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Endovascular stroke management

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https://www.readbyqxmd.com/read/28099563/brazilian-guidelines-for-endovascular-treatment-of-patients-with-acute-ischemic-stroke
#1
Octávio Marques Pontes-Neto, Pedro Cougo, Sheila Cristina Ouriques Martins, Daniel G Abud, Raul G Nogueira, Maramélia Miranda, Luiz Henrique de Castro-Afonso, Leticia C Rebello, José Guilherme M Pereira Caldas, Rodrigo Bazan, Daniel C Bezerra, Marco Tulio Rezende, Gabriel R de Freitas, Alexandre Longo, Pedro Magalhães, João José Freitas de Carvalho, Francisco José Montalverne, Fabricio Oliveira Lima, Gustavo H V Andrade, Ayrton R Massaro, Jamary Oliveira-Filho, Rubens Gagliardi, Gisele Sampaio Silva
These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus...
January 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#2
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28089197/long-term-follow-up-analysis-of-microsurgical-clip-ligation-and-endovascular-coil-embolization-for-dorsal-wall-blister-aneurysms-of-the-internal-carotid-artery
#3
Mason A Brown, Cristian F Guandique, Jonathan Parish, Aubrey C McMillan, Stephen Lehnert, Nassir Mansour, Michael Tu, Bradley N Bohnstedt, Troy D Payner, Thomas J Leipzig, Andrew J DeNardo, John A Scott, Aaron A Cohen-Gadol
: Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15...
January 11, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28059705/emergent-endovascular-management-of-long-segment-and-flow-limiting-carotid-artery-dissections-in-acute-ischemic-stroke-intervention-with-multiple-tandem-stents
#4
S A Ansari, A L Kühn, A R Honarmand, M Khan, M C Hurley, M B Potts, B S Jahromi, A Shaibani, M J Gounis, A K Wakhloo, A S Puri
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4)...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28048545/we-de-207a-04-advances-in-radiological-neuro-endovascular-interventional-imaging
#5
S Rudin
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048454/we-de-207a-00-advances-in-image-guided-neurointerventions-clinical-pull-and-technology-push
#6
Jeffrey Siewerdsen, Rebecca Fahrig
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047800/we-de-207a-01-parallels-in-the-evolution-of-x-ray-angiographic-systems-and-devices-used-for-minimally-invasive-endovascular-therapy
#7
C Strother
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047144/we-de-207a-02-advances-in-cone-beam-ct-anatomical-and-functional-imaging-in-angio-suite-to-enable-one-stop-shop-stroke-imaging-workflow
#8
G Chen
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046482/we-de-207a-03-recent-advances-in-devices-used-in-neuro-interventions
#9
M Gounis
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28045241/evidence-for-and-risks-of-endovascular-treatment-of-asymptomatic-acute-type-b-aortic-dissection
#10
Rachel E Clough, Christoph A Nienaber
Acute aortic dissection is a challenging disease to manage. Type B aortic dissection has traditionally been divided temporally into acute and chronic cases but more recently this classification has been modified to include a sub-acute phase. Computed tomography is the imaging technique used most frequently in diagnosis and management. Active management of blood pressure is essential and should include beta-blockade unless contra-indicated. In-hospital outcomes are generally acceptable in patients with medically managed acute uncomplicated type B aortic dissection, with up to 90% of patients surviving to hospital discharge but by 5-years up to 50% of patients are dead with a significant proportion dying from aortic rupture...
January 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28004633/endovascular-revascularization-of-a-symptomatic-common-carotid-artery-occlusion
#11
Julie Kromm, Tim E Darsaut, Khurshid Khan, Robert Ashforth, Esseddeeg Ghrooda
Although the common carotid artery is the second most common site for extracranial carotid artery stenosis, complete symptomatic occlusion in the absence of devastating stroke is rare. We present a case of complete common carotid artery occlusion failing medical management and requiring endovascular intervention. The clinical presentation, diagnostic investigations, and management of complete carotid artery occlusions are discussed.
January 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/27995806/etiologies-of-internal-carotid-artery-pseudo-occlusions-in-acute-stroke-patients-what-neurointerventionalists-can-expect
#12
Süha Akpınar, Pınar Gelener, Güliz Yilmaz
In cases of acute stroke, differentiation between an occluded and a patent internal carotid artery (ICA) is crucial for diagnosis and management. Although computed tomography angiography (CTA) can be highly accurate in defining high-grade stenosis and ICA occlusions, misleading ICA occlusion patterns are not rare in acute stroke patients. We investigated the underlying causes of ICA pseudo-occlusions with CTA with respect to digital subtraction angiography (DSA). 11 out of 72 patients had pseudo-occlusion on CTA...
December 20, 2016: British Journal of Radiology
https://www.readbyqxmd.com/read/27993454/incidence-of-stroke-following-thoracic-endovascular-aortic-repair-for-descending-aortic-aneurysm-a-systematic-review-of-the-literature-with-meta-analysis
#13
REVIEW
R S von Allmen, B Gahl, J T Powell
OBJECTIVE: Stroke is an increasingly recognised complication following thoracic endovascular aortic repair (TEVAR). The aim of this study was to systematically synthesise the published data on perioperative stroke incidence during TEVAR for patients with descending thoracic aneurysmal disease and to assess the impact of left subclavian artery (LSA) coverage on stroke incidence. METHODS: A systematic review of English and German articles on perioperative (in-hospital or 30 day) stroke incidence following TEVAR for descending aortic aneurysm was performed, including studies with ≥50 cases, using MEDLINE and EMBASE (2005-2015)...
December 16, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27965381/opercular-index-score-a-ct-angiography-based-predictor-of-capillary-robustness-and-neurological-outcomes-in-the-endovascular-management-of-acute-ischemic-stroke
#14
Alexander Copelan, Monzer Chehab, Waleed Brinjikji, Zachary Wilseck, David F Kallmes, Jeffery Wilseck
BACKGROUND: Many CT angiography (CTA) collateral scoring systems are either subjective or complex and time consuming. OBJECTIVE: To evaluate the correlation between a CTA collateral scoring system-the Opercular Index Score (OIS)-with neurological outcomes at 90 days following endovascular treatment for acute ischemic stroke (AIS) secondary to large vessel occlusion. METHODS: Fifty-five patients with AIS due to distal internal carotid artery, M1, or proximal M2 occlusions who underwent endovascular treatment were included...
December 13, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27960179/angioplasty-and-stenting
#15
Thomas W Leung, Ashley M Wabnitz, Zhongrong Miao, Marc I Chimowitz
The high rate of recurrent strokes in patients with intracranial atherosclerotic disease (ICAS) despite medical therapy prompted intracranial angioplasty and/or stenting an adjunctive treatment option. The minute calibers of cerebral arteries, the relative paucity of supporting medial and adventitia layers, the presence of end-anastomosing perforator branches, and the vascular tortuosity from groin to head all demand specialized operative skills and dedicated tools. Since the stroke mechanism of ICAS is diverse, patient selection for endovascular treatment requires a sound understanding of the underlying pathophysiology...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27942770/management-of-unruptured-saccular-aneurysms-of-the-m1%C3%A2-segment-with-flow-diversion-a%C3%A2-single-centre-experience
#16
Pervinder Bhogal, Rosa Martinez, Oliver Gansladt, Hansjörg Bäzner, Hans Henkes, Marta Aguilar
PURPOSE: The optimal strategy for the treatment of M1 segment aneurysms has not yet been determined as both standard microneurosurgical and endovascular techniques can pose challenges. We sought to determine the efficacy of flow diverting stents to treat small, unruptured aneurysms of the M1 segment. METHODS: We retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular aneurysm of the middle cerebral artery (MCA) between February 2009 and February 2016...
December 11, 2016: Clinical Neuroradiology
https://www.readbyqxmd.com/read/27916638/therapeutical-options-in-the-management-of-carotid-dissection
#17
Ombretta Martinelli, Salvatore Venosi, Jamila BenHamida, Alban Malaj, Cristina Belli, Francesco Giosue' Irace, Roberto Gattuso, Giacomo Frati, Bruno Gossetti, Luigi Irace
BACKGROUND: 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 women and 16 men, age range 25-65 years, mean 42) with CAD were included in this study. The internal carotid artery dissection was spontaneous in 32 patients and posttraumatic in the remaining 12 (in 1 case, it was bilateral)...
December 1, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#18
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
#19
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...
February 2017: 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
#20
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
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