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Large vessel occlusion

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https://www.readbyqxmd.com/read/28931265/diagnostic-and-interventional-optical-angioscopy-in-ex-vivo-carotid-arteries
#1
Luis E Savastano, Neeraj Chaudhary, Carlos Murga-Zamalloa, Michael Wang, Thomas Wang, B Gregory Thompson
BACKGROUND: Angioscopy - or endovascular endoscopy - is a catheter-based technique employing a flexible fiberoptic angioscope to directly visualize arterial lumen. Poor resolution and excessive stiffness of pre-existent angioscopes limited their use clinically. Recent advances resulted in novel fused optical fiber bundle angioscopes with improved flexibility and imaging resolution. Use of these devices in endovascular neurosurgery is still largely unexplored. OBJECTIVE: To evaluate image quality and feasibility of optical angioscopes for diagnostic and interventional neuro-angioscopy in carotid arteries of human cadavers...
February 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28925313/hemodynamics-and-oxygen-extraction-in-chronic-large-artery-steno-occlusive-disease-clinical-applications-for-predicting-stroke-risk
#2
Colin P Derdeyn
Depending on the adequacy of collateral sources of blood flow, arterial stenosis or occlusion may lead to reduced perfusion pressure and ultimately reduced blood flow in the distal territory supplied by that vessel. There are two well-defined compensatory mechanisms to reduced pressure or flow - autoregulatory vasodilation and increased oxygen extraction fraction. Other changes, such as metabolic downregulation, are likely. The positive identification of autoregulatory vasodilation and increased oxygen extraction fraction in humans is an established risk factor for future ischemic stroke in some disease states such as atherosclerotic carotid stenosis and occlusion...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28916666/regional-evaluation-of-the-severity-based-stroke-triage-algorithm-for-emergency-medical-services-using-discrete-event-simulation
#3
Brittany M Bogle, Andrew W Asimos, Wayne D Rosamond
BACKGROUND AND PURPOSE: The Severity-Based Stroke Triage Algorithm for Emergency Medical Services endorses routing patients with suspected large vessel occlusion acute ischemic strokes directly to endovascular stroke centers (ESCs). We sought to evaluate different specifications of this algorithm within a region. METHODS: We developed a discrete event simulation environment to model patients with suspected stroke transported according to algorithm specifications, which varied by stroke severity screen and permissible additional transport time for routing patients to ESCs...
September 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28911993/ocular-manifestations-of-familial-transthyretin-amyloidosis
#4
Margaret M Reynolds, Kevin K Veverka, Morie A Gertz, Angela Dispenzieri, Steven R Zeldenrust, Nelson Leung, Jose S Pulido
PURPOSE: Among patients with familial amyloidosis, mutation in the transthyretin (TTR) protein is the most common type. Patients with TTR amyloidosis have been noted to have ocular, especially vitreous, involvement. In this report, an analysis of the types and frequency of ocular manifestations in TTR amyloidosis is presented. DESIGN: Observational case series. METHODS: Two hundred and sixty-three patients who presented to Mayo Clinic with TTR amyloidosis between January 1, 1970, and November 1, 2014, consented to be included in the Mayo Clinic amyloidosis database maintained by the Department of Hematology...
September 11, 2017: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/28904450/acute-ischemic-stroke-treatment-using-mechanical-thrombectomy-a-study-of-137-patients
#5
Rakeshsingh K Singh, Vishal Annaji Chafale, Rakesh Shyam Lalla, Keyurkumar Chandrakantbhai Panchal, Anil Pandurang Karapurkar, Satish Vasant Khadilkar, Pawan K Ojha, Yogesh Godge, Rakesh K Singh, Rajesh Benny
BACKGROUND: Mechanical thrombectomy (MT) is the most effective treatment in large vessel occlusion (LVO). We have analyzed our initial experience of MT of 137 patients in anterior circulation (AC) and posterior circulation (PC) LVO using Solitaire stent retriever device. METHODS: Retrospective cohort analysis of 112 AC and 25 PC acute ischemic strokes was done considering various baseline characteristics, risk factors, National Institute of Health Stroke Scale (NIHSS) change, revascularization rate, complications, and functional outcome at 3 months using modified Rankin score...
July 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28900664/-prehospital-care-for-stroke-patients
#6
REVIEW
C H Nolte, H J Audebert
The effectiveness of thrombolysis or mechanical recanalization for acute stroke is higher, the sooner these therapies are started. Therefore, acute stroke patients need to be evaluated by qualified staff for these therapies as soon as possible. Lay persons need to identify the typical symptoms of stroke as an emergency and act accordingly by calling the emergency medical system (EMS). The EMS team reassesses the symptoms and prompts cerebral imaging. Cerebral imaging is performed ideally in hospitals with a stroke unit where subsequent (stroke) treatments occur...
September 12, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#7
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...
September 11, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28887393/white-matter-hyperintensity-volume-and-outcome-of-mechanical-thrombectomy-with-stentriever-in-acute-ischemic-stroke
#8
Kunakorn Atchaneeyasakul, Thabele Leslie-Mazwi, Kathleen Donahue, Anne-Katrin Giese, Natalia S Rost
BACKGROUND AND PURPOSE: Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices...
September 8, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28882658/increased-risk-for-unfavorable-outcome-in-patients-with-pre-existing-disability-undergoing-endovascular-therapy
#9
Ronen R Leker, Pavel Gavriliuc, Nour Eddine Yaghmour, John M Gomori, Jose E Cohen
INTRODUCTION: Most studies evaluating endovascular therapy (EVT) for stroke only included patients without pre-existing disabilities. However, in real life many patients have pre-existing disabilities, and whether they can benefit from EVT remains unknown. METHODS: Patients with emergent large vessel occlusions undergoing EVT were prospectively enrolled. Patients with no or mild pre-existing disabilities (modified Rankin Scale [mRS], 0-2) were compared with patients presenting with pre-existing moderate disability (mRS ≥ 3)...
September 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28877524/selection-paradigms-for-large-vessel-occlusion-acute-ischemic-stroke-endovascular-therapy
#10
Mehdi Bouslama, Meredith T Bowen, Diogo C Haussen, Seena Dehkharghani, Jonathan A Grossberg, Letícia C Rebello, Srikant Rangaraju, Michael R Frankel, Raul G Nogueira
BACKGROUND: Optimal patient selection methods for thrombectomy in large vessel occlusion stroke (LVOS) are yet to be established. We sought to evaluate the ability of different selection paradigms to predict favorable outcomes. METHODS: Review of a prospectively collected database of endovascular patients with anterior circulation LVOS, adequate CT perfusion (CTP), National Institutes of Health Stroke Scale (NIHSS) ≥10 from September 2010 to March 2016. Patients were retrospectively assessed for thrombectomy eligibility by 4 mismatch criteria: Perfusion-Imaging Mismatch (PIM): between CTP-derived perfusion defect and ischemic core volumes; Clinical-Core Mismatch (CCM): between age-adjusted NIHSS and CTP core; Clinical-ASPECTS Mismatch (CAM-1): between age-adjusted NIHSS and ASPECTS; Clinical-ASPECTS Mismatch (CAM-2): between NIHSS and ASPECTS...
September 7, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28875550/outcomes-of-endovascular-treatment-for-acute-large-vessel-ischemic-stroke-more-than-6-hours-after-symptom-onset
#11
Ronan Motyer, Hong Kuan Kok, Hamed Asadi, Alan O'Hare, Paul Brennan, Sarah Power, Seamus Looby, Patrick Nicholson, David Williams, Sean Murphy, Michael D Hill, Mayank Goyal, John McManus, Paul O'Brien, John Thornton
BACKGROUND AND OBJECTIVES: Benefit from endovascular thrombectomy (EVT) for large vessel occlusion (LVO) acute ischemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 hours. We evaluated clinical outcomes in patients undergoing late EVT at our institution. METHODS: Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS...
September 5, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28871268/xylem-vessel-diameter-affects-the-compartmentalization-of-the-vascular-pathogen-phaeomoniella-chlamydospora-in-grapevine
#12
Jérôme Pouzoulet, Elia Scudiero, Marco Schiavon, Philippe E Rolshausen
Fungal wilt diseases are a threat to global food safety. Previous studies in perennial crops showed that xylem vessel diameter affects disease susceptibility. We tested the hypothesis that xylem vessel diameter impacts occlusion processes and pathogen compartmentalization in Vitis vinifera L. We studied the interaction between four grape commercial cultivars with the vascular wilt pathogen Phaeomoniella chlamydospora. We used qPCR and wood necrotic lesion length to measure fungal colonization coupled with histological studies to assess differences in xylem morphology, pathogen compartmentalization, and fungal colonization strategy...
2017: Frontiers in Plant Science
https://www.readbyqxmd.com/read/28867358/radiation-induced-large-vessel-cerebral-vasculopathy-in-pediatric-patients-with-brain-tumors-treated-with-proton-radiation-therapy
#13
Stephen F Kralik, Gordon A Watson, Chie-Schin Shih, Chang Y Ho, Whitney Finke, Jeffrey Buchsbaum
PURPOSE: The purpose of this research was to evaluate the incidence, time to development, imaging patterns, risk factors, and clinical significance of large vessel cerebral vasculopathy in pediatric patients with brain tumors treated with proton radiation therapy. METHODS AND MATERIALS: A retrospective study was performed on 75 consecutive pediatric patients with primary brain tumors treated with proton radiation therapy. Radiation-induced large vessel cerebral vasculopathy (RLVCV) was defined as intracranial large vessel arterial stenosis or occlusion confirmed on magnetic resonance angiography, computed tomographic angiography, catheter angiography, or a combination of these within an anatomic region with previous exposure to proton beam therapy and not present before radiation therapy...
July 12, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28864867/safety-of-the-solitaire-4%C3%A2-%C3%A3-%C3%A2-40%C3%A2-mm-stent-retriever-in-the-treatment-of-ischemic-stroke
#14
Felix Zibold, Pasquale Mordasini, Pascal Mosimann, Eike Piechowiak, Tomas Dobrocky, Urs Fischer, Marcel Arnold, Sebastian Bellwald, Jan Gralla
PURPOSE: Stent retrievers apply mechanical force to the intracranial vasculature. Our aim was to evaluate the safety and efficacy of the long Solitaire 4 × 40 mm stent retriever for large vessel occlusion in stroke patients. METHODS: We conducted a retrospective analysis of all patients treated for acute ischemic large vessel occlusion stroke with the Solitaire 2 FR 4 × 40 device between May and October 2016 at our institution. Patient-specific data at baseline and at discharge were documented...
September 1, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28864702/design-and-validation-of-a-clinical-scale-for-prehospital-stroke-recognition-severity-grading-and-prediction-of-large-vessel-occlusion-the-shortened-nih-stroke-scale-for-emergency-medical-services
#15
Jan Christoph Purrucker, Florian Härtig, Hardy Richter, Andreas Engelbrecht, Johannes Hartmann, Jonas Auer, Christian Hametner, Erik Popp, Peter Arthur Ringleb, Simon Nagel, Sven Poli
OBJECTIVE: To develop an NIH Stroke Scale (NIHSS)-compatible, all-in-one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO). METHODS: Emergency medical services (EMS) personnel and stroke physicians (n=326) rated each item of the NIHSS regarding suitability for prehospital use; best rated items were included. Stroke recognition was evaluated retrospectively in 689 consecutive patients with acute stroke or stroke mimics, prediction of LVO in 741 consecutive patients with ischaemic stroke with acute vessel imaging independent of admission NIHSS score...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28862032/heparin-pre-treatment-in-patients-with-st-segment-elevation-myocardial-infarction-and-the-risk-of-intracoronary-thrombus-and-total-vessel-occlusion-insights-from-the-taste-trial
#16
Sofia Karlsson, Pontus Andell, Moman A Mohammad, Sasha Koul, Göran K Olivecrona, Stefan K James, Ole Fröbert, David Erlinge
BACKGROUND: Pre-treatment with unfractionated heparin is common in ST-segment elevation myocardial infarction (STEMI) protocols, but the effect on intracoronary thrombus burden is unknown. We studied the effect of heparin pre-treatment on intracoronary thrombus burden and Thrombolysis in Myocardial Infarction (TIMI) flow prior to percutaneous coronary intervention in patients with STEMI. METHODS: The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial angiographically assessed intracoronary thrombus burden and TIMI flow, prior to percutaneous coronary intervention, in patients with STEMI...
August 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28861849/internal-carotid-artery-occlusion-pathophysiology-diagnosis-and-management
#17
REVIEW
Konark Malhotra, Nitin Goyal, Georgios Tsivgoulis
PURPOSE OF REVIEW: Acute internal carotid artery occlusion (ICAO) is associated with large infarcts and poor clinical outcomes and contributes to morbidity and mortality worldwide. In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO. RECENT FINDINGS: Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO...
August 31, 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28860105/ascertaining-the-value-of-noninvasive-measures-obtained-using-color-duplex-ultrasound-and-central-aortic-pressure-monitoring-during-the-management-of-cerebral-arteriovenous-malformation-resection-protocol-for-a-prospective-case-control-pilot-study
#18
Kathryn J Busch, Hosen Kiat
BACKGROUND: Dramatic hemodynamic changes occur upon removal of an arteriovenous malformation of the brain (bAVM) with a number of potentially serious perioperative complications, such as intracranial hemorrhage and venous occlusive hypertensive syndrome. As these complications largely occur in the postoperative inpatient period, a rapid, repeatable noninvasive investigation to serially monitor relevant intracranial hemodynamics may be of benefit. Though, transcranial Doppler (TCD) and transcranial color duplex (TCCD) are techniques used and available to provide hemodynamic measurements postoperatively, the time course of hemodynamic sequences following bAVM resection remains uncertain...
August 31, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28855390/tissue-selective-salvage-of-the-white-matter-by-successful-endovascular-stroke-therapy
#19
Justus F Kleine, Mirjam Kaesmacher, Benedikt Wiestler, Johannes Kaesmacher
BACKGROUND AND PURPOSE: White matter (WM) is less vulnerable to ischemia than gray matter. In ischemic stroke caused by acute large-vessel occlusion, successful recanalization might therefore sometimes selectively salvage the WM, leading to infarct patterns confined to gray matter. This study examines occurrence, determinants, and clinical significance of such effects. METHODS: Three hundred twenty-two patients with acute middle cerebral artery occlusion subjected to mechanical thrombectomy were included...
August 30, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28844546/etiological-classification-of-stroke-in-patients-with-chagas-disease-using-toast-causative-classification-system-toast-and-ascod-phenotyping
#20
Rodrigo de Paiva Bezerra, Maramélia Araújo de Miranda Alves, Adriana Bastos Conforto, Daniela Laranja Gomes Rodrigues, Gisele Sampaio Silva
BACKGROUND: Cardioembolism is considered a major pathophysiological mechanism in patients with ischemic stroke (IS) and Chagas disease (CD). However, a previous study reported that other stroke subtypes are present in more than 40% of CD patients according to the TOAST classification. Therefore, the aim of our study was to evaluate the etiologic classification of stroke in patients with CD using the Causative Classification System (CCS), the ASCOD, and the TOAST classifications in a prospective cohort of patients...
August 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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