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Endovascular stroke management

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https://www.readbyqxmd.com/read/29132938/endovascular-management-of-extracranial-occlusions-at-the-hyperacute-phase-of-stroke-with-tandem-occlusions
#1
Marc-Antoine Labeyrie, Vittorio Civelli, Peggy Reiner, Emmanuel Cognat, Armand Aymard, Annouk Bisdorff, Jean-Pierre Saint-Maurice, Emmanuel 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 10, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/29118801/trends-in-endovascular-treatment-of-aneurysmal-subarachnoid-hemorrhages
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28982494/techniques-for-endovascular-treatment-of-acute-ischemic-stroke
#7
REVIEW
L Pierot, M Gawlitza, S Soize
Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28973661/cerebral-ischemic-reperfusion-injury-following-recanalization-of-large-vessel-occlusions
#8
Fawaz Al-Mufti, Krishna Amuluru, William Roth, Rolla Nuoman, Mohammad El-Ghanem, Philip M Meyers
Although stroke has recently dropped to become the nation's fifth leading cause of mortality, it remains the top leading cause of morbidity and disability in the US. Recent advances in stroke treatment, including intravenous fibrinolysis and mechanical thromboembolectomy, allow treatment of a greater proportion of stroke patients than ever before. While intra-arterial fibrinolysis with recombinant tissue plasminogen is an effective for treatment of a broad range of acute ischemic strokes, endovascular mechanical thromboembolectomy procedures treat severe strokes due to large artery occlusions, often resistant to intravenous drug...
July 11, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28962011/treatment-of-dissecting-distal-vertebral-artery-v4-aneurysms-with-flow-diverters
#9
Jacquelyn A Corley, Ali Zomorodi, L Fernando Gonzalez
BACKGROUND: Dissecting aneurysms of the intracranial vertebral arteries are rare; however, treatment of these presents multiple challenges, including high risk of rebleeding, development of thromboembolic strokes, and progressive partial thrombosis. Flow diverters, such as Pipeline Endovascular Devices (PEDs; Covidien, Medtronic Inc, Dublin, Ireland), have emerged as a potential treatment option. OBJECTIVE: To present our experience with patients treated at our institution with PEDs for dissecting distal vertebral artery (V4 segment) aneurysms...
August 9, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28959488/review-of-acute-ischaemic-stroke-in-pakistan-progress-in-management-and-future-perspectives
#10
REVIEW
Ali Zohair Nomani, Sumaira Nabi, Mazhar Badshah, Shahzad Ahmed
Ischaemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarise facts pertaining to acute ischaemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We reviewed the available literature on stroke from Pakistan and through this article we primarily aim to present the current acute ischaemic stroke management in Pakistan in juxtaposition to that of the developed world...
March 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28947226/outcomes-of-thoracic-endovascular-aortic-repair-in-adult-coarctation-patients
#11
Salim Lala, Salvatore T Scali, Robert J Feezor, Satish Chandrekashar, Kristina A Giles, Javairiah Fatima, Scott A Berceli, Martin R Back, Thomas S Huber, Thomas M Beaver, Adam W Beck
BACKGROUND: Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR. METHODS: All TEVAR patients treated for primary coarctation or late sequelae of previous open repair (eg, pseudoaneurysm, recurrent coarctation or anastomotic stenosis related to index open coarctation repair) were reviewed...
September 22, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28946832/a-multicenter-randomized-controlled-trial-of-endovascular-therapy-following-imaging-evaluation-for-ischemic-stroke-defuse-3
#12
Gregory W Albers, Maarten G Lansberg, Stephanie Kemp, Jenny P Tsai, Phil Lavori, Soren Christensen, Michael Mlynash, Sun Kim, Scott Hamilton, Sharon D Yeatts, Yuko Palesch, Roland Bammer, Joe Broderick, Michael P Marks
Rationale Early reperfusion in patients experiencing acute ischemic stroke is effective in patients with large vessel occlusion. No randomized data are available regarding the safety and efficacy of endovascular therapy beyond 6 h from symptom onset. Aim The aim of the study is to demonstrate that, among patients with large vessel anterior circulation occlusion who have a favorable imaging profile on computed tomography perfusion or magnetic resonance imaging, endovascular therapy with a Food and Drug Administration 510 K-cleared mechanical thrombectomy device reduces the degree of disability three months post stroke...
October 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28946776/complications-and-perioperative-management-of-patients-undergoing-thoracic-endovascular-aortic-repair
#13
Anna P Sattah, Michael H Secrist, Shawn Sarin
Endovascular treatments have become increasingly common for patients with a variety of thoracic aortic pathologies. Although considered less invasive than traditional open surgical approaches, they are nonetheless complex procedures. Patients undergo manipulation of an often calcified aorta near the origin of the carotid and subclavian vessels and have stents placed in a curved vessel adjacent to a perpetually beating heart. These stents can obstruct blood flow to the spinal cord, induce an inflammatory response, and in rare cases erode into the adjacent trachea or esophagus...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28943484/endovascular-chimney-technique-for-aortic-arch-pathologies-treatment-a-systematic-review-and-meta-analysis
#14
REVIEW
Yue Li, Zhongzhou Hu, Jianchang Wang, Yue Zhang, Zhong Chen, Hongchao Zhang
BACKGROUND: Endovascular chimney technique has been increasingly reported in treating aortic arch pathologies. However, there are still concerns about this technique. The aim of this study is to evaluate the safety and outcome of this technique by performing a systematic review and meta-analysis. METHODS: Medline, EMBASE, and Cochrane databases were systematically searched to identify studies on the management of aortic arch pathologies using chimney technique. Studies were reviewed and selected using a priori defined criteria by 2 independent observers who abstracted data on study characteristics, study quality, and outcomes...
September 22, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28931251/managing-arterial-injury-in-endoscopic-skull-base-surgery-case-series-and-review-of-the-literature
#15
Alicia Del Carmen Becerra Romero, Jagath Lal Gangadharan, Evan D Bander, Yves Pierre Gobin, Vijay K Anand, Theodore H Schwartz
BACKGROUND: The most feared complications following endoscopic endonasal skull base surgery are arterial vascular injuries. Previously published literature is restricted to internal carotid artery injuries. The ideal method for controlling arterial bleeding during this kind of procedure is debated, and a variety of techniques have been advocated. OBJECTIVE: To evaluate the management and outcome following intraoperative arterial injury during endoscopic endonasal skull base surgery...
February 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28923278/can-adjunctive-therapies-augment-the-efficacy-of-endovascular-thrombolysis-a-potential-role-for-activated-protein-c
#16
REVIEW
Arun Paul Amar, Abhay P Sagare, Zhen Zhao, Yaoming Wang, Amy R Nelson, John H Griffin, Berislav V Zlokovic
In the management of acute ischemic stroke, vessel recanalization correlates with functional status, mortality, cost, and other outcome measures. Thrombolysis with intravenous tissue plasminogen activator has many limitations that restrict its applicability, but recent advances in the development of mechanical thrombectomy devices as well as improved systems of stroke care have resulted in greater likelihood of vessel revascularization. Nonetheless, there remains substantial discrepancy between rates of recanalization and rates of favorable outcome...
September 18, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28923240/national-survey-on-perioperative-anaesthetic-management-in-the-endovascular-treatment-of-acute-ischaemic-stroke
#17
O Romero Kräuchi, L Valencia, F Iturri, A Mariscal Ortega, A López Gómez, R Valero
OBJECTIVE: To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. MATERIALS AND METHOD: A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. RESULTS: Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72...
September 15, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28902821/-outcomes-of-open-endovascular-operations-on-the-internal-carotid-artery-in-acute-stage-of-ischaemic-stroke
#18
A I Khripun, A D Priamikov, A B Mironkov, I N Tiurin, S A Asratian, V S Suriakhin, O V Simonov, O A Sazhina, V P Mikhaĭlenko
INTRODUCTION: The authors share their experience in diagnosis and treatment of patients with acute ischaemic stroke. PATIENTS AND METHODS: The study included a total of 33 patients. Of these, 20 patients (Study Group) were operated on at terms ranging from 2 to 7 days after onset of acute cerebral circulatory impairment. The Control Group was composed of 13 patients with ischaemic stroke, having refused surgical prevention of recurrent stroke. Both groups were matched by age, gender, level of neurological deficiency and size of cerebral ischaemic foci...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28895447/early-experience-with-endovascular-aneurysm-sealing-in-combination-with-parallel-grafts-for-the-treatment-of-complex-abdominal-aneurysms-the-ascend-registry
#19
Matt Thompson, Marwan Youssef, Rudolf Jacob, Sebastian Zerwes, Michel Reijnen, Piotr Szopinski, Patrick Berg, Grzegorz Oszkinis, Andrew Holden
PURPOSE: To report the results of the ASCEND Registry of cases involving endovascular aneurysm sealing (EVAS) in combination with chimney grafts (chEVAS) for the treatment of para- and juxtarenal aortic aneurysms (AAA). METHODS: A retrospective, multicenter registry established in 8 vascular centers between 2013 and 2016 recorded the treatment results and follow-up of chEVAS procedures for nonruptured AAAs; data were analyzed using standardized outcome measures...
September 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#20
REVIEW
B Kallmünzer, M Köhrmann
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h...
November 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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