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Endovascular and stroke

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https://www.readbyqxmd.com/read/27922251/endovascular-prevention-and-treatment-of-stroke-related-to-extracranial-carotid-artery-disease
#1
Leonardo Rangel-Castilla, Gary B Rajah, Hakeem J Shakir, Jason M Davies, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, L N Hopkins
Acute ischemic stroke (AIS) is the leading cause of premature mortality and morbidity worldwide for both men and women. Extracranial carotid artery stenosis/occlusion is responsible for approximately 11.5%% of ischemic strokes, whereas extracranial large vessel disease comprises roughly 16.6% of ischemic strokes. Carotid artery disease has been the source of significant debate among neurovascular and cardiovascular specialists, as well as vascular surgeons, as to the best method of revascularization, surgical reconstruction versus endovascular recanalization...
December 6, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27921203/treatment-of-uncomplicated-type-b-aortic-dissection
#2
REVIEW
Hitoshi Matsuda
Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter >40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3-6 months after onset...
December 5, 2016: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27916638/therapeutical-options-in-the-management-of-carotid-dissection
#3
Ombretta Martinelli, Salvatore Venosi, Jamila BenHamida, Alban Malay, Cristina Belli, Francesco Giosue' Irace, Roberto Gattuso, Giacomo Frati, Bruno Gossetti, Luigi Irace
OBJECTIVE: The best management of carotid artery dissection (CAD) is still controversial ranging from antiplatelet medication to open surgery or endovascular treatment. In this retrospective study we assessed the safety and efficacy of endovascular stent angioplasty for the treatment of CAD. METHODS: From February 2006 to February 2016, 44 patients (28 females and 16 males, age range 25-65 years, mean 42) with CAD were included in this study. The internal carotid artery (ICA) dissection was spontaneous in origin in 32 patients and post-traumatic in the remaining 12 (1 case it was bilateral)...
December 1, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27909202/prediction-of-blood-brain-barrier-disruption-and-intracerebral-hemorrhagic-infarction-using-arterial-spin-labeling-magnetic-resonance-imaging
#4
Takeya Niibo, Hajime Ohta, Shirou Miyata, Ichiro Ikushima, Kazuchika Yonenaga, Hideo Takeshima
BACKGROUND AND PURPOSE: Arterial spin-labeling magnetic resonance imaging is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke. We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in acute ischemic stroke patients. METHODS: In a retrospective study, arterial spin-labeling was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline magnetic resonance angiography...
December 1, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#5
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906754/management-of-acute-stroke-in-patients-on-oral-anticoagulants
#6
Jan C Purrucker, Thorsten Steiner
PURPOSE OF REVIEW: An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs...
November 30, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27906117/carotid-artery-stenting-versus-no-stenting-assisting-thrombectomy-for-acute-ischaemic-stroke-protocol-for-a-systematic-review-of-randomised-clinical-trials-with-meta-analyses-and-trial-sequential-analyses
#7
Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Gluud, Derk Wolfgang Krieger
BACKGROUND: In patients with intracranial large vessel arterial occlusion, ipsilateral extracranial carotid artery occlusions or near-occlusions pose a significant hurdle in endovascular management of acute ischaemic stroke. Stenting of the carotid lesion may be beneficial in this situation to provide a stable access for introducing catheters through the carotid lesion into the intracranial vasculature and the target occlusion. Furthermore, carotid stenting may ensure ample blood flow for wash-out of clot material and reperfusion of the ischaemic penumbral tissue...
December 1, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27903477/simultaneous-endovascular-repair-for-thoracic-and-abdominal-aortic-pathologies-early-and-mid-term-results
#8
Yuanyuan Guo, Hongbo Cai, Bin Yang, Hui Jin
OBJECTIVES: To analyse information from a single clinical centre, evaluating early and mid-term results of simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) for co-existing thoracic and abdominal aortic pathologies. METHODS: From January 2005 to December 2014, 13 patients (8 men, 5 women; mean age, 75.3 years, range, 69-82 years) with concomitant thoracic and abdominal aortic disease (aneurysms, type B dissection, penetrating aortic ulcers) were treated with simultaneous TEVAR and EVAR...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27899742/acute-endovascular-treatment-delivery-to-ischemic-stroke-patients-transferred-within-a-telestroke-network-a-retrospective-observational-study
#9
Jessica Barlinn, Johannes Gerber, Kristian Barlinn, Lars-Peder Pallesen, Timo Siepmann, Charlotte Zerna, Claudia Wojciechowski, Volker Puetz, Rüdiger von Kummer, Heinz Reichmann, Jennifer Linn, Ulf Bodechtel
BACKGROUND: Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. AIM: We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. METHODS: Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center...
November 29, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27899517/endovascular-management-of-cerebral-septic-embolism-three-recent-cases-and-review-of-the-literature
#10
Eugene L Scharf, Tia Chakraborty, Alejandro Rabinstein, Amrendra S Miranpuri
Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27895297/power-of-an-adaptive-trial-design-for-endovascular-stroke-studies-simulations-using-ims-interventional-management-of-stroke-iii-data
#11
Maarten G Lansberg, Ninad S Bhat, Sharon D Yeatts, Yuko Y Palesch, Joseph P Broderick, Gregory W Albers, Tze L Lai, Philip W Lavori
BACKGROUND AND PURPOSE: Adaptive trial designs that allow enrichment of the study population through subgroup selection can increase the chance of a positive trial when there is a differential treatment effect among patient subgroups. The goal of this study is to illustrate the potential benefit of adaptive subgroup selection in endovascular stroke studies. METHODS: We simulated the performance of a trial design with adaptive subgroup selection and compared it with that of a traditional design...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27895242/availability-of-endovascular-therapies-for-cerebrovascular-disease-at-primary-stroke-centers
#12
Mark J Alberts, Jean Range, William Spencer, Vicki Cantwell, M J Hampel
BACKGROUND: Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. METHODS: We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes...
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27891422/panvascular-disease-in-familial-hypercholesterolaemia-treated-with-endovascular-simultaneous-bilateral-carotid-stenting
#13
Anand Alurkar, Lakshmi Sudha Prasanna Karanam, Shripal Shah, Pandurang Mare
Familial Hypercholesterolaemia (FH) is a monogenic autosomal dominant disorder affecting 1 in 500 individuals. We report a case of 32-year-old female with FH, previously not on any treatment, who presented with recurrent bilateral Middle Cerebral Artery (MCA) territory strokes and dyspnoea on exertion due to severe panvascualar disease involving descending aorta, innominate, subclavian, common carotid, internal carotid and coronary vessels. Her complete clinical work up was done and was started on lipid lowering drug treatment and low calorie diet...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27889285/aberrant-left-vertebral-artery-transposition-and-concomitant-carotid-subclavian-bypass-for-treatment-of-acute-intramural-hematoma-with-thoracic-endovascular-aortic-repair
#14
Sheila N Blumberg, Mark A Adelman, Thomas S Maldonado
Aberrant left vertebral artery (LVA) origin off the aortic arch is an uncommon anatomic variant. Treatment of the thoracic aortic pathology that necessitates its coverage has not been described. We present a patient with an acute intramural hematoma with a dominant LVA originating from the aortic arch. A LVA-to-carotid artery transposition with shunt placement, carotid-to-subclavian bypass, and thoracic endovascular aortic repair were performed. The patient recovered uneventfully, without any evidence of stroke...
November 23, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#15
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27888269/internal-carotid-artery-pseudoaneurysm-and-ischemic-stroke-secondary-to-retropharyngeal-and-parapharyngeal-abscess-a-case-report-and-review-of-the-literature
#16
Michael W Ruff, Deena M Nasr, James P Klaas, Deborah L Renaud
Internal carotid artery pseudoaneurysm is an uncommon complication of retropharyngeal and parapharyngeal abscess in children. Treatment of the pseudoaneurysm has evolved in recent years from surgical ligation to endovascular techniques. Neurologic sequelae most commonly consist of Horner's syndrome with cerebral ischemia being uncommon. The clinical course of a 2-year-old boy with retropharyngeal abscess complicated by internal carotid artery pseudoaneurysm, is described and the literature is reviewed. A conventional angiogram confirmed the presence of a large pseudoaneurysm with no anterograde flow distal to the pseudoaneurysm and substantial collateral flow across the circle of Willis, with filling of the left anterior and middle cerebral arteries via the anterior and posterior communicating arteries...
November 25, 2016: Journal of Child Neurology
https://www.readbyqxmd.com/read/27876658/stenting-for-carotid-web-a-case-report
#17
R Martínez-Pérez, S P Lownie, S Pandey, M R Boulton
BACKGROUND: The carotid web is an intraluminal shelf-like projection arising from the posterior wall of the carotid bifurcation, and is an uncommon etiology of ischemic strokes. Our objective is to describe the feasibility of endovascular stenting to treat this condition CASE REPORT: In a 47-year-old female with a sudden occlusion of her right middle cerebral artery. CT angiogram and digital subtraction angiography showed the presence of a carotid web in the ipsilateral carotid bifurcation...
November 19, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27876083/two-year-clinical-follow-up-of-the-multicenter-randomized-clinical-trial-of-endovascular-treatment-for-acute-ischemic-stroke-in-the-netherlands-mr-clean-design-and-statistical-analysis-plan-of-the-extended-follow-up-study
#18
Lucie A van den Berg, Marcel G W Dijkgraaf, Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Hester Lingsma, Charles B M Majoie, Diederik W J Dippel, Aad J van der Lugt, Robert J van Oostenbrugge, Wim H van Zwam, Yvo B W E M Roos
BACKGROUND: MR CLEAN was the first randomized trial to demonstrate the short-term clinical effectiveness of endovascular treatment in patients with acute ischemic stroke caused by large vessel occlusion in the anterior circulation. Several other trials confirmed that endovascular treatment improves clinical outcome at three months. However, limited data are available on long-term clinical outcome. We aimed to estimate the effect of endovascular treatment on functional outcome at two-year follow-up in patients with acute ischemic stroke...
November 22, 2016: Trials
https://www.readbyqxmd.com/read/27871458/eligibility-for-mechanical-thrombectomy-in-acute-ischemic-stroke-a-phase-iv-multi-center-screening-log-registry
#19
Georgios Tsivgoulis, Nitin Goyal, Robert Mikulik, Vijay K Sharma, Aristeidis H Katsanos, Ramin Zand, Prakash R Paliwal, Andromachi Roussopoulou, Ondrej Volny, Abhi Pandhi, Christina Zompola, Lucas Elijovich, Apostolos Safouris, Jason Chang, Andrei V Alexandrov, Anne W Alexandrov
No eligibility screening logs were kept in recent mechanical thrombectomy (MT) RCTs establishing safety and efficacy of endovascular reperfusion therapies for acute ischemic stroke (AIS). We sought to evaluate the potential eligibility for MT among consecutive AIS patients in a prospective international multicenter study. We prospectively evaluated consecutive AIS patients admitted in four tertiary-care stroke centers during a twelve-month period. Potential eligibility for MT was evaluated using inclusion criteria from MR CLEAN & REVASCAT...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27859971/frequency-and-outcome-of-total-anterior-circulation-strokes-without-intracranial-large-vessel-occlusion
#20
E Giralt-Steinhauer, A Ois, S Abilleira, X Urra, P Cardona-Portela, M Gomis, M Castellanos, C Molina, J Martí-Fàbregas, A Pellisé, D Cànovas, M Gómez-Choco, J Kuprinski, D Cocho, J Roquer
BACKGROUND AND PURPOSE: The percentage of patients with clinical total anterior circulation infarct (TACI) syndrome treated with reperfusion therapies in the absence of intracranial large-vessel occlusion (ILVO) was determined and their characteristics and outcome are described. METHODS: Data from a population-based, prospective, externally audited registry of all stroke patients treated with intravenous thrombolysis (IVT) and endovascular therapies in Catalonia from January 2011 to December 2013 were used...
November 10, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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