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Endovascular and stroke

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https://www.readbyqxmd.com/read/29775605/outcomes-of-planned-2-stage-hybrid-aortic-repair-with-dacron-replaced-proximal-landing-zone
#1
David N Ranney, Babatunde A Yerokun, Ehsan Benrashid, Muath Bishawi, Adam Williams, Richard L McCann, G Chad Hughes
BACKGROUND: Results of hybrid arch repair (HAR) utilizing native zone 0 proximal landing zone (PLZ) have been unsatisfactory in many series, especially in the setting of ascending aortic dilation (>4.0 cm). This study reports early and late outcomes of planned 2-stage HAR with open 1st stage proximal aortic replacement (PAR) followed by 2nd stage thoracic endovascular aortic repair (TEVAR) with PLZ within the Dacron replaced zone 0. METHODS: N=34 patients underwent planned 2-stage HAR between 1/2006-8/2017...
May 15, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29775153/feasibility-safety-and-changes-in-systolic-blood-pressure-associated-with-endovascular-revascularization-of-symptomatic-and-chronically-occluded-cervical-internal-carotid-artery-using-a-newly-suggested-radiographic-classification-of-chronically-occluded-cervical
#2
David Hasan, Mario Zanaty, Robert M Starke, Elias Atallah, Nohra Chalouhi, Pascal Jabbour, Amit Singla, Waldo R Guerrero, Daichi Nakagawa, Edgar A Samaniego, Nnenna Mbabuike, Rabih G Tawk, Adnan H Siddiqui, Elad I Levy, Roberta L Novakovic, Jonathan White, Clemens M Schirmer, Thomas G Brott, Hussain Shallwani, L Nelson Hopkins
OBJECTIVE The overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%-7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA and to assess the changes in systemic blood pressure following successful revascularization. METHODS The radiographic images of 100 consecutive subjects with COICA were analyzed...
May 18, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29774008/repeated-endovascular-treatment-of-early-recurrent-proximal-middle-cerebral-artery-occlusion-case-report-and-brief-review-of-the-literature
#3
Simon Fandler, Hannes Deutschmann, Franz Fazekas, Thomas Gattringer
Mechanical thrombectomy (MT) is the gold standard treatment for large vessel occlusion (LVO) stroke of the anterior circulation. Whether MT can also be effectively and safely performed in early recurrent LVO is largely unclear. We present the case of a middle-aged patient who was successfully treated by MT for right proximal middle cerebral artery (MCA) occlusion with excellent outcome. One day after discharge (9 days after the first MT), the patient was readmitted with wake-up stroke. MRI again revealed right proximal MCA occlusion with severe diffusion-perfusion mismatch...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29773716/thrombectomy-6-24-hours-after-stroke-in-trial-ineligible-patients
#4
Shashvat M Desai, Marcelo Rocha, Bradley J Molyneaux, Matthew Starr, Cynthia L Kenmuir, Bradley A Gross, Brian Thomas Jankowitz, Tudor G Jovin, Ashutosh P Jadhav
BACKGROUND AND PURPOSE: The DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials. METHODS: A retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6-24 hour time window...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29773566/multisociety-consensus-quality-improvement-revised-consensus-statement-for-endovascular-therapy-of-acute-ischemic-stroke-from-the-american-association-of-neurological-surgeons-aans-american-society-of-neuroradiology-asnr-cardiovascular-and-interventional-radiology
#5
https://www.readbyqxmd.com/read/29772576/wake-up-stroke-versus-stroke-with-known-onset-time-clinical-and-multimodality-ct-imaging-characteristics
#6
Jan W Dankbaar, Henri P Bienfait, Coen van den Berg, Edwin Bennink, Alexander D Horsch, Tom van Seeters, Irene C van der Schaaf, L Jaap Kappelle, Birgitta K Velthuis
BACKGROUND: Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. METHODS: All patients were selected from a large prospective cohort study (Dutch acute stroke study)...
May 17, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29770736/carotid-artery-stenosis-screening-where-are-we-now
#7
Rebecca Mortimer, Subramanian Nachiappan, David C Howlett
Stroke poses a significant burden on healthcare and is the second largest cause of death globally. Both medical and surgical interventions to reduce the risk of stroke in asymptomatic patients have been shown to be effective but identifying the target at risk population is more problematic. Screening for carotid artery stenosis offers one pathway for this, as there is some correlation between risk of stroke and extent of stenosis. Identification of patients who are at risk of cardiovascular disease as well as stroke, allows initiation of effective medical treatment of modifiable risk factors to address this risk...
May 17, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29770166/free-radical-damage-in-ischemia-reperfusion-injury-an-obstacle-in-acute-ischemic-stroke-after-revascularization-therapy
#8
REVIEW
Ming-Shuo Sun, Hang Jin, Xin Sun, Shuo Huang, Fu-Liang Zhang, Zhen-Ni Guo, Yi Yang
Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29770118/neuroinflammation-as-a-target-for-intervention-in-subarachnoid-hemorrhage
#9
REVIEW
Airton Leonardo de Oliveira Manoel, R Loch Macdonald
Aneurysmal subarachnoid hemorrhage (SAH) is a sub-type of hemorrhagic stroke associated with the highest rates of mortality and long-term neurological disabilities. Despite the improvement in the management of SAH patients and the reduction in case fatality in the last decades, disability and mortality remain high in this population. Brain injury can occur immediately and in the first days after SAH. This early brain injury can be due to physical effects on the brain such as increased intracranial pressure, herniations, intracerebral, intraventricular hemorrhage, and hydrocephalus...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29769241/multivessel-occlusion-in-patients-subjected-to-thrombectomy-prevalence-associated-factors-and-clinical-implications
#10
Johannes Kaesmacher, Pascal J Mosimann, Mattia Giarrusso, Marwan El-Koussy, Felix Zibold, Eike Piechowiak, Tomas Dobrocky, Raphael Meier, Simon Jung, Sebastian Bellwald, Marcel Arnold, Pasquale Mordasini, Urs Fischer, Jan Gralla
BACKGROUND AND PURPOSE: Patients with embolic large-vessel occlusion may present with additional coincidental acute occlusions within or distant from the involved territory, referred to as multivessel occlusion (MVO). Purpose of this study was to assess prevalence of MVO, associated factors, and clinical relevance in patients undergoing endovascular stroke treatment. METHODS: Image data of consecutive endovascular candidates (n=720) with direct access to angiography were extracted from a prospective registry...
May 16, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29765393/support-of-new-triage-protocol-among-acute-stroke-care-providers
#11
Haitham M Hussein, David C Anderson
Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29764930/closure-of-large-bore-9-f-arterial-puncture-sites-with-the-angioseal-sts-device-in-acute-stroke-patients-after-intravenous-recombinant-tissue-plasminogen-activator-rt-pa
#12
Hendrik Janssen, Monika Killer-Oberpfalzer, Ruediger Lange
PURPOSE: This retrospective analysis was performed to evaluate whether large bore 9 F puncture sites can be safely closed with the 8 F AngioSeal STS device after endovascular stroke procedures in patients who did or did not receive recombinant tissue plasminogen activator (rt-PA). METHODS: Out of 161 consecutive endovascular stroke procedures we identified 72 patients who met the inclusion criteria, of whom 46 received rt-PA before the endovascular procedure and 26 did not...
May 15, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29763889/neutrophil-lymphocyte-ratio-predicts-functional-and-safety-outcomes-after-endovascular-treatment-for-acute-ischemic-stroke
#13
Zhenhui Duan, Huaiming Wang, Zhen Wang, Yonggang Hao, Wenjie Zi, Dong Yang, Zhiming Zhou, Wenhua Liu, Min Lin, Zhonghua Shi, Penghua Lv, Yue Wan, Gelin Xu, Yunyun Xiong, Wusheng Zhu, Xinfeng Liu
BACKGROUND AND OBJECTIVE: Endovascular treatment (EVT) is proven to be safe and effective for treating acute large vessel occlusion stroke (LVOS). The neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, which plays an important role in the process of treating ischemic stroke. This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT. METHODS: Patients were selected from the EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry...
May 15, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29761023/comparing-outcome-and-recanalization-results-in-patients-with-anterior-circulation-stroke-following-endovascular-treatment-with-and-without-a-treatment-with-rt-pa-a-single-center-study
#14
Mohamed Al-Khaled, Toralf Brüning, Carina Gottwald, Florian Roessler, Georg Royl, Thomas Eckey
Objectives: Endovascular treatment (ET), in addition to a therapy with intravenous recombinant tissue plasminogen activator IV rt-PA in patients with acute ischemic stroke, has been found to improve outcome. However, data about ET in patients who have not received therapy with rt-PA due to contraindications for IV rt-PA are sparse. Comparison of ET with IV rt-PA versus ET alone in patients with stroke is done using a proximal intracranial arterial occlusion (internal carotid artery, middle cerebral artery (M1-Segment))...
May 2018: Brain and Behavior
https://www.readbyqxmd.com/read/29758322/endovascular-repair-of-an-inadvertent-right-vertebral-artery-rupture-during-dialysis-catheter-insertion
#15
Kalliopi-Maria Tasopoulou, Christos Argyriou, Michael Mantatzis, Konstantia Kantartzi, Ploumis Passadakis, George S Georgiadis
Central venous (CV) catheterization is not only an invaluable diagnostic modality but also an essential therapeutic tool for the treating physician, enabling rapid and reliable intravenous administration of drugs and fluids, providing venous access to patients undergoing long-term continuous or repeated intravenous treatment such as chemotherapy or it can be used for haemodialysis in patients suffering from acute or chronic renal disease. On the other hand, CV catheterization can lead to a wide range of life-threatening complications for the patient especially if left untreated or become late-diagnosed...
May 11, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29755897/improving-door-to-groin-puncture-time-for-mechanical-thrombectomy-via-iterative-quality-protocol-interventions
#16
Vincent J Cheung, Arvin R Wali, David R Santiago-Dieppa, Robert C Rennert, Michael G Brandel, Jeffrey A Steinberg, Brian R Hirshman, Kevin Porras, Peter Abraham, Julie Jurf, Emily Botts, Scott Olson, J Scott Pannell, Alexander A Khalessi
INTRODUCTION: Delays in door to groin puncture time (DGPT) for patients with ischemic stroke caused by acute large vessel occlusions (LVO) are associated with worse clinical outcomes. We present the results of a quality improvement protocol for endovascular stroke treatment at the University of California, San Diego (UCSD) that aimed to minimize DGPT. MATERIALS AND METHODS: Our stroke team implemented a series of quality improvement measures to decrease DGPT, with a target of 90 minutes or less...
March 10, 2018: Curēus
https://www.readbyqxmd.com/read/29754671/rationale-and-design-for-the-vascular-outcomes-study-of-asa-along-with-rivaroxaban-in-endovascular-or-surgical-limb-revascularization-for-peripheral-artery-disease-voyager-pad
#17
Warren H Capell, Marc P Bonaca, Mark R Nehler, Edmond Chen, John M Kittelson, Sonia S Anand, Scott D Berkowitz, Eike Sebastian Debus, Fabrizio Fanelli, Lloyd Haskell, Manesh R Patel, Rupert Bauersachs, William R Hiatt
BACKGROUND: Patients with peripheral artery disease (PAD) undergoing a lower-extremity revascularization are at heightened risk for ischemic cardiac and limb events. Although intensification of antithrombotic therapy after revascularization has demonstrated benefit in coronary disease populations, this approach has not been well studied or shown consistent benefit in PAD. Recent trial evidence demonstrated that a treatment strategy of rivaroxaban added to background antiplatelet therapy reduced ischemic risk in patients following recent acute coronary syndromes, as well as in patients with stable atherosclerotic vascular disease...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29753622/acute-ischemic-dissection-of-an-s-shaped-carotid-artery-the-one-stop-value-of-using-a-detachable-solitaire-ab-stent
#18
Hongchao Shi, Jiankang Hou, Wanyin Shi, Jianping Gu
This study aimed to evaluate the efficacy and safety of endovascular repair using detachable Solitaire AB stents for acute ischemic dissection of "S"-shaped carotid arteries. From May 2015 to December 2016, a total of 127 patients with acute ischemic stroke (AIS) underwent endovascular treatment in our center. Among them, five AISs were due to acute dissection of an "S"-shaped carotid artery. Coexisting carotid embolism was identified in all five patients, who first underwent successful Solitaire AB stent-based retrieval of the embolism...
May 9, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29752489/cerebral-venous-thrombosis-state-of-the-art-diagnosis-and-management
#19
REVIEW
Adam A Dmytriw, Jin Soo A Song, Eugene Yu, Colin S Poon
PURPOSE: This review article aims to discuss the pathophysiology, clinical presentation, and neuroimaging of cerebral venous thrombosis (CVT). Different approaches for diagnosis of CVT, including CT/CTV, MRI/MRV, and US will be discussed and the reader will become acquainted with imaging findings as well as limitations of each modality. Lastly, this exhibit will review the standard of care for CVT treatment and emerging endovascular options. METHODS: A literature search using PubMed and the MEDLINE subengine was completed using the terms "cerebral venous thrombosis," "stroke," and "imaging...
May 11, 2018: Neuroradiology
https://www.readbyqxmd.com/read/29751188/reversible-cerebral-vasoconstriction-syndrome-as-an-unusual-complication-of-a-dural-arteriovenous-fistula-treated-with-onyx-embolization
#20
Douglas Gonsales, Fabiano das Gracas, Roberta Santos, Pedro Aguilar-Salinas, Ricardo A Hanel
BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare entity with an unknown pathophysiology. RCVS has been reported to occur more frequently in women aged 20 to 50 years. Several mechanisms have been postulated involving transient deregulation of cerebral arterial tone, small vessel endothelial dysfunction, biochemical factors, hormonal deregulation, oxidative stress, and genetic predisposition. All these mechanisms and triggers are related with sympathetic over-activation which eventually produce vasoconstriction...
May 8, 2018: World Neurosurgery
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