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Large vessel occlusion

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https://www.readbyqxmd.com/read/29783870/safety-and-efficacy-of-a-new-outreach-distal-access-catheter-tactics-for-coil-embolization-of-unruptured-intracranial-aneurysms
#1
Toshinori Matsushige, Shigeyuki Sakamoto, Daizo Ishii, Katsuhiro Shinagawa, Koji Shimonaga, Masahiro Hosogai, Tomohiro Kawasumi, Junpei Oshita, Takahito Okazaki, Kaoru Kurisu
Background and purpose Current large-bore catheters can be easily and safely placed in the intracranial vessels for the stabilization of microcatheters in several neurointervention scenarios. We considered that a novel 3.4 French catheter (TACTICS, Technorat Corporation, Aichi, Japan) might be useful for intermediate/distal access in a triaxial system. Here, we present our initial experience using the TACTICS catheter for treatment of intracranial aneurysms. Materials and methods A total of 35 endovascular coils were placed to embolize unruptured intracranial aneurysms of the anterior circulation using the TACTICS catheter between December 2016 and November 2017...
January 1, 2018: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29781051/prehospital-prediction-of-large-vessel-occlusion-in-suspected-stroke-patients
#2
REVIEW
Kevin J Keenan, Charles Kircher, Jason T McMullan
PURPOSE OF REVIEW: Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29774008/repeated-endovascular-treatment-of-early-recurrent-proximal-middle-cerebral-artery-occlusion-case-report-and-brief-review-of-the-literature
#3
Simon Fandler, Hannes Deutschmann, Franz Fazekas, Thomas Gattringer
Mechanical thrombectomy (MT) is the gold standard treatment for large vessel occlusion (LVO) stroke of the anterior circulation. Whether MT can also be effectively and safely performed in early recurrent LVO is largely unclear. We present the case of a middle-aged patient who was successfully treated by MT for right proximal middle cerebral artery (MCA) occlusion with excellent outcome. One day after discharge (9 days after the first MT), the patient was readmitted with wake-up stroke. MRI again revealed right proximal MCA occlusion with severe diffusion-perfusion mismatch...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29773716/thrombectomy-6-24-hours-after-stroke-in-trial-ineligible-patients
#4
Shashvat M Desai, Marcelo Rocha, Bradley J Molyneaux, Matthew Starr, Cynthia L Kenmuir, Bradley A Gross, Brian Thomas Jankowitz, Tudor G Jovin, Ashutosh P Jadhav
BACKGROUND AND PURPOSE: The DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials. METHODS: A retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6-24 hour time window...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29773715/embolus-retriever-with-interlinked-cages-versus-other-stent-retrievers-in-acute-ischemic-stroke-an-observational-comparative-study
#5
Philipp Gruber, Salome Zeller, Carlos Garcia-Esperon, Jatta Berberat, Javier Anon, Michael Diepers, Krassen Nedeltchev, Fabian Flottmann, Jens Fiehler, Luca Remonda, Timo Kahles
BACKGROUND AND PURPOSE: Given the promising performance of the new Embolus Retriever with Interlinked Cages (ERIC) in smaller case series, we sought to assess the efficacy and safety of mechanical thrombectomy (MT) with ERIC compared with other stent retrievers (SRs) in acute ischemic stroke due to large vessel occlusion (LVO). METHODS: We reviewed the databases of two comprehensive stroke centers in in Germany and Switzerland for MT due to LVO in the anterior circulation with either ERIC or another SR as a first device...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29769241/multivessel-occlusion-in-patients-subjected-to-thrombectomy-prevalence-associated-factors-and-clinical-implications
#6
Johannes Kaesmacher, Pascal J Mosimann, Mattia Giarrusso, Marwan El-Koussy, Felix Zibold, Eike Piechowiak, Tomas Dobrocky, Raphael Meier, Simon Jung, Sebastian Bellwald, Marcel Arnold, Pasquale Mordasini, Urs Fischer, Jan Gralla
BACKGROUND AND PURPOSE: Patients with embolic large-vessel occlusion may present with additional coincidental acute occlusions within or distant from the involved territory, referred to as multivessel occlusion (MVO). Purpose of this study was to assess prevalence of MVO, associated factors, and clinical relevance in patients undergoing endovascular stroke treatment. METHODS: Image data of consecutive endovascular candidates (n=720) with direct access to angiography were extracted from a prospective registry...
May 16, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29767732/dietary-intake-of-alpha-linolenic-acid-is-not-appreciably-associated-with-the-risk-of-ischemic-stroke-among-middle-aged-danish-men-and-women
#7
Christian S Bork, Stine K Venø, Søren Lundbye-Christensen, Marianne U Jakobsen, Anne Tjønneland, Erik B Schmidt, Kim Overvad
Background: Intake of the plant-derived omega-3 (n-3) fatty acid alpha-linolenic acid (ALA) may reduce the risk of ischemic stroke. Objective: We have investigated the associations between dietary intake of ALA and the risk of ischemic stroke and ischemic stroke subtypes. Methods: This was a follow-up study. A total of 57,053 participants aged 50-64 y were enrolled into the Danish Diet, Cancer and Health cohort between 1993 and 1997. Intake of ALA was assessed by a validated semiquantitative food frequency questionnaire...
May 15, 2018: Journal of Nutrition
https://www.readbyqxmd.com/read/29765393/support-of-new-triage-protocol-among-acute-stroke-care-providers
#8
Haitham M Hussein, David C Anderson
Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29763889/neutrophil-lymphocyte-ratio-predicts-functional-and-safety-outcomes-after-endovascular-treatment-for-acute-ischemic-stroke
#9
Zhenhui Duan, Huaiming Wang, Zhen Wang, Yonggang Hao, Wenjie Zi, Dong Yang, Zhiming Zhou, Wenhua Liu, Min Lin, Zhonghua Shi, Penghua Lv, Yue Wan, Gelin Xu, Yunyun Xiong, Wusheng Zhu, Xinfeng Liu
BACKGROUND AND OBJECTIVE: Endovascular treatment (EVT) is proven to be safe and effective for treating acute large vessel occlusion stroke (LVOS). The neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, which plays an important role in the process of treating ischemic stroke. This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT. METHODS: Patients were selected from the EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry...
May 15, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29761219/intracranial-rescue-stent-angioplasty-after-stent-retriever-thrombectomy-multicenter-experience
#10
Robert Forbrig, Hannah Lockau, Fabian Flottmann, Tobias Boeckh-Behrens, Christoph Kabbasch, Maximilian Patzig, Anastasios Mpotsaris, Jens Fiehler, Thomas Liebig, Goetz Thomalla, Oezguer A Onur, Silke Wunderlich, Kornelia Kreiser, Moriz Herzberg, Frank A Wollenweber, Sascha Prothmann, Franziska Dorn
PURPOSE: Stent-retriever thrombectomy (SRT) for acute intracranial large artery occlusion (LAO) may not result in permanent recanalization in rare cases, e.g. due to an underlying stenosis or dissection. In this specific patient group, rescue stent angioplasty (RSA) may be the only treatment option to achieve permanent vessel patency and potentially a good clinical outcome. To date, the experience with RSA is limited. METHODS: In this retrospective analysis, interventional and clinical data of patients with acute intracranial LAO of the anterior and posterior circulation who underwent RSA after SRT due to an underlying lesion between 2012-2017 in four neurovascular centers were studied...
May 14, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29758114/time-well-spent-in-recanalizing-complex-cerebrovascular-occlusions
#11
Perttu J Lindsberg
After publication of several randomized, controlled trials demonstrating the efficacy of mechanical thrombectomy (MT) following intravenous t-PA (IV t-PA) the current guidelines of acute management of cerebrovascular have been revised (1,2). In addition to IV t-PA within 4,5 hours applied in a wide spectrum of ischemic stroke subtypes, MT has been proven as the second therapeutic target in a longer time window in much more selected cases of large vessel occlusions (LVO). This article is protected by copyright...
May 14, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29755897/improving-door-to-groin-puncture-time-for-mechanical-thrombectomy-via-iterative-quality-protocol-interventions
#12
Vincent J Cheung, Arvin R Wali, David R Santiago-Dieppa, Robert C Rennert, Michael G Brandel, Jeffrey A Steinberg, Brian R Hirshman, Kevin Porras, Peter Abraham, Julie Jurf, Emily Botts, Scott Olson, J Scott Pannell, Alexander A Khalessi
INTRODUCTION: Delays in door to groin puncture time (DGPT) for patients with ischemic stroke caused by acute large vessel occlusions (LVO) are associated with worse clinical outcomes. We present the results of a quality improvement protocol for endovascular stroke treatment at the University of California, San Diego (UCSD) that aimed to minimize DGPT. MATERIALS AND METHODS: Our stroke team implemented a series of quality improvement measures to decrease DGPT, with a target of 90 minutes or less...
March 10, 2018: Curēus
https://www.readbyqxmd.com/read/29748424/intravenous-recombinant-tissue-type-plasminogen-activator-influence-on-outcome-in-anterior-circulation-ischemic-stroke-treated-by-mechanical-thrombectomy
#13
Marc Ferrigno, Nicolas Bricout, Didier Leys, Laurent Estrade, Charlotte Cordonnier, Thomas Personnic, Maeva Kyheng, Hilde Henon
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) improves functional outcome in patients with ischemic stroke related to proximal-vessel occlusion in the anterior circulation. Whether MT alone is as effective as IVT/MT remains controversial. We aimed at evaluating the influence of IVT in patients with large anterior circulation artery occlusion treated with MT. METHODS: We did a prospective observational cohort study in patients with stroke related to large anterior circulation artery occlusion treated by MT who were admitted to Lille University Hospital, Lille, France...
May 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29739917/magnetic-resonance-imaging-selection-for-endovascular-stroke-therapy-workflow-in-the-goliath-trial
#14
Claus Z Simonsen, Albert J Yoo, Mads Rasmussen, Kristina E Sørensen, Thabele Leslie-Mazwi, Grethe Andersen, Leif H Sørensen
BACKGROUND AND PURPOSE: The GOLIATH trial (General or Local Anesthesia in Intra-Arterial Therapy) compared infarct growth and outcome in patients undergoing endovascular therapy under either general anesthesia or conscious sedation. Magnetic resonance imaging was performed before and after the procedure to study infarct growth. In this post hoc analysis of GOLIATH, we aimed to characterize the workflow of patients undergoing magnetic resonance imaging selection before endovascular therapy...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29739914/computed-tomographic-perfusion-predicts-poor-outcomes-in-a-randomized-trial-of-endovascular-therapy
#15
Robert Wannamaker, Taurian Guinand, Bijoy K Menon, Andrew Demchuk, Mayank Goyal, Donald Frei, Aditya Bharatha, Tudor G Jovin, Jai Shankar, Timo Krings, Blaise Baxter, Christine Holmstedt, Richard Swartz, Dar Dowlatshahi, Richard Chan, Donatella Tampieri, Hana Choe, Paul Burns, Nina Gentile, Jeremy Rempel, Ashfaq Shuaib, Brian Buck, Andrew Bivard, Michael Hill, Kenneth Butcher
BACKGROUND AND PURPOSE: In the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times), patients with large vessel occlusions and small infarct cores identified with computed tomography (CT)/CT angiography were randomized to endovascular therapy or standard of care. CT perfusion (CTP) was obtained in some cases but was not used to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29739912/early-cerebral-vein-after-endovascular-ischemic-stroke-treatment-predicts-symptomatic-reperfusion-hemorrhage
#16
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
#17
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/29736159/consensus-statements-by-korean-society-of-interventional-neuroradiology-and-korean-stroke-society-hyperacute-endovascular-treatment-workflow-to-reduce-door-to-reperfusion-time
#18
Dae-Hyun Kim, Byungjun Kim, Cheolkyu Jung, Hyo Suk Nam, Jin Soo Lee, Jin Woo Kim, Woong Jae Lee, Woo-Keun Seo, Ji-Hoe Heo, Seung Kug Baik, Byung Moon Kim, Joung-Ho Rha
Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers...
May 7, 2018: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/29734653/the-janus-face-of-vegf-in-stroke
#19
REVIEW
Samuel J Geiseler, Cecilie Morland
The family of vascular endothelial growth factors (VEGFs) are known for their regulation of vascularization. In the brain, VEGFs are important regulators of angiogenesis, neuroprotection and neurogenesis. Dysregulation of VEGFs is involved in a large number of neurodegenerative diseases and acute neurological insults, including stroke. Stroke is the main cause of acquired disabilities, and normally results from an occlusion of a cerebral artery or a hemorrhage, both leading to focal ischemia. Neurons in the ischemic core rapidly undergo necrosis...
May 4, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29725176/clinical-outcomes-of-endovascular-thrombectomy-in-tissue-plasminogen-activator-versus-non-tissue-plasminogen-activator-patients-at-primary-stroke-care-centers
#20
Gregory Imbarrato, Joshua Bentley, Ajeet Gordhan
Background: The effect of intravenous tissue plasminogen activator (IV tPA) administration before endovascular intervention as compared to without at thrombectomy-capable low-volume centers on procedural aspects and patient outcomes has not been investigated. Methods: Retrospective chart review was performed in all consecutive large vessel cerebrovascular accident patients treated with endovascular therapy at two select rural primary stroke centers between 2011 and 2015...
April 2018: Journal of Neurosciences in Rural Practice
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