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Large vessel occlusion

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https://www.readbyqxmd.com/read/29331206/mechanical-thrombectomy-determining-the-proportion-of-eligible-acute-ischemic-stroke-patients-in-the-cohort-of-single-academic-stroke-center
#1
Marcin Wiącek, Rafał Kaczorowski, Bartosz Sieczkowski, Natalia Kanas, Halina Bartosik-Psujek
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. METHODS: We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016)...
December 26, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29329730/mechanical-thrombectomy-in-acute-ischaemic-stroke-a-review-of-the-different-techniques
#2
REVIEW
V Leung, A Sastry, S Srivastava, D Wilcock, A Parrott, S Nayak
Endovascular mechanical thrombectomy (MT) is reserved for acute ischaemic stroke secondary to large vessel occlusion. The various MT techniques employed in the treatment of hyperacute strokes are constantly evolving with new devices and improvisation of existing technology (Wahlgren, et al 2016). In this review, we describe a variety of MT techniques gained from our experience of performing over 350 procedures in 7 years of providing a 24/7 service within the national framework of a hyperacute stroke centre...
January 9, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29326380/neuroendovascular-management-of-emergent-large-vessel-occlusion-update-on-the-technical-aspects-and-standards-of-practice-by-the-standards-and-guidelines-committee-of-the-society-of-neurointerventional-surgery
#3
Chirag D Gandhi, Fawaz Al Mufti, I Paul Singh, Todd Abruzzo, Barbara Albani, Sameer A Ansari, Adam S Arthur, Mark Bain, Blaise W Baxter, Ketan R Bulsara, Justin M Caplan, Michael Chen, Guilherme Dabus, Don Frei, Steven W Hetts, M Shazam Hussain, Mahesh V Jayaraman, Yasha Kayan, Richard P Klucznik, Seon-Kyu Lee, William J Mack, Thabele Leslie-Mazwi, Ryan A McTaggart, Philip M Meyers, Maxim Mokin, Athos T Patsalides, Charles J Prestigiacomo, G Lee Pride, Robert M Starke, Peter J Sunenshine, Justin F Fraser
No abstract text is available yet for this article.
January 11, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29326379/blood-pressure-levels-post-mechanical-thrombectomy-and-outcomes-in-non-recanalized-large-vessel-occlusion-patients
#4
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Kira Dillard, Diana Alsbrook, Jason J Chang, Balaji Krishnaiah, Christopher Nickele, Daniel Hoit, Khalid Alsherbini, Andrei V Alexandrov, Adam S Arthur, Lucas Elijovich
OBJECTIVE: Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO. METHODS: Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24 hours following MT in consecutive nrLVO patients...
January 11, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29319574/risk-factors-of-vasopressor-induced-symmetrical-peripheral-gangrene
#5
Jung Woo Kwon, Min Ki Hong, Bo Young Park
BACKGROUND: Symmetrical peripheral gangrene (SPG) is an uncommon syndrome showing symmetrical gangrene in acral regions without evidence of large-vessel occlusion or vasculitis. Intravenous vasopressors are frequently used to manage hemodynamically unstable patients. There have been few reports about SPG after using inotropics. However, risk factors for SPG have not been extensively studied. Therefore, the objective of this study was to analyze several cases of SPG and identify risk factors for SPG...
January 9, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29316375/selection-criteria-for-endovascular-therapy-for-acute-ischaemic-stroke-are-patients-missing-out
#6
Julian Maingard, Leonid Churilov, Peter Mitchell, Richard Dowling, Bernard Yan
INTRODUCTION: Endovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. METHODS: We included patients with anterior circulation stroke treated with ECR from a single centre...
January 9, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29315369/patency-of-branch-vessels-reimplanted-during-thoraco-abdominal-aortic-replacement-implications-for-the-surgical-technique
#7
Sang Yoon Kim, Suryeun Chung, Dong Jung Kim, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
OBJECTIVES: Reimplantation of branch vessels is an important component of thoraco-abdominal aortic aneurysm repair. The goal of this study was to assess the anatomical results of branch vessel reimplantation, which have rarely been investigated. METHODS: Among 168 patients who underwent computed tomography after thoraco-abdominal aortic aneurysm repair, the technique of branch vessel reimplantation and determination of their patency were investigated. Late computed tomographic images were available for 81 patients (mean interval 55...
January 5, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29313057/regional-differences-in-thrombectomy-rates-secondary-use-of-billing-codes-in-the-miracum-medical-informatics-for-research-and-care-in-university-medicine-consortium
#8
Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach
BACKGROUND AND PURPOSE: Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS: Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines...
January 8, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29311286/endovascular-thrombectomy-in-acute-ischemic-stroke
#9
REVIEW
Panagiotis Papanagiotou, George Ntaios
Despite several effective strategies of stroke prevention, the stroke epidemic still constitutes the leading cause of permanent disability. The recent series of well-designed, convincingly-positive randomized controlled trials of endovascular thrombectomy in stroke patients with large vessel occlusion launched a paradigm shift and a new era in acute stroke management. The present review provides an overview of the technical aspects of the procedure, discusses patient selection criteria, summarizes the current evidence from randomized trials about its efficacy and safety, and explores its implications in the organization of acute stroke care...
January 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29305274/combination-of-24-hour-and-7-day-relative-neurological-improvement-strongly-predicts-90-day-functional-outcome-of-endovascular-stroke-therapy
#10
Jie Pu, Huaiming Wang, Mingyi Tu, Wenjie Zi, Yonggang Hao, Dong Yang, Wenhua Liu, Yue Wan, Yu Geng, Min Lin, Ping Jin, Yunyun Xiong, Gelin Xu, Qin Yin, Xinfeng Liu
BACKGROUND AND PURPOSE: Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. METHODS: We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected...
January 3, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29298860/pre-hospital-detection-of-acute-ischemic-stroke-secondary-to-emergent-large-vessel-occlusion-lessons-learned-from-electrocardiogram-and-acute-myocardial-infarction
#11
REVIEW
Alexander G Chartrain, Christopher Paul Kellner, J Mocco
Currently, there is no device capable of detecting acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO) in the pre-hospital setting. The inability to reliably identify patients that would benefit from primary treatment with endovascular thrombectomy remains an important limitation to optimizing emergency medical services (EMS) triage models and time-to-treatment. Several clinical grading scales that rely solely on clinical examination have been proposed and have demonstrated only moderate predictive ability for ELVO...
January 3, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29297717/cincinnati-prehospital-stroke-scale-can-identify-large-vessel-occlusion-stroke
#12
Christopher T Richards, Ryan Huebinger, Katie L Tataris, Joseph M Weber, Laura Eggers, Eddie Markul, Leslee Stein-Spencer, Kenneth S Pearlman, Jane L Holl, Shyam Prabhakaran
OBJECTIVE: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), a simple assessment tool currently used by emergency medical services (EMS) providers, can be used to identify LVO. METHODS: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29296999/safety-and-efficacy-of-a-3-dimensional-stent-retriever-with-aspiration-based-thrombectomy-vs-aspiration-based-thrombectomy-alone-in-acute-ischemic-stroke-intervention-a-randomized-clinical-trial
#13
Raul G Nogueira, Donald Frei, Jawad F Kirmani, Osama Zaidat, Demetrius Lopes, Aquilla S Turk, Donald Heck, Brian Mason, Diogo C Haussen, Elad I Levy, Siddhart Mehta, Marc Lazzaro, Michael Chen, Arnd Dörfler, Albert J Yoo, Colin P Derdeyn, Lee Schwamm, David Langer, Adnan Siddiqui
Importance: The treatment effects of individual mechanical thrombectomy devices in large-vessel acute ischemic stroke (AIS) remain unclear. Objective: To determine whether the novel 3-dimensional (3-D) stent retriever used in conjunction with an aspiration-based mechanical thrombectomy device (Penumbra System; Penumbra) is noninferior to aspiration-based thrombectomy alone in AIS. Design, Setting, and Participants: This randomized, noninferiority clinical trial enrolled patients at 25 North American centers from May 19, 2012, through November 19, 2015, with follow-up for 90 days...
January 2, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29284886/monitored-anesthesia-care-for-the-acute-ischemic-stroke-patient-with-end-stage-pulmonary-disease
#14
Kevin C Lee, Brian C Lee, Steven E Miller
The majority of patients who suffer acute ischemic stroke (AIS) from large vessel occlusion are at a significant risk for disability or death. Because patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO) are therapeutically anticoagulated, intravenous recombinant tissue plasminogen activator is contraindicated. For AIS management, these patients must undergo emergent intra-arterial therapy. Presented is a patient on VA ECMO who subsequently suffered a large vessel embolic stroke requiring emergent surgical intervention...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29284735/contact-aspiration-versus-stent-retriever-in-patients-with-acute-ischemic-stroke-with-m2-occlusion-in-the-aster-randomized-trial-contact-aspiration-versus-stent-retriever-for-successful-revascularization
#15
Benjamin Gory, Bertrand Lapergue, Raphael Blanc, Julien Labreuche, Malek Ben Machaa, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin
BACKGROUND AND PURPOSE: Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy, especially contact aspiration (CA), in such distal intracranial occlusions is still under debate. We compared reperfusion, adverse events, neurological recovery, and functional outcome of patients with isolated M2 occlusions according to the first-line strategy mechanical thrombectomy devices (CA versus stent retriever [SR])...
December 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29284734/impact-of-prehospital-triage-scales-to-detect-large-vessel-occlusion-on-resource-utilization-and-time-to-treatment
#16
Ludwig Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres
BACKGROUND AND PURPOSE: Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. METHODS: Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale...
December 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29282331/in-large-vessel-occlusive-stroke-time-is-brain%C3%A2-but-collaterals-are-time
#17
EDITORIAL
Adam de Havenon, Andrew M Southerland
No abstract text is available yet for this article.
December 27, 2017: Neurology
https://www.readbyqxmd.com/read/29281734/safety-of-bridging-antiplatelet-therapy-with-the-gpiib-iiia-inhibitor-tirofiban-after-emergency-stenting-in-stroke
#18
John-Ih Lee, Michael Gliem, Gebke Gerdes, Bernd Turowski, Marius Kaschner, Bastian Kraus, Hans-Peter Hartung, Sebastian Jander
BACKGROUND: In a proportion of stroke patients with acute large vessel occlusion permanent stent implantation is mandatory to achieve successful recanalization. The optimum platelet inhibition strategy after such emergency stenting is unknown. We therefore analyzed the outcome of early glycoprotein (gp) IIb/IIIa inhibitor treatment after emergency stenting in acute stroke. METHODS: Sixty patients with emergency stenting were identified in our stroke unit registry from 12/2010-06/2014 and analyzed retrospectively...
2017: PloS One
https://www.readbyqxmd.com/read/29276498/role-of-hyperintense-acute-reperfusion-marker-for-classifying-the-stroke-etiology
#19
Hee Young Choi, Kyung Mi Lee, Hyug-Gi Kim, Eui Jong Kim, Woo Suk Choi, Bum Joon Kim, Sung Hyuk Heo, Dae-Il Chang
Purpose: The hyperintense acute reperfusion marker (HARM) is a delayed enhancement of the subarachnoid or subpial space observed on post-contrast fluid-attenuated inversion recovery (FLAIR) images and is associated with permeability changes to the blood-brain barrier in acute stroke. We investigated the relationship between HARM and stroke etiology based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. In addition, we evaluated the relationship between HARM and stroke locations with respect to vascular territories and anatomic compartments...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29273536/variability-of-stroke-patients-meeting-endovascular-stroke-trial-criteria-in-a-non-clinical-trial-setting
#20
Jennifer E Fugate, Waleed Brinjikji, Harry Cloft, David F Kallmes, Alejandro A Rabinstein
BACKGROUND: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. METHODS: Retrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010-November 2014...
December 19, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
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