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https://www.readbyqxmd.com/read/29909558/blood-brain-barrier-permeability-assessed-by-perfusion-computed-tomography-predicts-hemorrhagic-transformation-in-acute-reperfusion-therapy
#1
Taewon Kim, Jaseong Koo, Seong-Hoon Kim, In-Uk Song, Sung-Woo Chung, Kwang-Soo Lee
Hemorrhagic transformation (HT) is one of the most feared complications of acute recanalization therapies. The aim of this study was to evaluate whether blood-brain barrier permeability (BBBP) imaging can predict HT in the setting of acute recanalization therapy and to determine the sensitivity and specificity of BBBP for the prediction of HT according to the type of reperfusion therapy. We assessed a total of 46 patients who received recanalization therapy (intravenous (IV) recombinant tissue plasminogen activator (tPA), mechanical thrombectomy with a stent retriever or both) for acute ischemic stroke within the internal carotid artery or middle cerebral artery...
June 16, 2018: Neurological Sciences
https://www.readbyqxmd.com/read/29907575/current-evidence-for-anesthesia-management-during-endovascular-stroke-therapy-updated-systematic-review-and-meta-analysis
#2
Nitin Goyal, Konark Malhotra, Muhammad F Ishfaq, Georgios Tsivgoulis, Christopher Nickele, Daniel Hoit, Adam S Arthur, Andrei V Alexandrov, Lucas Elijovich
INTRODUCTION: Debate continues about the optimal anesthetic management for patients undergoing endovascular treatment (ET) of acute ischemic stroke due to emergent large vessel occlusion. OBJECTIVE: To compare, using current evidence, the clinical outcomes and procedural characteristics among patients undergoing general anesthesia (GA) and local or monitored anesthesia (non-GA). METHODS: We performed a systematic review and meta-analysis of all available studies that involved the use of stent retrievers for ET (stentriever group)...
June 15, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29903395/incidence-prognosis-and-prediction-of-haemorrhagic-transformation-after-revascularisation-for-stroke
#3
P B García Jurado, E Roldán Romero, M E Pérez Montilla, R Valverde Moyano, I M Bravo Rey, F Delgado Acosta, F A Bravo-Rodríguez
INTRODUCTION: Haemorrhagic transformation is a major complication of acute ischaemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial haemorrhage (ICH) after revascularisation therapy. METHODS: We conducted a retrospective, single-centre study including 235 patients with AIS who underwent intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy and/or endovascular treatment. A binary logistic regression model was used to determine the variables associated with ICH, parenchymal haematomas (PH), modified Rankin Scale (mRS) scores, and mortality...
June 11, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/29900409/estimating-the-number-of-uk-stroke-patients-eligible-for-endovascular-thrombectomy
#4
Peter McMeekin, Philip White, Martin A James, Christopher I Price, Darren Flynn, Gary A Ford
Introduction: Endovascular thrombectomy is a highly effective treatment for acute ischemic stroke due to large arterial occlusion. Routine provision will require major changes in service configuration and workforce. An important first step is to quantify the population of stroke patients that could benefit. We estimated the annual UK population suitable for endovascular thrombectomy using standard or advanced imaging for patient selection. Patients and methods: Evidence from randomised control trials and national registries was combined to estimate UK stroke incidence and define a decision-tree describing the endovascular thrombectomy eligible population...
December 2017: European stroke journal
https://www.readbyqxmd.com/read/29898080/rescue-therapy-with-stent-retrievers-for-thromboembolism-during-endovascular-treatment-of-intracranial-aneurysms
#5
Zeferino Demartini Junior, Luana A Maranha Gatto, Gelson Luis Koppe, Tatiana F von Hertwig de Oliveira, Alexandre Novicki Francisco
Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths...
May 2018: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/29896044/open-replacement-of-the-thoracoabdominal-aorta-short-and-long-term-outcomes-at-a-single-institution
#6
Davide Carino, Young Erben, Mohammad A Zafar, Mrinal Singh, Adam J Brownstein, Maryann Tranquilli, John Rizzo, Bulat A Ziganshin, John A Elefteriades
Background  Despite much progress in the surgical and endovascular treatment of thoracoabdominal aortic diseases (TAADs), there is no consensus regarding the optimal approach to minimize operative mortality and end-organ dysfunction. We report our experience in the past 16 years treating TAAD by open surgery. Methods  A retrospective review of all TAAD patients who underwent an open repair since January 2000 was performed. The primary endpoints included early morbidity and mortality, and the secondary endpoints were overall death and rate of aortic reintervention...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/29894594/percutaneous-access-versus-surgical-cut-down-for-tavr-where-do-we-go-from-here
#7
EDITORIAL
Ismail Ates, Mehmet Cilingiroglu
Transcatheter aortic valve replacement is now the standard of care for severe symptomatic aortic stenosis patients who are at high-surgical risk. Percutaneous approach without a surgical cut down has been increasingly adapted by some centers in USA. Percutaneous approach seems to be associated with shorter hospital stay, similar short and late vascular complications, less disabling stroke, similar mortality as well as significantly less hospital cost. However, this technique also requires operators to be able to manage any vascular complications using advanced endovascular interventions to achieve complete hemostasis...
June 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29893647/the-powerful-benefit-of-endovascular-thrombectomy-for-acute-ischemic-stroke-driving-major-changes-in-stroke-systems-of-care-and-imaging-triage
#8
https://www.readbyqxmd.com/read/29893641/cost-effectiveness-of-endovascular-therapy-for-acute-ischemic-stroke-a-systematic-review-of-the-impact-of-patient-age
#9
Wolfgang G Kunz, Myriam G Hunink, Konstantinos Dimitriadis, Thomas Huber, Franziska Dorn, Felix G Meinel, Bastian O Sabel, Ahmed E Othman, Maximilian F Reiser, Birgit Ertl-Wagner, Wieland H Sommer, Kolja M Thierfelder
Purpose To determine the impact of patient age on the cost-effectiveness of endovascular therapy (EVT) in addition to standard care (SC) in large-vessel-occlusion stroke for patients aged 50 to 100 years in the United States. Materials and Methods A decision-analytic Markov model was used to estimate direct and indirect lifetime costs and quality-adjusted life years (QALYs). Age-dependent input parameters were obtained from the literature. Deterministic and probabilistic sensitivity analysis for age at index stroke were used...
June 12, 2018: Radiology
https://www.readbyqxmd.com/read/29891030/the-history-of-proximal-carotid-protection-and-flow-reversal-to-prevent-stent-angioplasty-embolization
#10
Juan Parodi, Mark C Bates, Takao Ohki, Claudio Schönholz
Innovation in medicine is often driven by the observations of imaginative physicians who are blessed with insatiable curiosity, coupled with the inability to accept technical boundaries, the status quo of patient care, or the acceptance of procedural morbidity. Few examples illustrate this truism better than the physician-originated clinical research that transformed the safety of carotid stent angioplasty over the last 2 decades. Initial clinical application of carotid stenting suggested that proximal protection may be a better approach to prevent embolic stroke during the angioplasty procedure...
March 2018: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29888985/exosome-mediated-amplification-of-endogenous-brain-repair-mechanisms-and-brain-and-systemic-organ-interaction-in-modulating-neurological-outcome-after-stroke
#11
Poornima Venkat, Jieli Chen, Michael Chopp
Ischemic stroke is caused by a regional interruption of cerebral blood flow to the brain. Rigorous pre-clinical and clinical research has made landmark progress in stroke treatment using thrombolytics and endovascular thrombectomy. Although numerous successful neuroprotective therapeutic agents for ischemic stroke have been reported in pre-clinical studies, most of them failed in clinical testing. Persistent pre-clinical research has demonstrated that the ischemic brain is not only passively dying but is also actively recovering...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29886718/nationwide-estimation-of-eligibility-for-endovascular-thrombectomy-based-on-the-dawn-trial
#12
Keon-Joo Lee, Beom Joon Kim, Dong-Eog Kim, Wi-Sun Ryu, Moon-Ku Han, Joon-Tae Kim, Kang-Ho Choi, Ki-Hyun Cho, Jae-Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Mi-Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, Keun-Sik Hong, Yong-Jin Cho, Tai Hwan Park, Kyung Bok Lee, Jun Lee, Ji Sung Lee, Juneyoung Lee, Hee-Joon Bae
No abstract text is available yet for this article.
May 2018: Journal of Stroke
https://www.readbyqxmd.com/read/29886218/concomitant-hybrid-arch-vessel-reconstruction-and-intracranial-clot-retrieval-in-takayasu-s-arteritis-presenting-with-acute-cerebral-ischaemia-a-case-report
#13
Leonard Shan, David Goh, Timothy Wagner
INTRODUCTION: Type 1 Takayasu's arteritis (TA) predominantly affects the supra-aortic branches. Occlusive disease can cause catastrophic complications such as stroke and death. Open and endovascular techniques of revascularisation are described for extracranial disease. There is currently no default choice of surgical intervention. Furthermore, the management of distal intracranial complications has not been described. PRESENTATION OF CASE: A 25-year-old lady with known TA on immunosuppression presents with acute left middle cerebral artery (MCA) stroke...
June 7, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29884480/predictors-of-serious-morbidity-and-mortality-after-endovascular-repair-of-aortoiliac-lesions
#14
A Taylor Thomas, I Michael Leitman
BACKGROUND: Endovascular approaches to aortoiliac disease are becoming increasingly frequent due to decreases in recovery time, bleeding, and discomfort. Despite this trend, little is known about the predictors of complications. This study was designed to identify risk factors for major 30-day morbidity and mortality after endovascular repair. METHODS: Data were derived from the 2015-2016 Participant User Files and Procedure Targeted databases of the American College of Surgeons National Surgical Quality Improvement Program...
June 5, 2018: Surgery
https://www.readbyqxmd.com/read/29882711/cost-effectiveness-analysis-of-mechanical-thrombectomy-with-stent-retriever-in-the-treatment-of-acute-ischemic-stroke-in-italy
#15
Michele Ruggeri, Matteo Basile, Andrea Zini, Salvatore Mangiafico, Elio Clemente Agostoni, Kyriakos Lobotesis, Jeffrey Saver, Silvia Coretti, Cralo Drago, Americo Cicchetti
BACKGROUND: Stroke has a significant disease burden in terms of acute and long-term disability in Italy and throughout the world. Endovascular treatments for the management of a stroke event have been coupled in the past years with the possibility to mechanically remove the occlusion by means of specially designed thrombectomy devices, and their exclusive use showed levels of effectiveness in line with those of the existing pharmacological treatments. OBJECTIVE: To assess the cost-effectiveness of mechanical thrombectomy (MT) with the Solitaire™ Revascularization Device (stent retriever) for the treatment of acute ischemic stroke (AIS) in patients with large vessel occlusions (LVOs), comparing MT plus intravenous tissue plasminogen activation (MT plus IV t-PA) versus IV t-PA alone, in Italy...
June 8, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29882061/combined-treatment-approach-to-cerebral-arteriovenous-malformation-in-pediatric-patients-stereotactic-radiosurgery-to-partially-onyx-embolized-avm
#16
Daniel Umansky, Benjamin W Corn, Ido Strauss, Natan Shtraus, Shlomi Constantini, Vladimir Frolov, Shimon Maimon, Andrew A Kanner
PURPOSE: Treatment of cerebral arteriovenous malformations (AVM)-the most common cause of stroke in the pediatric population-can be challenging due to the complexity of size, morphology, and location. There is a significant risk in comparison to AVM treatment among adults. Thus, AVM treatment in the pediatric population imposes unique challenges. Recent improvements include optimized catheter techniques and better embolization materials, such as Onyx, a non-adhesive liquid embolic agent used in the adult population...
June 7, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29879696/tenacity-of-collateral-perfusion-in-proximal-cerebral-arterial-occlusions-6-12-h-after-onset
#17
Beom Joon Kim, Hyeran Kim, Han-Gil Jeong, Mi Hwa Yang, Cheol Kyu Jung, Moon-Ku Han, Jae Hyoung Kim, Andrew M Demchuk, Hee-Joon Bae
BACKGROUND: Clinical trials have shown that benefits of endovascular recanalization (EVT) for acute ischemic stroke patients with sizable penumbral tissues seems plausible even beyond 6 h after their last seen normal (LSN). Persistency of ischemic penumbra remains unclear in delayed periods. METHODS: From a prospective stroke registry database, we identified 111 acute ischemic stroke patients who had internal carotid artery or middle cerebral artery occlusion with baseline National Institutes of Health Stroke Scale scores ≥6 points and arrived 6-12 h after LSN...
June 7, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29875592/superficial-temporal-artery-middle-cerebral-artery-bypass-for-the-treatment-of-complex-middle-cerebral-artery-aneurysms
#18
Chien-Hui Lee, Sheng-Tzung Tsai, Tsung-Lang Chiu
Objectives: Direct microsurgical clipping for complex middle cerebral artery (MCA) aneurysms may require a long ischemic time. Sacrifice of the parent artery with trapping or endovascular coiling also may lead to ischemic stroke. We described our institutional experience with the treatment of complex MCA aneurysms using extracranial-intracranial (EC-IC) (superficial temporal artery [STA]-MCA) bypass. Materials and Methods: We retrospectively reviewed patients who had treatment of IC aneurysms with the assistance of STA-MCA bypass from July 2002 to December 2016...
April 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/29874923/endovascular-thrombectomy-in-anterior-circulation-stroke-and-clinical-value-of-bridging-with-intravenous-thrombolysis
#19
Arturs Balodis, Maija Radzina, Evija Miglane, Anthony Rudd, Andrejs Millers, Janis Savlovskis, Karlis Kupcs
Background Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT...
January 1, 2018: Acta Radiologica
https://www.readbyqxmd.com/read/29871562/safety-profile-of-an-8f-femoral-arteriotomy-closure-using-the-angio-seal-device-in-thrombolysed-acute-stroke-patients-undergoing-thrombectomy
#20
James Wareham, Sebastian Luppe, Adam Youssef, Robert Crossley, Alex Mortimer
Background The relationship between bridging thrombolysis and femoral access site complications after mechanical thrombectomy remains contested. Use of a closure device could minimise bleeding complications. This study aimed to elucidate the rate of access site complications in a cohort of patients treated using an 8F groin sheath with subsequent closure using the Angio-Seal to assess safety and the impact of bridging thrombolysis on access site complication rate. Methods All patients with large vessel occlusive stroke treated between 2014 and 2017 with thrombectomy with or without bridging thrombolysis were reviewed...
January 1, 2018: Interventional Neuroradiology
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