW
V Leung, A Sastry, S Srivastava, D Wilcock, A Parrott, S Nayak
Endovascular mechanical thrombectomy (MT) is reserved for acute ischaemic stroke secondary to large vessel occlusion. The various MT techniques employed in the treatment of hyperacute strokes are constantly evolving with new devices and improvisation of existing technology (Wahlgren, et al 2016). In this review, we describe a variety of MT techniques gained from our experience of performing over 350 procedures in 7 years of providing a 24/7 service within the national framework of a hyperacute stroke centre...
January 9, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29327997/mechanical-thrombectomy-in-basilar-artery-occlusion-influence-of-reperfusion-on-clinical-outcome-and-impact-of-the-first-line-strategy-adapt-vs-stent-retriever
#11
Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, Bertrand Lapergue
OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29325502/rehearsal-using-patient-specific-simulation-to-improve-endovascular-efficiency
#12
Mathew Wooster, Adam Doyle, Sean Hislop, Roan Glocker, Paul Armstrong, Michael Singh, Karl A Illig
OBJECTIVE: To determine whether rehearsal using patient-specific information loaded onto an endovascular simulator prior to carotid stenting improves procedural efficiency and outcomes. METHODS: Patients scheduled for carotid artery stenting who had adequate preoperative computed tomography (CT) imaging were considered for enrollment. After obtaining informed consent, patients were randomized to control versus rehearsal groups. Those in the rehearsal group had their CT scans loaded into an endovascular simulator (Angio Mentor) followed by case rehearsal by the attending on the simulator within 24 hours prior to the procedure; control patients underwent routine carotid stenting without rehearsal...
January 1, 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29321339/detection-of-anterior-circulation-large-artery-occlusion-in-ischemic-stroke-using-noninvasive-cerebral-oximetry
#13
Alexander C Flint, Shiv G Bhandari, Sean P Cullen, Adhikari V Reddy, Daniel P Hsu, Vivek A Rao, Minal Patel, Jasmeen Pombra, Nancy J Edwards, Sheila L Chan
BACKGROUND AND PURPOSE: Large artery occlusion (LAO) in ischemic stroke requires recognition and triage to an endovascular stroke treatment center. Noninvasive LAO detection is needed to improve triage. METHODS: Prospective study to test whether noninvasive cerebral oximetry can detect anterior circulation LAO in acute stroke. Interhemispheric ΔBrSO2 in LAO was compared with controls. RESULTS: In LAO stroke, mean interhemispheric ΔBrSO2 was -8...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29321337/associations-between-collateral-status-and-thrombus-characteristics-and-their-impact-in-anterior-circulation-stroke
#14
Heitor C Alves, Kilian M Treurniet, Bruna G Dutra, Ivo G H Jansen, Anna M M Boers, Emilie M M Santos, Olvert A Berkhemer, Diederik W J Dippel, Aad van der Lugt, Wim H van Zwam, Robert J van Oostenbrugge, Hester F Lingsma, Yvo B W E M Roos, Albert J Yoo, Henk A Marquering, Charles B L M Majoie
BACKGROUND AND PURPOSE: Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome. METHODS: Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195)...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29316375/selection-criteria-for-endovascular-therapy-for-acute-ischaemic-stroke-are-patients-missing-out
#15
Julian Maingard, Leonid Churilov, Peter Mitchell, Richard Dowling, Bernard Yan
INTRODUCTION: Endovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. METHODS: We included patients with anterior circulation stroke treated with ECR from a single centre...
January 9, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29311286/endovascular-thrombectomy-in-acute-ischemic-stroke
#16
REVIEW
Panagiotis Papanagiotou, George Ntaios
Despite several effective strategies of stroke prevention, the stroke epidemic still constitutes the leading cause of permanent disability. The recent series of well-designed, convincingly-positive randomized controlled trials of endovascular thrombectomy in stroke patients with large vessel occlusion launched a paradigm shift and a new era in acute stroke management. The present review provides an overview of the technical aspects of the procedure, discusses patient selection criteria, summarizes the current evidence from randomized trials about its efficacy and safety, and explores its implications in the organization of acute stroke care...
January 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29310519/intranasal-stem-cell-treatment-as-a-novel-therapy-for-subarachnoid-hemorrhage
#17
Cora H Nijboer, Elke Kooijman, Cindy T van Velthoven, Erik Van Tilborg, Ivo A Tiebosch, Niels Eijkelkamp, Rick M Dijkhuizen, Jozef Kesecioglu, Cobi Heijnen
Subarachnoid hemorrhage (SAH) represents a major health problem in Western society due to high mortality and morbidity, and the relative young age of patients. Currently, efficacious therapeutic options are very limited. Mesenchymal stem cell (MSC) administration has been shown to improve functional outcome and lesion size in experimental models of stroke and neonatal hypoxic-ischemic brain injury. Here we studied the therapeutic potential of intranasally administered bone marrow-derived MSCs relatively late post-insult using a rat endovascular puncture model for SAH...
January 8, 2018: Stem Cells and Development
https://www.readbyqxmd.com/read/29305274/combination-of-24-hour-and-7-day-relative-neurological-improvement-strongly-predicts-90-day-functional-outcome-of-endovascular-stroke-therapy
#18
Jie Pu, Huaiming Wang, Mingyi Tu, Wenjie Zi, Yonggang Hao, Dong Yang, Wenhua Liu, Yue Wan, Yu Geng, Min Lin, Ping Jin, Yunyun Xiong, Gelin Xu, Qin Yin, Xinfeng Liu
BACKGROUND AND PURPOSE: Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. METHODS: We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected...
January 3, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29303452/different-learning-curves-between-stent-retrieval-and-a-direct-aspiration-first-pass-technique-for-acute-ischemic-stroke
#19
Hidehisa Nishi, Akira Ishii, Ichiro Nakahara, Shoji Matsumoto, Nobutake Sadamasa, Yasutoshi Kai, Ryota Ishibashi, Michio Yamamoto, Satoshi Morita, Izumi Nagata
OBJECTIVE The clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods. METHODS In each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29303110/-role-of-thrombectomy-in-acute-ischemic-stroke
#20
Albert Pall Sigurdsson
This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources...
January 2018: Læknablađiđ
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