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https://www.readbyqxmd.com/read/28102025/the-direct-referral-to-endovascular-center-criteria-a-proposal-for-pre-hospital-evaluation-of-acute-stroke-in-the-madrid-stroke-network
#1
J Rodríguez-Pardo, B Fuentes, M Alonso de Leciñana, Á Ximénez-Carrillo, G Zapata-Wainberg, J Álvarez-Fraga, F J Barriga, L Castillo, J Carneado-Ruiz, J Díaz-Guzman, J Egido-Herrero, A de Felipe, J Fernández-Ferro, L Frade-Pardo, Á García-Gallardo, A García-Pastor, A Gil-Núñez, C Gómez-Escalonilla, M Guillán, Y Herrero-Infante, J Masjuan-Vallejo, M Á Ortega-Casarrubios, J Vivancos-Mora, E Díez-Tejedor
BACKGROUND AND PURPOSE: For patients with acute ischaemic stroke due to large-vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT-providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large-vessel occlusion at a pre-hospital level, but their predictive value for MT is low...
January 19, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28100764/drip-n-ship-versus-mothership-for-endovascular-treatment-modeling-the-best-transportation-options-for-optimal-outcomes
#2
Matthew S W Milne, Jessalyn K Holodinsky, Michael D Hill, Anders Nygren, Chao Qiu, Mayank Goyal, Noreen Kamal
BACKGROUND AND PURPOSE: There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip 'n Ship) or with PSC bypass and direct transport to the CSC (Mothership)...
January 18, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28099563/brazilian-guidelines-for-endovascular-treatment-of-patients-with-acute-ischemic-stroke
#3
Octávio Marques Pontes-Neto, Pedro Cougo, Sheila Cristina Ouriques Martins, Daniel G Abud, Raul G Nogueira, Maramélia Miranda, Luiz Henrique de Castro-Afonso, Leticia C Rebello, José Guilherme M Pereira Caldas, Rodrigo Bazan, Daniel C Bezerra, Marco Tulio Rezende, Gabriel R de Freitas, Alexandre Longo, Pedro Magalhães, João José Freitas de Carvalho, Francisco José Montalverne, Fabricio Oliveira Lima, Gustavo H V Andrade, Ayrton R Massaro, Jamary Oliveira-Filho, Rubens Gagliardi, Gisele Sampaio Silva
These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus...
January 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/28096478/demographic-procedural-and-30-day-safety-results-from-the-web-intra-saccular-therapy-study-web-it
#4
David Fiorella, Andrew Molyneux, Alexander Coon, Istvan Szikora, Isil Saatci, Feyyaz Baltacioglu, Ali Sultan, Adam Arthur
INTRODUCTION: The Woven EndoBridge (WEB) represents a novel intrasaccular therapeutic option for the treatment of intracranial wide-necked bifurcation aneurysms (WNBAs). The WEB-IT Study is a pivotal Investigational Device Exemption (IDE) study to determine the safety and effectiveness of the WEB device for the treatment of WNBAs located in the anterior and posterior intracranial circulations. We present the patient demographics, procedural characteristics, and 30-day adverse event data for the US WEB-IT study...
January 17, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28095449/does-antiplatelet-therapy-during-bridging-thrombolysis-increase-rates-of-intracerebral-hemorrhage-in-stroke-patients
#5
Anne Broeg-Morvay, Pasquale Mordasini, Agnieszka Slezak, Kai Liesirova, Julia Meisterernst, Gerhard Schroth, Marcel Arnold, Simon Jung, Heinrich P Mattle, Jan Gralla, Urs Fischer
BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) after bridging thrombolysis for acute ischemic stroke is a devastating complication. We aimed to assess whether the additional administration of aspirin during endovascular intervention increases bleeding rates. METHODS: We retrospectively compared bleeding complications and outcome in stroke patients who received bridging thrombolysis with (tPA+ASA) and without (tPA-ASA) aspirin during endovascular intervention between November 2008 and March 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28089998/first-clinical-experience-with-targeted-renal-nerve-demodulation-trend-1-using-a-neurotropic-agent-for-the-treatment-of-sympathetic-hypertension
#6
Nicholas Kipshidze, Horst Sievert, Michael H Wholey, Konstantin Kipiani, Vakhtang Kipiani, Tea Mukhuradze, Mark Wholey, Emily Stein, K T Venkateswara Rao
AIMS: To evaluate the feasibility and safety of a novel targeted neuromodulatory treatment for sympathetic hypertension involving a one-time local injection of neurotropic agents near renal nerves. METHODS AND RESULTS: Seven patients suffering from uncontrolled hypertension per ESH-ESC guidelines were treated using a single dose of NW2013, a neurotropic Na+/K+ ATPase antagonist. A microneedle catheter was used to administer 1.2 mL of NW2013 (0.6 mL per artery) to the perivascular space surrounding renal arteries using percutaneous endovascular procedures under fluoroscopic guidance...
January 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#7
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28089539/reperfusion-therapy-in-patients-with-acute-ischaemic-stroke-caused-by-cervical-artery-dissection
#8
L A Crespo Araico, R Vera Lechuga, A Cruz-Culebras, C Matute Lozano, A de Felipe Mimbrera, P Agüero Rabes, E Viedma Guiard, C Estévez Fraga, J Masjuan Vallejo
INTRODUCTION: Cervical artery dissection (CAD) is responsible for up to 20% of all ischaemic strokes in patients younger than 45. The benefits of acute-phase reperfusion therapy in these patients have yet to be confirmed. METHODS: We conducted a retrospective review of patients with CAD admitted to a comprehensive stroke centre between 2010 and 2015. We recorded baseline clinical characteristics, treatments, functional outcomes, and mortality. RESULTS: We identified 35 cases of CAD (23 carotid/12 vertebral); mean age was 43...
January 12, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28089197/long-term-follow-up-analysis-of-microsurgical-clip-ligation-and-endovascular-coil-embolization-for-dorsal-wall-blister-aneurysms-of-the-internal-carotid-artery
#9
Mason A Brown, Cristian F Guandique, Jonathan Parish, Aubrey C McMillan, Stephen Lehnert, Nassir Mansour, Michael Tu, Bradley N Bohnstedt, Troy D Payner, Thomas J Leipzig, Andrew J DeNardo, John A Scott, Aaron A Cohen-Gadol
: Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15...
January 11, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28081270/outcome-and-treatment-effects-in-stroke-associated-with-acute-cervical-ica-occlusion
#10
Michael Gliem, John-Ih Lee, Aurica Barckhan, Bernd Turowski, Hans-Peter Hartung, Sebastian Jander
BACKGROUND: Endovascular therapy (EVT) with stent retrievers in addition to i.v. thrombolysis (IVT) has proven effective in acute stroke patients with middle cerebral artery (MCA, M1 segment) and distal internal carotid artery (ICA) occlusion. Limited data exist concerning acute cervical ICA occlusion, either alone or in combination with intracranial ICA occlusion (tandem occlusion). Therefore we analyzed outcome and treatment effects in stroke associated with cervical ICA occlusion, with specific focus on the impact of intracranial ICA or M1 patency...
2017: PloS One
https://www.readbyqxmd.com/read/28068417/preserved-collateral-blood-flow-in-the-endovascular-m2cao-model-allows-for-clinically-relevant-profiling-of-injury-progression-in-acute-ischemic-stroke
#11
Philip Little, Ola Kvist, Rikard Grankvist, Stefan Jonsson, Peter Damberg, Michael Söderman, Fabian Arnberg, Staffan Holmin
Interventional treatment regimens have increased the demand for accurate understanding of the progression of injury in acute ischemic stroke. However, conventional animal models severely inhibit collateral blood flow and mimic the malignant infarction profile not suitable for treatment. The aim of this study was to provide a clinically relevant profile of the emergence and course of ischemic injury in cases suitable for acute intervention, and was achieved by employing a M2 occlusion model (M2CAO) that more accurately simulates middle cerebral artery (MCA) occlusion in humans...
2017: PloS One
https://www.readbyqxmd.com/read/28067615/intracranial-atherosclerosis-from-anatomy-to-pathophysiology
#12
Yuehua Pu, Linfang Lan, Xinyi Leng, Lawrence Ks Wong, Liping Liu
Background Intracranial atherosclerotic stenosis is an important etiology subtype of ischemic stroke. Stenosis severity was thought to be the main reference index for clinical treatment and research. However, stenosis could not reflect the ischemia risk completely, instead the hemodynamic state across the lesion, the extent of collateral circulation, and perfusion impairment downstream the stenosis are more important. Aims We write this review aimed to summarize novel angiographic methods applied in the evaluation of functional severity of ICAS, and commented on their limitations and prospects in future research...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28065240/endovascular-repair-for-acute-type-b-aortic-dissection
#13
Wei Ye, Chang-Wei Liu, Xiao-Jun Song, Yong-Jun Li, Bao Liu, Yue-Hong Zheng, Rong Zeng
Objective To report experience and result of endovascular repair for acute type B aortic dissection (ATBD). Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and 10 cases underwent visceral artery revascularization...
December 20, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/28064357/ischemic-stroke-experimental-models-and-reality
#14
REVIEW
Clemens J Sommer
The vast majority of cerebral stroke cases are caused by transient or permanent occlusion of a cerebral blood vessel ("ischemic stroke") eventually leading to brain infarction. The final infarct size and the neurological outcome depend on a multitude of factors such as the duration and severity of ischemia, the existence of collateral systems and an adequate systemic blood pressure, etiology and localization of the infarct, but also on age, sex, comorbidities with the respective multimedication and genetic background...
January 7, 2017: Acta Neuropathologica
https://www.readbyqxmd.com/read/28062859/outcomes-after-direct-thrombectomy-or-combined-intravenous-and-endovascular-treatment-are-not-different
#15
Sònia Abilleira, Aida Ribera, Pedro Cardona, Marta Rubiera, Elena López-Cancio, Sergi Amaro, Ana Rodríguez-Campello, Pol Camps-Renom, David Cánovas, Maria Angels de Miquel, Alejandro Tomasello, Sebastian Remollo, Antonio López-Rueda, Elio Vivas, Joan Perendreu, Miquel Gallofré
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. METHODS: Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score...
January 6, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28062805/intravenous-thrombolysis-before-endovascular-therapy-for-large-vessel-strokes-can-lead-to-significantly-higher-hospital-costs-without-improving-outcomes
#16
Ansaar T Rai, SoHyun Boo, Chelsea Buseman, Amelia K Adcock, Abdul R Tarabishy, Maurice M Miller, Thomas D Roberts, Jennifer R Domico, Jeffrey S Carpenter
BACKGROUND: Limited efficacy of IV recombinant tissue plasminogen activator (rt-PA) for large vessel occlusions (LVO) raises doubts about its utility prior to endovascular therapy. PURPOSE: To compare outcomes and hospital costs for anterior circulation LVOs (middle cerebral artery, internal carotid artery terminus (ICA-T)) treated with either primary endovascular therapy alone (EV-Only) or bridging therapy (IV+EV)). METHODS: A single-center retrospective analysis was performed...
January 6, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28059705/emergent-endovascular-management-of-long-segment-and-flow-limiting-carotid-artery-dissections-in-acute-ischemic-stroke-intervention-with-multiple-tandem-stents
#17
S A Ansari, A L Kühn, A R Honarmand, M Khan, M C Hurley, M B Potts, B S Jahromi, A Shaibani, M J Gounis, A K Wakhloo, A S Puri
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4)...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28048545/we-de-207a-04-advances-in-radiological-neuro-endovascular-interventional-imaging
#18
S Rudin
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048454/we-de-207a-00-advances-in-image-guided-neurointerventions-clinical-pull-and-technology-push
#19
Jeffrey Siewerdsen, Rebecca Fahrig
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047800/we-de-207a-01-parallels-in-the-evolution-of-x-ray-angiographic-systems-and-devices-used-for-minimally-invasive-endovascular-therapy
#20
C Strother
: 1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures...
June 2016: Medical Physics
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