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Endovascular and stroke

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https://www.readbyqxmd.com/read/28536177/interfacility-transfer-directly-to-the-neuroangiography-suite-in-acute-ischemic-stroke-patients-undergoing-thrombectomy
#1
Ashutosh P Jadhav, Cynthia L Kenmuir, Amin Aghaebrahim, Kaustubh Limaye, Lawrence R Wechsler, Maxim D Hammer, Matthew T Starr, Bradley J Molyneaux, Marcelo Rocha, Francis X Guyette, Christian Martin-Gill, Andrew F Ducruet, Bradley A Gross, Brian T Jankowitz, Tudor G Jovin
BACKGROUND AND PURPOSE: In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times. METHODS: We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV)...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#2
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28533448/correction-to-predictors-of-the-aspiration-component-success-of-a-direct-aspiration-first-pass-technique-adapt-for-the-endovascular-treatment-of-stroke-reperfusion-strategy-in-anterior-circulation-acute-stroke
#3
https://www.readbyqxmd.com/read/28532498/the-golden-hour-of-acute-ischemic-stroke
#4
Rajiv Advani, Halvor Naess, Martin W Kurz
BACKGROUND: Acute Ischemic Stroke (AIS) treatment has been revolutionised in the last two decades with the increasing use of Intravenous Thrombolysis (IVT) and with the advent of Endovascular therapy (EVT). AIS treatment and outcome are time dependant and time saving measures are being implemented at every step of the treatment chain. These changes have resulted in lower treatment times in-hospital, but it is unclear if this translates into more patients being treated within 60 min of symptom onset - the Golden Hour...
May 22, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28531910/extracranial-carotid-disease-and-effect-of-intra-arterial-treatment-in-patients-with-proximal-anterior-circulation-stroke-in-mr-clean
#5
Olvert A Berkhemer, Jordi Borst, Manon Kappelhof, Albert J Yoo, Lucie A van den Berg, Puck S S Fransen, Debbie Beumer, Wouter J Schonewille, Paul J Nederkoorn, Marieke J H Wermer, Henk A Marquering, Hester F Lingsma, Yvo B W E M Roos, Robert J van Oostenbrugge, Diederik W J Dippel, Wim H van Zwam, Charles B L M Majoie, Bart J Emmer, Aad van der Lugt
Background: The presence of extracranial carotid disease (ECD) is associated with less favorable clinical outcomes a in patients with acute ischemic stroke caused by intracranial proximal occlusion. Acute intra-arterial treatment (IAT) in the setting of extracranial and intracranial lesions is considered challenging, and whether it yields improved outcomes remains uncertain. Objective: To examine whether the presence of ECD modified the effect of IAT for intracranial proximal anterior circulation occlusion...
May 23, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28527930/outcomes-of-open-and-endovascular-lower-extremity-revascularization-in-active-smokers-with-advanced-peripheral-arterial-disease
#6
Samuel L Chen, Matthew D Whealon, Nii-Kabu Kabutey, Isabella J Kuo, Michael D Sgroi, Roy M Fujitani
OBJECTIVE: Concern over perioperative and long-term durability of lower extremity revascularizations among active smokers is a frequent deterrent for vascular surgeons to perform elective lower extremity revascularization. In this study, we examined perioperative outcomes of lower extremity endovascular (LEE) revascularization and open lower extremity bypass (LEB) in active smokers with intermittent claudication (IC) and critical limb ischemia (CLI). METHODS: Active smokers undergoing LEE or LEB from 2011 to 2014 were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted vascular data set...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28527926/initial-and-midterm-results-of-the-bolton-relay-thoracic-aortic-endovascular-pivotal-trial
#7
Mark A Farber, W Anthony Lee, Wilson Y Szeto, Jean M Panneton, Christopher J Kwolek
OBJECTIVE: To report the initial and midterm results of the Bolton Relay Thoracic Stent Graft for the endovascular treatment of thoracic aortic lesions [thoracic endovascular aortic repair (TEVAR)]. METHODS: The Bolton Relay Thoracic Aortic Endovascular Pivotal Trial was a prospective, nonrandomized, multicenter, U.S. Investigational Device Exemption study conducted at 27 U.S. investigational sites. One hundred twenty TEVAR subjects were treated with the Relay device between January 2007 and May 2010, with 13 patients enrolled during the continued access phase through September 2012...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28524799/-y-stent-retriever-a-new-rescue-technique-for-refractory-large-vessel-occlusions
#8
Roberto Crosa, Alejandro M Spiotta, Matías Negrotto, Alejandra Jaume, Walter Casagrande
Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks...
May 19, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28522637/general-anesthesia-versus-conscious-sedation-for-endovascular-treatment-of-acute-ischemic-stroke-the-anstroke-trial-anesthesia-during-stroke
#9
Pia Löwhagen Hendén, Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, Sven-Erik Ricksten
BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28520657/ct-based-techniques-for-brain-perfusion
#10
Pradeep Krishnan, Amanda Murphy, Richard I Aviv
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology...
June 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28514469/association-of-very-low-volume-practice-with-vascular-surgery-outcomes-in-new-york
#11
Jialin Mao, Philip Goodney, Jack Cronenwett, Art Sedrakyan
Importance: Little research has focused on very low-volume surgery, especially in the context of decreasing vascular surgery volume with the adoption of endovascular procedures. Objective: To investigate the existence and outcomes of open abdominal aortic aneurysm repair (OAR) and carotid endarterectomy (CEA) performed by very low-volume surgeons in New York. Design, Settings, and Participants: This cohort study examined inpatient data of patients undergoing elective OAR or CEA from 2000 to 2014 from all New York hospitals...
May 17, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28511155/-the-role-of-inflammatory-biomarkers-in-cardiovascular-risk-stratification
#12
Світлана Г Пузік
INTRODUCTION: The increase in cardiovascular diseases requires the search for ways to predict complications based on research additional to traditional risk factors, conduct a study of the formation mechanisms of these complications and to design new treatment strategies. AIM: To get an idea about the relationship between inflammation in the blood vessels, atherosclerosis and cardiovascular consequences based on the study of the role of biomarkers of inflammation...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/28508117/single-center-experience-using-the-3max-reperfusion-catheter-for-the-treatment-of-acute-ischemic-stroke-with-distal-arterial-occlusions
#13
Kévin Premat, Bruno Bartolini, Flore Baronnet-Chauvet, Eimad Shotar, Vincent Degos, Paul Muresan, Federico Di Maria, Joseph Gabrieli, Charlotte Rosso, Silvia Pistocchi, Jacques Chiras, Nader Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3...
May 15, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28507269/randomized-multicenter-trial-of-artss-2-argatroban-with-recombinant-tissue-plasminogen-activator-for-acute-stroke
#14
Andrew D Barreto, Gary A Ford, Loren Shen, Claudia Pedroza, Jon Tyson, Chunyan Cai, Mohammad H Rahbar, James C Grotta
BACKGROUND AND PURPOSE: We conducted a randomized exploratory study to assess safety and the probability of a favorable outcome with adjunctive argatroban, a direct thrombin-inhibitor, administered to recombinant tissue-type plasminogen activator (r-tPA)-treated ischemic stroke patients. METHODS: Patients treated with standard-dose r-tPA, not receiving endovascular therapy, were randomized to receive no argatroban or argatroban (100 μg/kg bolus) followed by infusion of either 1 (low dose) or 3 μg/kg per minute (high dose) for 48 hours...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28506476/adherence-to-lipid-management-guidelines-is-associated-with-lower-mortality-and-major-adverse-limb-events-in-patients-undergoing-revascularization-for-chronic-limb-threatening-ischemia
#15
Thomas F X O'Donnell, Sarah E Deery, Jeremy D Darling, Katie E Shean, Murray A Mittleman, Gabrielle N Yee, Matthew R Dernbach, Marc L Schermerhorn
OBJECTIVE: The 2013 American College of Cardiology/American Heart Association lipid management guidelines recommend high-intensity statins for all patients ≤75 years old with chronic limb-threatening ischemia (CLTI) and moderate-intensity statins for CLTI patients >75 years old without contraindications or on dialysis, but these recommendations are based primarily on coronary and stroke data. We aimed to validate these guidelines in patients with CLTI and to assess current adherence to these recommendations...
May 12, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28503386/mechanical-thrombectomy-for-acute-ischemic-stroke-after-cardiac-surgery
#16
Ali S Haider, Prabhat Garg, Ian T Watson, Dean Leonard, Umair Khan, Ahmed Haque, Phu Nguyen, Kennith F Layton
Ischemic stroke is a rare yet devastating complication that may occur following cardiothoracic surgery. Fibrinolytic treatment is contraindicated due to elevated risk for hemorrhage. Mechanical thrombectomy entails a catheterized approach wherein the thrombus is physically removed from the vessel without the use of fibrinolytics, minimizing the possibility of intracranial hemorrhage. Here, we present two original cases of mechanical thrombectomy as treatment for patients experiencing emergent large vessel occlusion following cardiothoracic surgery...
April 11, 2017: Curēus
https://www.readbyqxmd.com/read/28502847/the-role-for-cardiologists-in-stroke-intervention
#17
REVIEW
Richard R Heuser
Even though cardiovascular disease (CVD) is still the leading cause of death in the United States, stroke is the second leading of global cause of death behind CVD . In the 21st Century, less than 40% of overall stroke patients are discharged to home and almost 25% of Medicare beneficiaries do not survive 90days. In spite of the fact that tissue plasminogen activator (TPA) has been approved for stroke care for 20years, only .75% of annual strokes are actually treated with intravenous (IV) TPA. Similar to how interventional cardiologists evolved from IV to catheter mechanical treatment for acute myocardial infarctions (AMI) over 30years ago, over the last few years, neurointerventionists now perform endovascular stroke therapy in many of these patients using stent retrievers...
May 11, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28502542/contemporary-evaluation-of-mortality-and-stroke-risk-after-thoracic-endovascular-aortic-repair
#18
Frances Y Hu, Zachary B Fang, Bradley G Leshnower, Yazan Duwayri, William D Jordan, Theresa W Gillespie, Ravi K Veeraswamy
OBJECTIVE: During the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologic processes. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary data set have yet to be reported. Previous studies have shown periprocedural mortality rates between 1.5% and 9.5% and procedure-related stroke rates of 2.3% to 8.2%. With advances in device engineering and increased experience of physicians, we hypothesized that the rates of these complications would be reduced in a more recent sample set...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28501656/perioperative-outcomes-of-open-versus-endovascular-repair-for-ruptured-thoracoabdominal-aneurysms
#19
Satinderjit S Locham, Joshua C Grimm, Isibor J Arhuidese, Besma Nejim, Tammam Obeid, James H Black, Mahmoud B Malas
OBJECTIVES: Open aneurysm repair (OAR) remains the gold standard for treating ruptured thoracoabdominal-aortic-aneurysms (TAAA). The aim of our study is to compare the 30-day post-operative outcomes among patients with ruptured TAAA undergoing OAR versus endovascular aneurysm repair. METHODS: Using the NSQIP database (2006-2015), we identified patients who underwent OAR and endovascular repair for a ruptured TAAA. Postoperative outcomes of interest included: mortality, renal failure, stroke, and cardiopulmonary complications...
May 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28498970/results-of-a-multimodal-approach-for-the-management-of-aortic-coarctation-and-its-complications-in-adults
#20
Pierre-Emmanuel Noly, Valéry Legris-Falardeau, Reda Ibrahim, Ismaïl El-Hamamsy, Raymond Cartier, Yoan Lamarche, Denis Bouchard, Jean-François Dorval, Nancy Poirier, Philippe Demers
OBJECTIVES: We aimed to assess the results of various tailored management strategies for adults with coarctation in our centre. METHODS: : We reviewed all adults patients treated for aortic caorctation between January 2000 and December 2015 in our institution. The primary end point was a composite of death, perioperative stroke, paraplegia, need for unplanned reoperation or occurrence of pseudoaneurysm during the follow-up. The mean follow-up was 82 ± 5 months...
May 11, 2017: Interactive Cardiovascular and Thoracic Surgery
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