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Endovascular stroke management

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https://www.readbyqxmd.com/read/29770736/carotid-artery-stenosis-screening-where-are-we-now
#1
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/29770118/neuroinflammation-as-a-target-for-intervention-in-subarachnoid-hemorrhage
#2
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/29758322/endovascular-repair-of-an-inadvertent-right-vertebral-artery-rupture-during-dialysis-catheter-insertion
#3
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/29752489/cerebral-venous-thrombosis-state-of-the-art-diagnosis-and-management
#4
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
#5
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
https://www.readbyqxmd.com/read/29749914/endovascular-thrombectomy-can-be-beneficial-to-acute-ischemic-stroke-patients-with-large-infarcts
#6
Shaowei Jiang, Ya Peng, Chao-Hui Jing, Ai-Hua Fei, Hai-Rong Wang, Cheng-Jin Gao, Miao Chen, Yi Li, Shuming Pan
OBJECTIVE This study aimed to assess whether patients with acute ischemic stroke (AIS) and large infarct lesions benefit from reperfusion management. To determine the efficacy of different recanalization managements on AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) < 6, the authors retrospectively analyzed hospitalized patients with AIS. METHODS Eighty-nine patients with AIS and ASPECTS < 6 were screened from 13,285 hospitalized patients treated by thrombolysis, thrombectomy, or conventional care in two stroke medical centers...
May 11, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29744519/mechanical-thrombectomy-a-brief-review-of-a-revolutionary-new-treatment-for-thromboembolic-stroke
#7
REVIEW
Pervinder Bhogal, Tommy Andersson, Volker Maus, Anastasios Mpotsaris, Leonard Yeo
The recent success of endovascular stroke treatment has heralded a new era in the management of acute ischemic stroke (AIS) with significantly improved outcome for patients. A large number of patients may be amenable to this new treatment and as the evidence expands the number of patients eligible for mechanical thrombectomy continues to increase. Recent evidence suggests that the time window for treatment can be extended up to 24 h after symptom onset for patients with anterior circulation strokes; however, many clinicians and medical professionals may not be aware of these recent changes and it is important that they are kept up-to-date with this rapidly evolving treatment...
May 9, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29743683/rivaroxaban-does-not-influence-hemorrhagic-transformation-in-a-diabetes-ischemic-stroke-and-endovascular-thrombectomy-model
#8
Feng-Di Liu, Rong Zhao, Xiao-Yan Feng, Yan-Hui Shi, Yi-Lan Wu, Xiao-Lei Shen, Ge-Fei Li, Yi-Sheng Liu, Ying Zhao, Xin-Wei He, Jia-Wen Yin, Mei-Ting Zhuang, Bing-Qiao Zhao, Jian-Ren Liu
Managing endovascular thrombectomy (ET) in diabetic ischemic stroke (IS) with novel anticoagulants is challenging due to putative risk of intracerebral hemorrhage. The study evaluates increased hemorrhagic transformation (HT) risk in Rivaroxaban-treated diabetic rats post ET. Diabetes was induced in male Sprague-Dawley rats by intraperitoneal injection of 60 mg/kg streptozotocin. After 4-weeks, rats were pretreated orally with 30 mg/kg Rivaroxaban/saline; prothrombin time was monitored. IS and ET was induced after 1 h, by thread-induced transient middle cerebral artery occlusion (tMCAO) that mimicked mechanical ET for proximal MCA occlusion at 60 min...
May 9, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29739912/early-cerebral-vein-after-endovascular-ischemic-stroke-treatment-predicts-symptomatic-reperfusion-hemorrhage
#9
Samuel C D Cartmell, Robyn L Ball, Rajani Kaimal, Nicholas A Telischak, Michael P Marks, Huy M Do, Robert L Dodd, Gregory W Albers, Maarten G Lansberg, Jeremy J Heit
BACKGROUND AND PURPOSE: Parenchymal hemorrhage (PH) after endovascular mechanical thrombectomy in acute ischemic stroke leads to worse outcomes. Better clinical and imaging biomarkers of symptomatic reperfusion PH are needed to identify patients at risk. We identified clinical and imaging predictors of reperfusion PH after endovascular mechanical thrombectomy with attention to early cerebral veins (ECVs) on postreperfusion digital subtraction angiography. METHODS: We performed a retrospective cohort study of consecutive acute ischemic stroke patients undergoing endovascular mechanical thrombectomy at our neurovascular referral center...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29736735/current-endovascular-approach-to-the-management-of-acute-ischemic-stroke
#10
REVIEW
Rakesh Khatri, Anantha R Vellipuram, Alberto Maud, Salvador Cruz-Flores, Gustavo J Rodriguez
PURPOSE OF REVIEW: The review provides an overview of current endovascular management of patients with acute ischemic stroke in the light of recent landmark trials proving unequivocal benefit of the intervention. RECENT FINDINGS: Several randomized trials looking at selective groups of patients presenting after an acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the endovascular treatment compared to intravenous thrombolysis, leading to expedited changes in the American Heart Association/American Stroke Association guidelines...
May 7, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29726291/management-of-acute-tandem-occlusions-stent-retriever-thrombectomy-with-emergency-stenting-or-angioplasty
#11
Wei Li, Zhonglun Chen, Zheng Dai, Rui Liu, Qin Yin, Huaiming Wang, Yonggang Hao, Yunfei Han, Zhongming Qiu, Yunyun Xiong, Wen Sun, Wenjie Zi, Gelin Xu, Xinfeng Liu
Objective To compare outcomes following intracranial stent retriever-based intracranial thrombectomy (SRT) with emergency extracranial internal carotid artery (EICA) stenting or angioplasty alone in patients presenting with acute stroke due to tandem occlusions of the ICA. Methods Consecutive patients with acute anterior tandem occlusion who received an endovascular intervention within 6h of symptom onset between January 2013 and June 2016 were included in this prospective study. Demographic, radiological, procedural and clinical outcome data were compared between the stenting and the angioplasty alone groups...
January 1, 2018: Journal of International Medical Research
https://www.readbyqxmd.com/read/29719555/a-review-of-pre-intervention-prognostic-scores-for-early-prognostication-and-patient-selection-in-endovascular-management-of-large-vessel-occlusion-stroke
#12
REVIEW
Syed Ali Raza, Srikant Rangaraju
Background: Endovascular therapy (ET) has emerged as a highly effective treatment for acute large vessel occlusion stroke (LVOS). Tools that facilitate optimal patient selection of patients for ET are needed in order to maximize therapeutic benefit in a cost-effective manner. Several pre-intervention prognostic scores for prediction of outcomes in LVOS patients and patient selection for ET have been developed and validated, but their clinical use has been limited. Here, we review existing pre-intervention prognostic scores, compare their prognostic accuracies and levels of validation and identify gaps in current knowledge...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29712518/unruptured-aneurysms-in-the-elderly-perioperative-outcomes-and-cost-analysis-of-endovascular-coiling-and-surgical-clipping
#13
Nicole A Silva, Belinda Shao, Michael J Sylvester, Jean Anderson Eloy, Chirag D Gandhi
OBJECTIVE Observation and neurosurgical intervention for unruptured intracranial aneurysms (UIAs) in the elderly population is rapidly increasing. Cerebral aneurysm coiling (CACo) is favored over cerebral aneurysm clipping (CAC) in elderly patients, yet some elderly individuals still undergo CAC. The cost-effectiveness of treating UIAs requires further exploration. Understanding the effect of intervention on hospital charges and length of stay (LOS) as well as perioperative mortality and complications can further shed light on its economic impact...
May 2018: Neurosurgical Focus
https://www.readbyqxmd.com/read/29700047/multicentric-experience-in-distal-to-proximal-revascularization-of-tandem-occlusion-stroke-related-to-internal-carotid-artery-dissection
#14
G Marnat, M Bühlmann, O F Eker, J Gralla, P Machi, U Fischer, C Riquelme, M Arnold, A Bonafé, S Jung, V Costalat, P Mordasini
BACKGROUND AND PURPOSE: Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort. MATERIALS AND METHODS: Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection...
April 26, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29685718/distal-arch-aneurysm-repair-using-left-subclavian-artery-transposition-with-stented-elephant-trunk-in-the-hybrid-repair-era
#15
Rui-Dong Qi, Jun-Ming Zhu, Yong-Min Liu, Lei Chen, Cheng-Nan Li, Xiao-Yan Xing, Nan Zhang, Li-Zhong Sun
BACKGROUND: Hybrid aortic arch repair is an invasive approach to the surgical management of distal aortic arch aneurysm. The complications associated with hybrid aortic arch repair, such as stroke and endoleaks, are not uncommon and late reintervention is frequent. We retrospectively reviewed our experience of distal aortic arch aneurysm repair using the stented elephant trunk procedure with left subclavian artery (LSCA)-left common carotid artery (LCCA) transposition in the hybrid repair era...
March 27, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29682469/conservative-management-versus-endovascular-or-open-surgery-in-the-spectrum-of-type-b-aortic-dissection
#16
Xun Yuan, Andreas Mitsis, Mohammed Ghonem, Ilias Iakovakis, Christoph A Nienaber
Background: Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes...
2018: Journal of visualized surgery
https://www.readbyqxmd.com/read/29666180/thrombectomy-for-acute-ischemic-stroke-in-the-elderly-a-real-world-experience
#17
Ali Alawieh, Arindam Chatterjee, Wuwei Feng, Guilherme Porto, Jan Vargas, Ryan Kellogg, Aquilla S Turk, Raymond D Turner, M Imran Chaudry, Alejandro M Spiotta
INTRODUCTION: Completed randomized trials on endovascular thrombectomy (ET) did not independently assess the efficacy of ET in the elderly (≥80 years old) who were often excluded or under-represented in trials. There were also inconsistent criteria for patient selection in this population across the different trials. This work evaluates outcomes after ET for acute ischemic stroke (AIS) in the elderly at a high volume stroke center. METHODS: We reviewed all cases of AIS that underwent a direct aspiration first pass technique (ADAPT) thrombectomy for large vessel occlusions between March 2013 and October 2017 while comparing outcomes in the elderly with younger counterparts...
April 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29644398/stent-placement-in-patients-with-acute-subarachnoid-haemorrhage-when-is-it-justified
#18
Andrew G Murchison, Victoria Young, Tanja Ddjurdjevic, Martino Cellerini, Rufus Corkill, Wilhelm Küker
PURPOSE: Endovascular stents are widely used for the elective treatment of cerebral aneurysms. Acute stenting is performed in the management of dissections, pseudo-aneurysms, broad-based aneurysms or as a 'bail out' measure after coil migration. The purpose of this study is to review the safety of using stents in acute subarachnoid haemorrhage. METHODS: The stent registry of our institution was reviewed for procedures in patients with acute subarachnoid haemorrhage...
April 11, 2018: Neuroradiology
https://www.readbyqxmd.com/read/29628947/recommendations-for-endovascular-care-of-stroke-patients
#19
Michelle Hill, Brenda A Glenn, Brenda J Reese, Benjamin Morrow
The field of neurointerventional radiology (NIR) therapy, including acute ischemic stroke intervention, endovascular intracranial aneurysm management, and treatment of intra- and extracranial large-vessel disease, has evolved over the past 18 years. To support this specialized advanced care requires nursing standards of care for staff to provide direct patient care in NIR suites and intensive management of this high-risk patient population. The intent of this paper is to provide a complementary document for the Stroke Interventional Laboratory Consensus (SILC) statement that will specifically address the nursing standards of care for patients in an NIR suite...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29622098/diagnosis-and-management-of-acute-ischemic-stroke
#20
REVIEW
Tasneem F Hasan, Alejandro A Rabinstein, Erik H Middlebrooks, Neil Haranhalli, Scott L Silliman, James F Meschia, Rabih G Tawk
Acute ischemic stroke (AIS) is among the leading causes of death and long-term disability. Intravenous tissue plasminogen activator has been the mainstay of acute therapy. Recently, several prospective randomized trials documented the value of endovascular revascularization in selected patients with large-vessel occlusion within the anterior circulation. This finding has led to a paradigm shift in the management of AIS, including wide adoption of noninvasive neuroimaging to assess vessel patency and tissue viability, with the supplemental and independent use of intravenous tissue plasminogen activator to improve clinical outcomes...
April 2018: Mayo Clinic Proceedings
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