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https://www.readbyqxmd.com/read/29316375/selection-criteria-for-endovascular-therapy-for-acute-ischaemic-stroke-are-patients-missing-out
#1
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/29296623/clarion-call-for-histopathological-clot-analysis-in-cryptogenic-ischemic-stroke-implications-for-diagnosis-and-treatment
#2
Sonu Bhaskar, Dennis Cordato, Cecilia Cappelen-Smith, Andrew Cheung, David Ledingham, David Celermajer, Christopher Levi
Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging...
December 2017: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/29288487/association-between-hemorrhagic-transformation-after-endovascular-therapy-and-poststroke-seizures
#3
Arthur Thevathasan, Jillian Naylor, Leonid Churilov, Peter J Mitchell, Richard J Dowling, Bernard Yan, Patrick Kwan
OBJECTIVE: Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy. METHODS: Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset...
December 30, 2017: Epilepsia
https://www.readbyqxmd.com/read/29238099/8-f-balloon-guide-catheter-for-embolization-of-anterior-circulation-aneurysms-an-institutional-experience-in-152-patients
#4
Tomotaka Ohshima, Chinmaya Dash, Andrey Belayev, Taiki Yamamoto, Shunsaku Goto, Yoko Kato
The use of 8-F balloon guide catheter (BGC) for proximal flow control was previously shown to prevent distal embolic complications during mechanical clot retrieval in patients with acute ischemic stroke. In this retrospective study, the utility of 8-F BGCs for proximal flow control during endovascular coiling of anterior circulation aneurysms was investigated. Patients who underwent endovascular coiling for anterior circulation aneurysms between August 2013 and December 2016 were retrospectively analyzed. Among a total of 152 patients included in this series, 64 patients presented with aneurysmal rupture, whereas the aneurysms were detected incidentally or due to mass effects in the remaining patients...
November 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/29222338/blood-sample-transportation-by-pneumatic-transportation-systems-a-systematic-literature-review
#5
REVIEW
Mads Nybo, Merete E Lund, Kjell Titlestad, Christian U Maegaard
BACKGROUND: Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed. METHODS: A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples...
December 8, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/29209269/if-time-is-brain-where-is-the-improvement-in-prehospital-time-after-stroke
#6
REVIEW
Jeremy N Pulvers, John D G Watson
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29176266/fibrin-clot-architecture-in-acute-ischemic-stroke-treated-with-mechanical-thrombectomy-with-stent-retrievers%C3%A3-cohort-study
#7
Dagmar Krajíčková, Antonín Krajina, Ivo Šteiner, Oldřich Vyšata, Roman Herzig, Miroslav Lojík, Vendelín Chovanec, Jan Raupach, Ondřej Renc, Jan Waishaupt, Eva Vítková, Petr Dulíček, Pavla Čabelková, Martin Vališ
BACKGROUND: The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i...
November 23, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29118805/novel-distal-emboli-protection-technology-the-embotrap
#8
Ju-Yu Chueh, Miklos G Marosfoi, Olivia W Brooks, Robert M King, Ajit S Puri, Matthew J Gounis
Background: Over the course of the thrombectomy procedure, clot fragments may become dislodged and lead to downstream emboli due to manipulation of an endovascular device. The EmboTrap thrombectomy system features an inner stent channel with an outer stent trap design that may potentially reduce the risk of distal clot fragmentation during clot removal. We tested the hypothesis that distal emboli to both the same and new territory generated during mechanical thrombectomy are a function of device design...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118797/comparison-of-vacuum-pressures-and-forces-generated-by-different-catheters-and-pumps-for-aspiration-thrombectomy-in-acute-ischemic-stroke
#9
Michael T Froehler
Background: Direct aspiration thrombectomy is an increasingly utilized technique in endovascular stroke treatment that relies on vacuum and suction force to remove the clot. This report assesses the pressures and forces generated by different catheters and pumps. Methods: Vacuum pressures were measured using a vacuum gauge for several catheters (Stryker Catalyst6, Penumbra Ace 064, Medtronic Arc 061, and Penumbra 041) and pumps (Penumbra pump, 60-mL syringe, and the ASPIRE device)...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29113900/dwell-time-of-stentriever-influences-complete-revascularisation-and-first-pass-tici3-revascularisation-in-acute-large-vessel-occlusive-stroke
#10
Santhosh Kumar Kannath, Jayadevan Enakshy Rajan, Sylaja Padmavathy N, Sankara Sarma P, Sajith Sukumaran, Sapna Erat Sreedharan, Tirur Raman Kapilamoorthy
BACKGROUND AND OBJECTIVE: In acute ischemic stroke with large vessel occlusion, the interaction between the clot retriever and the stent is critical for achieving successful recanalization. The ideal time of stent deployment (dwell time, DT) to improve revascularization is currently unknown., We systematically analysed the effect of different DT on final angiographic and clinical outcome of of patients who underwent mechanical thrombectomy. METHODS: The DT was progressively increased from 3 minutes to 5 minutes and later, 8 minutes during the study period...
November 4, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29089415/periprocedural-heparin-use-in-acute-ischemic-stroke-endovascular-therapy-the-trevo-2-trial
#11
Melanie J Winningham, Diogo C Haussen, Raul G Nogueira, David S Liebeskind, Wade S Smith, Helmi L Lutsep, Tudor G Jovin, Bin Xiang, Fadi Nahab
BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era. METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval...
October 31, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29077175/the-important-role-of-manual-aspiration-through-the-guiding-catheter-during-repeated-solitaire-mechanical-thrombectomy-in-acute-ischemic-stroke
#12
R Xu, X-K Zhao, M-L Wang, X Liu, D Xi
OBJECTIVE: Acute ischemic stroke (AIS) is an important global health problem. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the standard treatment. However, only a small number of patients benefit from it because of strict application restrictions. Increasing evidence has demonstrated that mechanical thrombectomy is an effective and safe therapy for AIS. PATIENTS AND METHODS: We present 14 cases of successful recanalization with Solitaire devices for AIS patients after stroke onset...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29068254/assessment-of-clot-length-with-multiphase-ct-angiography-in-patients-with-acute-ischemic-stroke
#13
Vanessa Polito, Roberta La Piana, Maria Del Pilar Cortes, Donatella Tampieri
Introduction Existing stroke literature demonstrates that rapid recanalization of vessels improves long-term prognosis after acute ischemic stroke. However, further optimization of the speed of the thrombectomy procedure, used to recanalize a blocked vessel, is limited by our minimal knowledge of the clot dimensions pre-procedure. Knowing the clot dimensions would allow planning of the thrombectomy procedure with the appropriate size and length of stent retriever, and determination of the correct site of the stent deployment ensuring total coverage of the clot by the stent retriever...
December 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/29025728/necessary-catheter-diameters-for-mechanical-thrombectomy-with-adapt
#14
O Nikoubashman, A Nikoubashman, M Büsen, M Wiesmann
BACKGROUND AND PURPOSE: Large-bore catheters allow mechanical thrombectomy in ischemic stroke by engaging and retrieving clots without additional devices (direct aspiration first-pass technique [ADAPT]). The purpose of this study was to establish a model for minimal catheter diameters needed for ADAPT. MATERIALS AND METHODS: We established a theoretic model for the calculation of minimal catheter diameters needed for ADAPT. We then verified its validity in 28 ADAPT maneuvers in a porcine in vivo model...
October 12, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29020910/clot-retrieval-and-acute-stroke-care
#15
Yun Tae Hwang, Yash Gawarikar
No abstract text is available yet for this article.
October 16, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/29020909/clot-retrieval-and-acute-stroke-care
#16
Kathleen L Bagot, Dominique A Cadilhac, Chris Bladin
No abstract text is available yet for this article.
October 16, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28878444/experimental-evaluation-and-training-of-stent-clot-retrieval-the-confront-clot-scrambling-method
#17
Tomotaka Ohshima, Shunsaku Goto, Taiki Yamamoto, Kojiro Ishikawa
The introduction of stent retrievers has changed the methods used for acute intracranial thrombectomy, but the training approach has not been discussed enough. We, therefore, aimed to establish a simple skill up method which can be used to train anytime and anywhere with low costs. Also, we introduce our experimental confront clot scrambling method (CCSM) which makes a profitable visualization in how the stent retriever works. The CCSM involved a sham clot set in the middle of a polyvinyl chloride tube, after which two stent retrievers were navigated from each side before being simultaneously withdrawn with the same force...
August 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/28838463/beware-cold-agglutinins-in-organ-donors-ex%C3%A2-vivo-lung-perfusion-from-an-uncontrolled-donation-after-circulatory-determination-of-death-donor-with-a-cold-agglutinin-a-case-report
#18
A Venkataraman, J W Blackwell, W K Funkhouser, K R Birchard, S E Beamer, W T Simmons, S H Randell, T M Egan
BACKGROUND: We began to recover lungs from uncontrolled donation after circulatory determination of death to assess for transplant suitability by means of ex vivo lung perfusion (EVLP) and computerized tomographic (CT) scan. Our first case had a cold agglutinin with an interesting outcome. CASE REPORT: A 60-year-old man collapsed at home and was pronounced dead by Emergency Medical Services personnel. Next-of-kin consented to lung retrieval, and the decedent was ventilated and transported...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28798266/thrombectomy-of-calcified-emboli-in-stroke-does-histology-of-thrombi-influence-the-effectiveness-of-thrombectomy
#19
Tomas Dobrocky, Eike Piechowiak, Alessandro Cianfoni, Felix Zibold, Luca Roccatagliata, Pascal Mosimann, Simon Jung, Urs Fischer, Pasquale Mordasini, Jan Gralla
BACKGROUND AND PURPOSE: Thrombus composition has been postulated to affect the success of endovascular therapy. Calcified clots are composed of large amounts of calcium phosphate which influences their mechanical properties and may serve as a model for testing this hypothesis. The aim of this study was to evaluate the recanalization and complication rates of calcified thromboemboli in patients with acute ischemic stroke who underwent thrombectomy. MATERIAL AND METHODS: A retrospective analysis was performed of all calcified intracranial thromboemboli in patients suffering an acute ischemic stroke, referred for endovascular therapy at two centers between January 2013 and July 2016...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28731381/reperfusion-after-ischemic-stroke-is-associated-with-reduced-brain-edema
#20
Hannah J Irvine, Ann-Christin Ostwaldt, Matthew B Bevers, Simone Dixon, Thomas Wk Battey, Bruce Cv Campbell, Stephen M Davis, Geoffrey A Donnan, Kevin N Sheth, Reza Jahan, Jeffrey L Saver, Chelsea S Kidwell, W Taylor Kimberly
Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3-5 for EPITHET; day 6-8 for MR RESCUE)...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
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