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Large vessel occlusion

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https://www.readbyqxmd.com/read/28727192/current-evidence-for-endovascular-therapy-in-stroke-and-remaining-uncertainties-r1
#1
REVIEW
Ronan Motyer, Hamed Asadi, John Thornton, Patrick Nicholson, Hong Kuan Kok
Class 1 level A evidence now supports endovascular thrombectomy as best practice in the management of large vessel occlusion acute ischemic stroke. However, significant questions pertaining to initial imaging, radiological assessment, patient selection and therapeutic limits remain unanswered. A specific cohort of patients who benefit from endovascular thrombectomy has been established, although current uncertainties regarding selection of those not meeting top-tier evidence criteria may potentially deny certain patients the benefit of intervention...
July 20, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28723732/role-of-anesthesia-in-endovascular-stroke-therapy
#2
Arthur Wang, Apolonia E Abramowicz
PURPOSE OF REVIEW: Recent randomized clinical trials have demonstrated strong efficacy of endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions; in the USA alone, tens of thousands of patients annually may benefit. The impact of the type of anesthesia used during mechanical thrombectomy on patient outcomes remains controversial. This review discusses the current literature on the effects of anesthesia type on patient outcome following endovascular stroke therapy...
July 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28723284/balloon-guide-catheter-in-large-vessel-occlusion-stroke-therapy
#3
Thanh N Nguyen, Osama O Zaidat
No abstract text is available yet for this article.
August 2017: Radiology
https://www.readbyqxmd.com/read/28721509/maintaining-patency-of-vascular-access-for-haemodialysis
#4
Nicholas Inston, J Al Shakarchi, A Khawaja, R Jones
All types of vascular access, a necessity for haemodialysis, are prone to thrombosis and if untreated this results in failure. Thrombosis results from the combination of impaired blood flow, endothelial and vessel wall injury and a propensity towards pro-coagulative states, either intrinsic or aggravated by dialysis or dehydration. The treatment of access thrombosis relies on removal of the clot (thrombectomy) and treatment of the underlying problem. In most cases this is stenosis secondary to neointimal hyperplasia which can occur early (failure to mature) or later...
July 18, 2017: Cardiovascular Engineering and Technology
https://www.readbyqxmd.com/read/28721323/endovascular-management-of-stroke-patients-with-large-vessel-occlusion-and-minor-stroke-symptoms
#5
REVIEW
Saeed A Alqahtani, Andrew B Stemer, Michael F McCullough, Randy S Bell, Jeffrey Mai, Ai-Hsi Liu, Rocco A Armonda
Endovascular mechanical thrombectomy for stroke patients with large vessel occlusion (LVO) in the anterior circulation has become the standard of care based on several major randomized clinical trials. The successful result reported by these trials constitutes what may be the largest achievement in the history of neurological sciences. However, most of these mechanical thrombectomy trials (except for the multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands, i...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28718030/precision-stroke-animal-models-the-permanent-mcao-model-should-be-the-primary-model-not-transient-mcao
#6
Devin W McBride, John H Zhang
An argument for preclinical stroke research to make more use of the permanent middle cerebral artery occlusion (MCAO) model, rather than transient MCAO, is presented. Despite STAIR recommending permanent MCAO as the primary model, preclinical stroke research has not been listened. In 2012, Hossmann reported that 64% of the treatment studies for MCAO used prompt transient MCAO models and only 36% of the studies used permanent MCAO or gradual transient MCAO (i.e., embolic stroke model). Then, in 2014 and 2015, 88% of published basic science studies on large vessel occlusion used the transient MCAO model...
July 17, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28717529/daily-variation-in-the-occurrence-of-different-subtypes-of-stroke
#7
Luciana Ripamonti, Roberto Riva, Fabiola Maioli, Corrado Zenesini, Gaetano Procaccianti
Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28717354/blood-pressure-and-penumbral-sustenance-in-stroke-from-large-vessel-occlusion
#8
REVIEW
Robert W Regenhardt, Alvin S Das, Christopher J Stapleton, Ronil V Chandra, James D Rabinov, Aman B Patel, Joshua A Hirsch, Thabele M Leslie-Mazwi
The global burden of stroke remains high, and of the various subtypes of stroke, large vessel occlusions (LVOs) account for the largest proportion of stroke-related death and disability. Several randomized controlled trials in 2015 changed the landscape of stroke care worldwide, with endovascular thrombectomy (ET) now the standard of care for all eligible patients. With the proven success of this therapy, there is a renewed focus on penumbral sustenance. In this review, we describe the ischemic penumbra, collateral circulation, autoregulation, and imaging assessment of the penumbra...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28716646/pulmonary-infarction-in-the-beginning
#9
Peter B Terry, Philip Clay Buescher
BACKGROUND: Massive pulmonary emboli can cause abrupt onset of symptoms simultaneous with large pulmonary artery occlusions. In contrast the temporal relationship between pulmonary vascular occlusion by smaller emboli and the development of pulmonary infarction symptoms is unknown. We describe the time interval between embolization and the onset of clinical symptoms and signs compatible with pulmonary infarction. METHODS: We examined the records of fifty six patients with Hereditary Hemorrhagic Telangiectasia (HHT) undergoing therapeutic balloon embolization of pulmonary arteriovenous malformations (PAVM's) in a single center after noting that some developed symptoms and signs compatible with pulmonary infarction...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28709561/factors-associated-with-need-for-revascularisation-in-non-coronary-arterial-occlusive-lesions-secondary-to-takayasu-s-arteritis
#10
C A Hinojosa, J E Anaya-Ayala, Z Gomez-Arcive, H Laparra-Escareno, A Torres-Machorro, R Lizola
OBJECTIVE/BACKGROUND: Takayasu's arteritis (TA) is rare inflammatory large vessel form of vasculitis. The objective of this study was to evaluate experience in the management of TA patients and to identify the influence of inflammatory markers and clinical variables associated with disease progression, worsening ischaemic symptoms, and the need for interventions. METHODS: Demographics, and laboratory and clinical variables in patients that required revascularisation procedures were compared with those who had adequate symptomatic control with medical management...
July 11, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28702769/short-and-long-term-outcomes-after-combined-intravenous-thrombolysis-and-mechanical-thrombectomy-versus-direct-mechanical-thrombectomy-a-prospective-single-center-study
#11
Giovanni Merlino, Massimo Sponza, Benedetto Petralia, Alessandro Vit, Vladimir Gavrilovic, Andrea Pellegrin, Michele Rana, Iacopo Cancelli, Sara Naliato, Simone Lorenzut, Roberto Marinig, Ferdinando Calzolari, Roberto Eleopra
Recent clinical trials demonstrated that mechanical thrombectomy (MT) using second-generation endovascular devices has beneficial effects in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, it remains controversial if intravenous thrombolysis (IVT) prior to MT is superior compared to direct mechanical thrombectomy (DMT). The aims of this study were to compare short and long-term outcomes between IVT + MT and DMT patients. We prospectively recruited AIS patients with LVO in the anterior or posterior circulation eligible for MT with and without prior IVT...
July 12, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28700136/an-automated-framework-to-quantify-areas-of-regional-ischemia-in-retinal-vascular-diseases-with-oct-angiography
#12
Neha Anegondi, Lavanya Chidambara, Devanshi Bhanushali, Santosh G K Gadde, Naresh Kumar Yadav, Abhijit Sinha Roy
In this observational and cross-sectional study, capillary non perfusion (CNP) and vascular changes in branch retinal vein occlusion (BRVO, sample size (n) = 26) and choroidal neovascularization (CNV, n = 29) were evaluated. Subjects underwent imaging using Optical coherence tomography angiography (Angiovue™ OCTA , RTVue XR, Optovue Inc., Fremont, CA). Local fractal analysis was applied to the OCTA images of superficial, deep and choriocapillaries layer. CNP area (BRVO eyes) and vascular parameters were computed using local fractal based method...
July 12, 2017: Journal of Biophotonics
https://www.readbyqxmd.com/read/28689236/etiological-classification-of-ischemic-stroke-in-young-patients-a-comparative-study-of-toast-ccs-and-asco
#13
Elif Gökçal, Elvin Niftaliyev, Talip Asil
Analysis of stroke subtypes is important for making treatment decisions and prognostic evaluations. The TOAST classification system is most commonly used, but the CCS and ASCO classification systems might be more useful to identify stroke etiologies in young patients whose strokes have a wide range of different causes. In this manuscript, we aim to compare the differences in subtype classification between TOAST, CCS, and ASCO in young stroke patients. The TOAST, CCS, and ASCO classification schemes were applied to 151 patients with ischemic stroke aged 18-49 years old and the proportion of subtypes classified by each scheme was compared...
July 8, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28687721/blood-pressure-levels-post-mechanical-thrombectomy-and-outcomes-in-large-vessel-occlusion-strokes
#14
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Jason J Chang, Kira Dillard, Muhammad Fawad Ishfaq, Katherine Nearing, Asim F Choudhri, Daniel Hoit, Anne W Alexandrov, Adam S Arthur, Lucas Elijovich, Andrei V Alexandrov
OBJECTIVE: There are limited data evaluating the effect of post mechanical thrombectomy (MT) blood pressure (BP) levels on early outcomes of patients with large vessel occlusions (LVO). We sought to investigate the association of BP course following MT with early outcomes in LVO. METHODS: Consecutive patients with LVO treated with MT during a 3-year period were evaluated. Hourly systolic BP (SBP) and diastolic BP (DBP) values were recorded for 24 hours following MT and maximum SBP and DBP levels were identified...
July 7, 2017: Neurology
https://www.readbyqxmd.com/read/28682888/spontaneous-recanalization-of-atherosclerotic-middle-cerebral-artery-occlusion-case-report
#15
Ying Mao, Yujing Huang, Li Zhang, Guangxian Nan
RATIONALE: Intracranial vascular atherosclerotic occlusion is one of the most common causes of ischemic stroke world wide. The involvement of large intracranial vessels, in particular, the middle cerebral artery, is usually associated with unfavorable outcomes in patients. Spontaneous recanalization of atherosclerotic occlusion is relatively rare. PATIENT CONCERNS: The first patient was a 43-year-old male with slurred speech and left-sided weakness for a duration of 24 hours...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28673811/fluid-attenuated-inversion-recovery-vascular-hyperintensities-in-patients-with-transient-ischemic-attack
#16
Marcelo Marinho de Figueiredo, Edson Amaro Júnior, Maramélia Araújo de Miranda Alves, Marcela Vazzoler, Renata Carolina Acre Nunes Miranda, Gisele Sampaio Silva
BACKGROUND: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) are common in patients with acute ischemic stroke, possibly representing impaired hemodynamics in the ischemic territory due to intracranial steno-occlusive disease. There are few reports on FVHs in patients with transient ischemic attack (TIA). AIMS: We investigated the prevalence of FVHs and its clinical correlations in patients with TIA. METHODS: We evaluated consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 hours of symptoms onset and intracranial and extracranial vascular imaging...
June 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28673107/annuloplasty-for-aortic-regurgitation-in-infantile-takayasu-arteritis-a-case-report
#17
Laura Linnemeier, Richa Sharma, Nayan Srivastava, Mark Turrentine
Aortic regurgitation (AR) is a life-threatening complication of Takayasu arteritis (TA). Takayasu arteritis is a large-vessel vasculitis with a predominance in young adolescent and adult females. Inflammation involves the aorta and its major branches resulting in arterial dilatation, stenosis, aneurysm, occlusion, and thrombosis formation. Pediatric TA cases have been reported to also cause severe complications such as coronary aneurysms, retinopathy, and hypertension due to renovascular stenosis. In this report, we present a rare occurrence of infantile TA with severe AR requiring surgical intervention after failing medical therapy...
January 1, 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28668275/midterm-outcomes-and-evolution-of-gutter-area-after-endovascular-aneurysm-repair-with-the-chimney-graft-procedure
#18
Hector W L de Beaufort, Elena Cellitti, Quirina M B de Ruiter, Michele Conti, Santi Trimarchi, Frans L Moll, Constantijn E V B Hazenberg, Joost A van Herwaarden
OBJECTIVE: The objective of this study was to describe our experience with endovascular aneurysm repair (EVAR) with the use of chimney grafts for branch vessel preservation. METHODS: Patients treated with a chimney graft procedure between October 2009 and May 2015 were included for analysis. Patients who were not considered eligible for open surgical repair or for conventional, branched, or fenestrated endovascular repair were selected. A standardized operating procedure with left brachial or axillary artery cutdown access for the chimney grafts and bilateral femoral artery cutdown access for the aortic main device was used...
June 28, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28663010/intravenous-fibrinolysis-in-ischemic-stroke-of-large-vessel-after-reversing-effect-of-dabigatran-with-idarucizumab
#19
Gary Alvarez Bravo, Emilio Orts Castro, Guilherme Carvalho Monteiro, Ignacio López Zuazo
Currently the use of idarucizumab to reverse the effect of dabigatran emerges as a possibility of treatment for those patients who present with an ischemic stroke despite taking this anticoagulant. We present our experience regarding the use of intravenous tissue plasminogen activator in a patient with ischemic stroke due to complete occlusion of the left middle cerebral artery after blocking the effect of dabigatran with idarucizumab and whose result was an almost total improvement of the neurologic deficit...
June 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28655816/optimal-transport-destination-for-ischemic-stroke-patients-with-unknown-vessel-status-use-of-prehospital-triage-scores
#20
Eckhard Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres, Ludwig Schlemm
BACKGROUND AND PURPOSE: Patients with acute ischemic stroke (AIS) and large vessel occlusion may benefit from direct transportation to an endovascular capable comprehensive stroke center (mothership approach) as opposed to direct transportation to the nearest stroke unit without endovascular therapy (drip and ship approach). The optimal transport strategy for patients with AIS and unknown vessel status is uncertain. The rapid arterial occlusion evaluation scale (RACE, scores ranging from 0 to 9, with higher scores indicating higher stroke severity) correlates with the National Institutes of Health Stroke Scale and was developed to identify patients with large vessel occlusion in a prehospital setting...
June 27, 2017: Stroke; a Journal of Cerebral Circulation
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