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Endovascular stroke management

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https://www.readbyqxmd.com/read/29338750/reperfusion-therapy-in-acute-ischemic-stroke-dawn-of-a-new-era
#1
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/29311286/endovascular-thrombectomy-in-acute-ischemic-stroke
#2
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/29296623/clarion-call-for-histopathological-clot-analysis-in-cryptogenic-ischemic-stroke-implications-for-diagnosis-and-treatment
#3
Sonu Bhaskar, Dennis Cordato, Cecilia Cappelen-Smith, Andrew Cheung, David Ledingham, David Celermajer, Christopher Levi
Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging...
December 2017: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/29288058/a-propensity-matched-comparison-for-open-and-endovascular-treatment-of-post-carotid-endarterectomy-restenosis
#4
Walter Dorigo, Aaron Fargion, Elena Giacomelli, Raffaele Pulli, Fabrizio Masciello, Sara Speziali, Giovanni Pratesi, Carlo Pratesi
OBJECTIVES: To compare results of open and endovascular management of post-carotid endarterectomy (CEA) restenosis. METHODS: This was a retrospective single centre matched case control study. From 2005 to 2015, 148 consecutive interventions for post-CEA restenosis were performed: 80 cases received carotid artery stenting (CAS) and 68 cases received redo CEA. Propensity score based matching was performed in a 1:1 ratio to compare outcomes. Coronary artery disease, degree of the carotid restenosis, timing of the re-intervention with respect to the primary intervention (greater or less than 24 months) and the presence of ipsilateral brain lesions were the covariates included in the matching...
December 26, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29279801/technical-factors-affecting-outcomes-following-endovascular-treatment-of-posterior-circulation-atherosclerotic-lesions
#5
Matthew D Alexander, Jeffrey M Rebhun, Steven W Hetts, Matthew R Amans, Fabio Settecase, Robert J Darflinger, Christopher F Dowd, Van V Halbach, Randall T Higashida, Daniel L Cooke
Background: Atherosclerotic disease of the vertebrobasilar system causes significant morbidity and mortality. All lesions require aggressive medical management, but the role of endovascular interventions remains unsettled. This study examines such endovascular interventions for vertebrobasilar atherosclerosis. Methods: Retrospective review was performed of prospectively maintained procedure logs at three hospitals with comprehensive neurointerventional services...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/29262429/blood-pressure-management-for-acute-ischemic-and-hemorrhagic-stroke-the-evidence
#6
Sang-Bae Ko, Byung-Woo Yoon
Hypertension is the most common modifiable risk factor for stroke (both ischemic and hemorrhagic types). In the hyperacute phase, a majority of patients shows an elevated blood pressure (BP) at the time of presentation because of sympathetic hyperactivity or a physiological response to tissue ischemia. Therefore, BP may decrease spontaneously in a few hours and may drop further when complete recanalization is achieved. In stroke guidelines, an elevated BP is usually left untreated up to a systolic BP (SBP) of 220 mm Hg and a diastolic BP of 120 mm Hg...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29239686/recurrent-posterior-circulation-infarcts-secondary-to-vertebral-artery-external-compression-treated-with-endovascular-deconstruction
#7
Aldo Fabrizio Berti, Atif Zafar, Asad Ikram, Christopher S Calder, Danielle Eckart Sorte
When multiple, recurrent infarcts occur in spite of maximal medical management, the level of suspicion for atypical vascular injury should be heightened. We present a case of a patient who presented with recurrent posterior circulation infarcts despite optimized medical management. On imaging, he was found to have external anatomical vertebral artery muscular and/or osseous compression leading to repetitive vascular injury and strokes. Recurrent intimal injury and vertebral artery to intracranial emboli despite anticoagulation and subsequent dual antiplatelet therapy necessitated definitive operative management...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29205798/carotid-cavernous-fistula-after-endovascular-intervention-for-chronic-carotid-artery-total-occlusion
#8
Chih-Fan Yeh, Yin-Hsien Chen, Mao-Shin Lin, Ching-Chang Huang, Chi-Sheng Hung, Shih-Wei Meng, Chih-Kuo Lee, Hsien-Li Kao
BACKGROUND AND PURPOSE: In addition to head trauma and cranial surgery, endovascular intervention for chronic carotid artery occlusion (CAO) may also result in carotid-cavernous fistula (CCF). The management and prognosis of iatrogenic CCF during CAO recanalization have never been well described and discussed in the literature. MATERIALS AND METHODS: We conducted a retrospective analysis for CAO recanalization attempts in National Taiwan University Hospital and affiliated hospitals...
December 4, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29191528/web-vessels-literature-review-and-neurointerventional-management
#9
Benedito J A Pereira, Ulysses Caus Batista, Renato Tavares Tosello, Igor Neia Ströher, Alex Machado Baeta, Ronie Leo Piske
OBJECTIVE: The aim of this study was to describe 27 patients with 32 web vessels (WVs) from our practice and provide a review of the literature regarding imaging diagnostics, clinical presentation, and treatment of WVs. METHODS: A MEDLINE search was performed using combinations of the following terms: "stroke in young adults," "web," "recurrent stroke," "diaphragm-like," "atypical fibromuscular hyperplasia," "atypical fibromuscular dysplasia," "septal fibromuscular dysplasia," "septa," "diaphragms," "pseudovalvular folds," and "carotid diaphragm...
November 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29176326/high-systolic-blood-pressure-after-successful-endovascular-treatment-affects-early-functional-outcome-in-acute-ischemic-stroke
#10
Ilko L Maier, Ioannis Tsogkas, Daniel Behme, Mathias Bähr, Michael Knauth, Marios-Nikos Psychogios, Jan Liman
BACKGROUND: Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence-based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization. The purpose of this study was to determine the role of blood pressure measurements as a predictor for early functional outcome in patients with successful EVT...
November 24, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29174232/endovascular-mechanical-thrombectomy-in-large-vessel-occlusion-ischemic-stroke-presenting-with-low-nihss-a-systematic-review-and-meta-analysis
#11
REVIEW
Christoph J Griessenauer, Caroline Medin, Julian Maingard, Ronil V Chandra, Wyatt Ng, Duncan Mark Brooks, Hamed Asadi, Monika Killer-Oberpfalzer, Clemens M Schirmer, Justin M Moore, Christopher S Ogilvy, Ajith J Thomas, Kevin Phan
INTRODUCTION: Mechanical thrombectomy has become the standard of care for management of most large vessel occlusion (LVO) strokes. When patients with LVO present with minor stroke symptomatology, no consensus on the role of mechanical thrombectomy exists. METHODS: A systematic review and meta-analysis was performed to identify studies that focused on mechanical thrombectomy, either as a standalone treatment or with intravenous tissue plasminogen activator (IV tPA), in patients with mild strokes with LVO, defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score ≤5 at presentation...
November 23, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29171362/complications-of-endovascular-treatment-for-acute-ischemic-stroke-prevention-and-management
#12
Joyce S Balami, Philip M White, Peter J McMeekin, Gary A Ford, Alastair M Buchan
Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29155470/safety-and-effectiveness-of-endovascular-embolization-or-stent-graft-reconstruction-for-treatment-of-acute-carotid-blowout-syndrome-in-patients-with-head-and-neck-cancer-case-series-and-systematic-review-of-observational-studies
#13
Daniel J Y Wong, Christopher Donaldson, Leon T Lai, Andrew Coleman, Charles Giddings, Lee-Anne Slater, Ronil V Chandra
BACKGROUND: Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. METHODS: A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques...
November 20, 2017: Head & Neck
https://www.readbyqxmd.com/read/29153441/complex-endovascular-repair-of-postdissection-arch-and-thoracoabdominal-aneurysms
#14
Rafaëlle Spear, Adrien Hertault, Katrien Van Calster, Nicla Settembre, Matthieu Delloye, Richard Azzaoui, Jonathan Sobocinski, Dominique Fabre, Mark Tyrrell, Stéphan Haulon
OBJECTIVE: We report our experience of the treatment of postdissection arch aneurysms and thoracoabdominal aortic aneurysms (TAAAs) by endovascular repair using fenestrated and branched endografts. METHODS: This study includes all patients presenting with chronic postdissection aneurysms >55 mm in diameter deemed unfit for open surgery and treated by complex endografting between October 2011 and April 2017. Where appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration, and tear enlargement were performed before the complex endovascular repair...
November 15, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29132938/endovascular-management-of-extracranial-occlusions-at-the-hyperacute-phase-of-stroke-with-tandem-occlusions
#15
M-A Labeyrie, V Civelli, P Reiner, E Cognat, A Aymard, A Bisdorff, J-P Saint-Maurice, E Houdart
BACKGROUND AND PURPOSE: The management of cervical artery occlusions in hyperacute stroke with tandem cervical/intracranial occlusions has not yet become standardized, especially when the circle of Willis is effective. METHODS: We retrospectively analyzed the safety and accuracy of current approaches to manage the cervical occlusion in consecutive patients with tandem occlusions addressed for intracranial mechanical thrombectomy (MT) in our department from January 2012 to May 2017...
November 11, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/29118801/trends-in-endovascular-treatment-of-aneurysmal-subarachnoid-hemorrhages
#16
Tapan Mehta, Neil Datta, Smit Patel, Kathan Mehta, Mohammed Hussain, Inaam Kureshi, Martin Ollenschleger, Amre Nouh
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes; 30-day mortality is as high as 40%. We sought to evaluate outcomes of aSAH patients treated 2004-2014 by endovascular therapy (EVT), to demonstrate associated trends, and to evaluate angioplasty use for aSAH-related cerebral vasospasm. Methods: The Nationwide Inpatient Sample (NIS) database 2004-2014 was used to derive a study cohort using ICD-9 codes. Survey procedures were used to adjust for stratified cluster design of NIS...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29062225/short-vs-prolonged-dual-antiplatelet-treatment-upon-endovascular-stenting-of-peripheral-arteries
#17
Mariya Kronlage, Maximilian Wassmann, Britta Vogel, Oliver J Müller, Erwin Blessing, Hugo Katus, Christian Erbel
INTRODUCTION: Peripheral artery disease (PAD) is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT) upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known. METHODS: In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/29059119/early-management-of-acute-cerebrovascular-accident
#18
Jody Manners, Alexis Steinberg, Lori Shutter
PURPOSE OF REVIEW: Stroke is common and often presents as a neurologic emergency that requires rapid evaluation and treatment to minimize debilitation. Recent advances in therapy expanded time windows for intra-arterial thrombectomy in ischemic stroke, and surgical interventions for clot evacuation in large intracranial hemorrhage have recently proven feasible. This review discusses recent data regarding new therapeutic options in both ischemic and hemorrhagic stroke, notably in scenarios in which therapy was previously limited to supportive care...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29021311/acute-ischemic-stroke-with-tandem-lesions-technical-endovascular-management-and-clinical-outcomes-from-the-escape-trial
#19
Zarina Assis, Bijoy K Menon, Mayank Goyal, Andrew M Demchuk, Jai Shankar, Jeremy L Rempel, Daniel Roy, Alexander Y Poppe, Victor Yang, Cheemun Lum, Dar Dowlatshahi, John Thornton, Hana Choe, Paul A Burns, Donald F Frei, Blaise W Baxter, Michael D Hill
BACKGROUND: Tandem occlusions of the extracranial carotid and intracranial carotid or middle cerebral artery have a particularly poor prognosis without treatment. Several management strategies have been used with no clear consensus recommendations. We examined subjects with tandem occlusions enrolled in the ESCAPE trial and their outcomes. METHODS: Data are from the ESCAPE trial. Additional data were sought on interventions for each subject. RESULTS: There were 54 (17%) subjects with tandem extracranial and intracranial occlusions...
October 11, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28987436/ischemic-stroke-advances-in-diagnosis-and-management
#20
REVIEW
Courtney R Cassella, Andy Jagoda
Acute ischemic stroke carries the risk of morbidity and mortality. Since the advent of intravenous thrombolysis, there have been improvements in stroke care and functional outcomes. Studies of populations once excluded from thrombolysis have begun to elucidate candidates who might benefit and thus should be engaged in the process of shared decision-making. Imaging is evolving to better target the ischemic penumbra salvageable with prompt reperfusion. Availability and use of computed tomography angiography identifies large-vessel occlusions, and new-generation endovascular therapy devices are improving outcomes in these patients...
November 2017: Emergency Medicine Clinics of North America
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