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Large vessel occlusion

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https://www.readbyqxmd.com/read/28344654/endovascular-thrombectomy-with-or-without-systemic-thrombolysis
#1
Georgios Tsivgoulis, Aristeidis H Katsanos, Dimitris Mavridis, Anne W Alexandrov, Georgios Magoufis, Adam Arthur, Valeria Caso, Peter D Schellinger, Andrei V Alexandrov
OBJECTIVES: Current recommendations advocate that pretreatment with intravenous thrombolysis (IVT) should first be offered to all eligible patients with emergent large vessel occlusion (ELVO) before an endovascular thrombectomy (ET) procedure. However, there are observational data that question the safety and efficacy of IVT pretreatment in patients with ELVO. METHODS: We performed a meta-analysis of the included subgroups from ET randomized controlled trials (RCTs) to evaluate the comparative efficacy between direct ET without IVT pretreatment and bridging therapy (IVT and ET) in patients with ELVO...
March 2017: Therapeutic Advances in Neurological Disorders
https://www.readbyqxmd.com/read/28339357/development-of-a-score-for-assessment-of-radiologic-damage-in-large-vessel-vasculitis-combined-arteritis-damage-score-cards
#2
Daiki Nakagomi, Claire Cousins, Jan Sznajd, Shunsuke Furuta, Aladdin J Mohammad, Raashid Luqmani, David Jayne
OBJECTIVES: Outcome assessment in large-vessel vasculitis (LVV) remains challenging and this impairs patient management and the conduct of clinical studies. Previous proposals for outcome tools have not included imaging. This study aimed to develop an imaging score to quantify damage in LVV and to assess the difference between Takayasu (TAK) and giant cell arteritis (GCA). METHODS: Ninety-six patients (41 TAK, 55 GCA) were identified from local registries at two University Hospitals in the UK...
March 13, 2017: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/28337932/stroke-lesions-in-a-large-upper-limb-rehabilitation-trial-cohort-rarely-match-lesions-in-common-preclinical-models
#3
Matthew A Edwardson, Ximing Wang, Brent Liu, Li Ding, Christianne J Lane, Caron Park, Monica A Nelsen, Theresa A Jones, Steven L Wolf, Carolee J Winstein, Alexander W Dromerick
BACKGROUND: Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals. OBJECTIVE: To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. METHODS: Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed...
January 1, 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/28330015/contact-aspiration-versus-stent-retriever-front-line-for-recanalisation-in-acute-cerebral-infarction-the-aster-trial
#4
Bertrand Lapergue, Julien Labreuche, Michel Piotin
RATIONALE: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion (LVO). Favorable outcome is strongly associated with the successful reperfusion status. New techniques for MT such as contact aspiration (CA) seem promising to increase reperfusion status and clinical outcome in retrospective studies. We aim at ascertaining whether CA is more efficient than stent retriever as a front-line endovascular procedure...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28330012/mechanical-thrombectomy-for-minor-and-mild-stroke-patients-harboring-large-vessel-occlusion-in-the-anterior-circulation-a-multicenter-case-control-study
#5
Cyril Dargazanli, Caroline Arquizan, Arturo Consoli, Benjamin Gory, Omer Eker, Xavier Ayrignac, Jean-Pierre Decroix, Astrid Corlobé, Isabelle Mourand, Grégory Gascou, Mahmoud Charif, Julien Labreuche, Alain Duhamel, Paul-Emile Labeyrie, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Carlos Riquelme, Oguzhan Coskun, Jean-Philippe Desilles, Frédéric Bourdain, Roberto Riva, Mikael Obadia, Francis Turjman, Georges Rodesch, Pierre Labauge, Alain Bonafé, Mikael Mazighi, Vincent Costalat, Michel Piotin, Raphaël Blanc, Bertrand Lapergue
BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. There is no proven effectiveness of MT in the subgroup of minor stroke with LVO in the anterior circulation and data about mechanical thrombectomy (MT) in this subgroup of patients are sparse, with optimal management of these patients being yet not definitely addressed. The purpose of this case-control study was to evaluate MT in patients suffering from acute ischemic stroke (AIS) and LVO in the anterior circulation, presenting with minor to mild stroke symptoms (NIHSS<8)...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28320175/mechanical-embolectomy-for-acute-ischemic-stroke-beyond-six-hours-from-symptom-onset-using-mri-based-perfusion-imaging
#6
Ryan A McTaggart, Shadi Yaghi, Daniel C Sacchetti, Richard A Haas, Morgan Hemendinger, Daniel Arcuri, Jeffrey M Rogg, Karen L Furie, Mahesh V Jayaraman
INTRODUCTION: There is very limited data on the use of MRI based perfusion imaging to select patients with acute ischemic stroke and large vessel occlusion (LVO) for intraarterial therapy beyond 6h from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6h from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. METHODS: This is a single institution (Rhode Island Hospital) retrospective study between December 1st, 2015, and July 30th, 2016 that included patients with acute ischemic stroke and proximal LVO with CT ASPECTS of 6 or more and 6-24h from symptom onset who were assessed for mechanical embolectomy using MRI based perfusion imaging...
April 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28319240/two-paradigms-for-endovascular-thrombectomy-after-intravenous-thrombolysis-for-acute-ischemic-stroke
#7
Gaspard Gerschenfeld, Ioan-Paul Muresan, Raphael Blanc, Michael Obadia, Marie Abrivard, Michel Piotin, Sonia Alamowitch
Importance: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome. Objective: To compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership)...
March 20, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28318953/mechanical-thrombectomy-in-wake-up-strokes-a-case-series-using-alberta-stroke-program-early-ct-score-aspects-for-patient-selection
#8
Angelos Aristeidis Konstas, Artin Minaeian, Ian B Ross
BACKGROUND: There is lack of published studies on mechanical thrombectomy with stent retrievers for wake-up stroke (WUS). OBJECTIVE: To report the outcomes of WUS patients with large vessel occlusions, selected for intervention based on Alberta Stroke Program Early CT Score (ASPECTS) and treated with stent retrievers or primary aspiration thrombectomy. METHODS: Data were collected retrospectively for each consecutive WUS patient undergoing mechanical thrombectomy with a stent retriever or primary aspiration catheter between February 2015 and September 2016...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28314758/immune-checkpoint-dysfunction-in-medium-and-large-vessel-vasculitis
#9
Ryu Watanabe, Hui Zhang, Gerald Berry, Jorg J Goronzy, Cornelia M Weyand
Giant cell arteritis (GCA) is a granulomatous vasculitis of the aorta and its medium-sized branch vessels. CD4 T-cells, macrophages and dendritic cells build granulomatous infiltrates that injure the vessel wall and elicit a maladaptive response-to-injury. Pathologic consequences include fragmentation of elastic membranes, destruction of the medial layer, microvascular neoangiogenesis, massive outgrowth of myofibroblasts, and lumen-occlusive intimal hyperplasia. Antigens have been suspected to drive the local activation of vasculitogenic CD4 T-cells, but recent data suggest a more generalized defect in the threshold setting of such T-cells, rendering them hyperreactive...
March 17, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28304205/stenting-of-the-cervical-internal-carotid-artery-in-acute-stroke-management-the-karolinska-experience
#10
Anastasios Mpotsaris, Christoph Kabbasch, Jan Borggrefe, Vamsi Gontu, Michael Soderman
Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28304189/physiological-remodeling-of-bifurcation-aneurysms-preclinical-results-of-the-eclips-device
#11
Thomas R Marotta, Howard A Riina, Ian McDougall, Donald R Ricci, Monika Killer-Oberpfalzer
OBJECTIVE Intracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations...
March 17, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28302155/a-prospective-randomised-placebo-controlled-double-masked-three-armed-multicentre-phase-ii-iii-trial-for-the-study-of-a-topical-treatment-of-ischaemic-central-retinal-vein-occlusion-to-prevent-neovascular-glaucoma-the-strong-study-study-protocol-for-a-randomised
#12
Katrin Lorenz, Yvonne Scheller, Katharina Bell, Franz Grus, Katharina A Ponto, Felix Bock, Claus Cursiefen, Jens Flach, Marta Gehring, Tunde Peto, Rufino Silva, Yossi Tal, Norbert Pfeiffer
BACKGROUND: Neovascular glaucoma (NVG) is rare, comprising only 3.9% of all glaucoma cases. The most common cause of NVG is ischaemic central retinal vein occlusion (iCRVO). NVG frequently results in blindness and painful end-stage glaucomatous damage leading to the need for enucleation. Currently, there is no preventive therapy for NVG following iCRVO. Rescue treatments have severe drawbacks. Accordingly, there is a great need for preventing the often visually devastating outcomes of NVG...
March 16, 2017: Trials
https://www.readbyqxmd.com/read/28292867/vessel-patency-at-24-hours-and-its-relationship-with-clinical-outcomes-and-infarct-volume-in-revascat-trial-randomized-trial-of-revascularization-with-solitaire-fr-device-versus-best-medical-therapy-in-the-treatment-of-acute-stroke-due-to-anterior-circulation
#13
Mònica Millán, Sebastià Remollo, Helena Quesada, Arturo Renú, Alejandro Tomasello, Priyanka Minhas, Natalia Pérez de la Ossa, Marta Rubiera, Laura Llull, Pedro Cardona, Fahad Al-Ajlan, María Hernández, Zarina Assis, Andrew M Demchuk, Tudor Jovin, Antoni Dávalos
BACKGROUND AND PURPOSE: Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)...
April 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28289756/predictive-value-of-pooled-cerebral-blood-volume-mapping-for-final-infarct-volume-in-patients-with-major-artery-occlusions-a%C3%A2-retrospective-analysis
#14
Lauma Ava, Joachim Berkefeld, Arne Lauer, Alexander Seiler, Waltraud Pfeilschifter, Monika Müller-Eschner, Se-Jong You, Stefan Weidauer, Ulrich Pilatus, Marlies Wagner
PURPOSE: Detection of ischemic core and collateral status is helpful to predict clinical success of thrombectomy in acute cerebral artery occlusion. Angiographic flat panel detector computed tomography (CT) with pooled blood volume (PBV) data acquisition was described to be helpful to estimate ischemic core in stroke patients prior to thrombectomy and to depict cerebral vessels. We therefore retrospectively evaluated preinterventional PBV data of a large collective of ischemic stroke patients prior to thrombectomy to test its predictive value on final infarct considering PBV maps and collateral status...
March 13, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28289148/admission-hyperglycemia-and-outcomes-in-large-vessel-occlusion-strokes-treated-with-mechanical-thrombectomy
#15
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Kira Dillard, Aristeidis H Katsanos, Georgios Magoufis, Jason J Chang, Ramin Zand, Daniel Hoit, Apostolos Safouris, Asim Choudhri, Anne W Alexandrov, Andrei V Alexandrov, Adam S Arthur, Lucas Elijovich
BACKGROUND AND PURPOSE: Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS: Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated...
March 13, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28285092/visceral-to-subcutaneous-fat-ratio-is-independently-related-to-small-and-large-cerebrovascular-lesions-even-in-healthy-subjects
#16
Satoshi Higuchi, Yusuke Kabeya, Kiyoe Kato
BACKGROUND AND AIMS: The severity of obesity is evaluated by visceral-to-subcutaneous fat ratio (VS ratio), which may be useful for predicting atherosclerosis. However, it is unclear how VS ratio affects different types of cerebrovascular lesions. This study was conducted to evaluate the clinical impact of visceral fat accumulation on the cerebrovascular lesions. METHODS: This cross-sectional study included 980 apparently healthy Japanese adults who underwent a health check-up program focused toward atherosclerosis, between 2011 and 2014...
March 2, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28282456/early-computed-tomography-based-scores-to-predict-decompressive-hemicraniectomy-after-endovascular-therapy-in-acute-ischemic-stroke
#17
Ilko L Maier, Daniel Behme, Marlena Schnieder, Ioannis Tsogkas, Katharina Schregel, Mathias Bähr, Michael Knauth, Jan Liman, Marios-Nikos Psychogios
BACKGROUND: Identification of patients requiring decompressive hemicraniectomy (DH) after endovascular therapy (EVT) is crucial as clinical signs are not reliable and early DH has been shown to improve clinical outcome. The aim of our study was to identify imaging-based scores to predict the risk for space occupying ischemic stroke and DH. METHODS: Prospectively derived data from patients with acute large artery occlusion within the anterior circulation and EVT was analyzed in this monocentric study...
2017: PloS One
https://www.readbyqxmd.com/read/28277464/clot-imaging-in-large-vessel-occlusion-strokes
#18
Johnny H Wong, Michael P Marks
Advances in mechanical thrombectomy techniques have resulted in improved, recanalization and functional outcomes in acute stroke, as demonstrated in recent, randomized trials comparing mechanical thrombectomy with thrombolysis. In conjunction with the technological advancements in thrombectomy devices, there has been better appreciation of stricter patient selection criteria for endovascular therapy based on pre-procedural imaging, including clot location, infarct volume, and penumbral territory at risk. Pre-procedural imaging performed to assess suitability for endovascular therapy commonly provides information on clot characteristics, such as clot location, length, density, and susceptibility, which can influence and may predict the efficacy of intravenous and endovascular treatments...
March 8, 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28272264/the-elevated-lipoprotein-associated-phospholipase-a2-activity-is-associated-with-the-occurrence-and-recurrence-of-acute-cerebral-infarction
#19
Lingli Wei, Zunyu Ke, Yu Zhao, Zhiyou Cai
There is a strong association between lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and atherosclerosis-related diseases. The aim of this study was to investigate the role of Lp-PLA2 in the ischemic stroke and further offer clinical evidence that measuring Lp-PLA2 helps predict the risk of stroke occurrence and recurrence. A total of 328 hospitalized patients were recruited, including 179 cases of acute cerebral infarction (ACI) and 149 non-ACI controls. The serum level of Lp-PLA2 in ACI was significantly higher than non-ACI...
April 12, 2017: Neuroreport
https://www.readbyqxmd.com/read/28263932/open-embolectomy-of-large-vessel-occlusion-in-the-endovascular-era-results-of-a-12-year-single-center-experience
#20
Tetsuyoshi Horiuchi, Junpei Nitta, Yoshinari Miyaoka, Alhusain Nagm, Keiji Tsutsumi, Kiyoshi Ito, Kazuhiro Hongo
BACKGROUND: and Purpose. Mechanical endovascular embolectomy using stent retrievers has gained popularity for the treatment of large vessel occlusion in acute ischemic stroke. Open embolectomy as direct surgical treatment has been limited, likely due to a fear of technical difficulty, therapeutic time window and time consuming. However, open embolectomy resulted in a high complete recanalization rate with safety profile. METHODS: The authors retrospectively reviewed the clinical and radiographic records of patients who underwent open embolectomy for major artery occlusion at acute stage...
March 2, 2017: World Neurosurgery
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