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Endovascular treatment of stroke

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https://www.readbyqxmd.com/read/28811003/the-impact-of-thoracic-endovascular-aortic-repair-on-long-term-survival-in-type-b-aortic%C3%A2-dissection
#1
Xiaoying Lou, Edward P Chen, Yazan M Duwayri, Ravi K Veeraswamy, William D Jordan, Carl A Zehner, Bradley G Leshnower
BACKGROUND: Currently, optimal medical therapy is first-line therapy for uncomplicated acute type B aortic dissection (aTBAD) despite poor long-term outcomes. This study examines the impact of thoracic endovascular aortic repair (TEVAR) in the acute and chronic phases on short-term and long-term survival of patients presenting with aTBAD. METHODS: A review of the Emory aortic database from 2000 to 2016 identified 398 patients diagnosed with aTBAD. At index hospitalization, complicated patients underwent TEVAR (aTEVAR [thoracic endovascular aortic repair in the acute phase], n = 80) and uncomplicated patients received optimal medical therapy (n = 318)...
August 12, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28808606/middle-cerebral-artery-dissection-causing-subarachnoid-hemorrhage-and-cerebral-infarction-trapping-with-high-flow-bypass-preserving-the-lenticulostriate-artery
#2
Hideaki Ono, Tomohiro Inoue, Shinya Suematsu, Takeo Tanishima, Akira Tamura, Isamu Saito, Nobuhito Saito
BACKGROUND: Spontaneous intracranial arterial dissection (IAD) is an increasingly important cause of stroke, such as subarachnoid hemorrhage (SAH) and hemodynamic or thromboembolic cerebral ischemia. IAD usually occurs in the posterior circulation, and is relatively rare in the anterior circulation including the middle cerebral artery (MCA). Various surgical and endovascular methods to reduce blood flow in the dissected lesion have been proposed, but no optimum treatment has been established...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28801174/the-cerebral-collateral-circulation-relevance-to-pathophysiology-and-treatment-of-stroke
#3
REVIEW
Myron D Ginsberg
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome...
August 8, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28799861/absence-of-cortical-vein-opacification-is-associated-with-lack-of-intra-arterial-therapy-benefit-in-stroke
#4
Ivo G H Jansen, Annemieke B van Vuuren, Wim H van Zwam, Ido R van den Wijngaard, Olvert A Berkhemer, Hester F Lingsma, Cornelis H Slump, Robert J van Oostenbrugge, Kilian M Treurniet, Diederik W J Dippel, Marianne A A van Walderveen, Aad van der Lugt, Yvo B W E M Roos, Henk A Marquering, Charles B L M Majoie, René van den Berg
Purpose To assess the degree of cortical vein opacification in patients with internal carotid artery or middle cerebral artery (MCA) stroke and to evaluate the relationship with treatment benefit from intra-arterial therapy (IAT). Materials and Methods Written informed consent was obtained from all patients in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands. From the trial's database, all patients (recruited from December 2010 until March 2014) with baseline computed tomographic (CT) angiograms were retrospectively included...
August 11, 2017: Radiology
https://www.readbyqxmd.com/read/28798906/cerebral-sinovenous-thrombosis
#5
REVIEW
Rebecca Ichord
Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30-50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28798267/pretreatment-predictors-of-malignant-evolution-in-patients-with-ischemic-stroke-undergoing-mechanical-thrombectomy
#6
Alessandro Davoli, Caterina Motta, Giacomo Koch, Marina Diomedi, Simone Napolitano, Angela Giordano, Marta Panella, Daniele Morosetti, Sebastiano Fabiano, Roberto Floris, Roberto Gandini, Fabrizio Sallustio
BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET. METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28798217/multicenter-experience-with-fred-jr-flow-re-direction-endoluminal-device-for-intracranial-aneurysms-in-small-arteries
#7
M A Möhlenbruch, O Kizilkilic, M Killer-Oberpfalzer, F Baltacioglu, C Islak, M Bendszus, S Cekirge, I Saatci, N Kocer
BACKGROUND AND PURPOSE: Flow diverters are emerging as an endovascular treatment alternative for proximally located intracranial aneurysms. However, treatment of aneurysms at and beyond the circle of Willis is not well-established. We assessed the clinical safety and efficacy of the Flow Re-Direction Endoluminal Device Jr (FRED Jr) dedicated to small-vessel diameters between 2.0 and 3.0 mm. MATERIALS AND METHODS: This was a multicenter observational clinical study of 42 patients with 47 aneurysms treated by a flow-direction technique with the FRED Jr...
August 10, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28794825/interventional-radiology-treatment-for-pulmonary-embolism
#8
REVIEW
Miguel A De Gregorio, Jose A Guirola, Celia Lahuerta, Carolina Serrano, Ana L Figueredo, William T Kuo
Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach...
July 28, 2017: World Journal of Radiology
https://www.readbyqxmd.com/read/28792246/assessing-the-efficacy-of-endovascular-therapy-in-stroke-treatments-updates-from-the-new-generation-of-trials
#9
Gregory B Walker, Ashutosh P Jadhav, Tudor G Jovin
For the past 20 years, intravenous recombinant tissue plasminogen activator (rt-PA) has been the only proven treatment for acute ischemic stroke. Large arteries such as the internal carotid artery, the middle cerebral artery and the basilar artery supply blood to large volumes of brain tissue. When occluded, these vessels may have low response rates to rt-PA resulting in devastating injury and death. . Areas Covered: In 2013, three trials evaluating the efficacy of mechanical thrombectomy in acute stroke were neutral, however, lessons learned from these trials resulted in a second generation of five trials in 2015 and a sixth in 2016 which all demonstrated significant benefit for select patients...
August 9, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28791192/dragon-score-predicts-functional-outcomes-in-acute-ischemic-stroke-patients-receiving-both-intravenous-tissue-plasminogen-activator-and-endovascular-therapy
#10
Arthur Wang, Noorie Pednekar, Rachel Lehrer, Akira Todo, Ramandeep Sahni, Stephen Marks, Michael F Stiefel
BACKGROUND: The DRAGON score, which includes clinical and computed tomographic (CT) scan parameters, predicts functional outcomes in ischemic stroke patients treated with intravenous tissue plasminogen activator (IV tPA). We assessed the utility of the DRAGON score in predicting functional outcome in stroke patients receiving both IV tPA and endovascular therapy. METHODS: A retrospective chart review of patients treated at our institution from February 2009 to October 2015 was conducted...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28790213/-surgical-treatment-of-cervical-carotid-artery-aneurysm
#11
Ryo Hamasaki, Toshiharu Yanagisawa, Yusuke Takahashi, Hiroaki Shimizu
Cervical carotid aneurysms are rare, and surgical treatment should be planned for each patient. The authors report 9 cases of cervical carotid aneurysm in 9 patients(mean age, 53.7 years;5 men)who were treated surgically between 2005 and 2014. The aneurysm was located in the internal carotid artery in 6 patients, the common carotid artery in 2 patients, and the carotid bifurcation in 1 patient. Four aneurysms were recurrences after a previous endovascular intervention(parent artery coil embolization, covered stent placement, or stent with coil embolization)...
August 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28776270/infarct-fogging-on-immediate-postinterventional-ct-a-not-infrequent-occurrence
#12
Sven Dekeyzer, Arno Reich, Ahmed E Othman, Martin Wiesmann, Omid Nikoubashman
PURPOSE: A pseudo-normalization of infarcted brain parenchyma, similar to the "fogging effect" which usually occurs after 2-3 weeks, can be observed on CT performed immediately after endovascular stroke treatment (EST). Goal of this study was to analyze the incidence of this phenomenon and its evolution on follow-up imaging. METHODS: One hundred fifty-two patients in our database of 949 patients, who were treated for acute stroke between January 2010 and January 2015, fulfilled the inclusion criteria of (a) EST for an acute stroke in the anterior circulation, (b) an ASPECT-score < 10 on pre-interventional CT, and (c) postinterventional CT imaging within 4...
August 3, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28768820/thrombectomy-versus-medical-management-for-large-vessel-occlusion-strokes-with-minimal-symptoms-an-analysis-from-stopstroke-and-gestor-cohorts
#13
Diogo C Haussen, Fabricio O Lima, Mehdi Bouslama, Jonathan A Grossberg, Gisele S Silva, Michael H Lev, Karen Furie, Walter Koroshetz, Michael R Frankel, Raul G Nogueira
INTRODUCTION: It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy. OBJECTIVE: To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score ≤5. METHODS: This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score ≤5, (2) premorbid modified Rankin Scale (mRS) score 0-2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions...
August 2, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28768462/approaches-to-the-field-recognition-of-potential-thrombectomy-candidates
#14
Stephen C van Gaal, Noreen Kamal, Michael J Betzner, Renee L Vilneff, Balraj Mann, Eddy S Lang, Andrew Demchuk, Brian Buck, Thomas Jeerakathil, Michael D Hill
Systems of care for acute ischemic stroke are being challenged to implement processes that ensure rapid access to endovascular thrombectomy. Optimizing existing regionalized stroke thrombolysis programs for endovascular thrombectomy will require accurate field recognition of treatment candidates. We begin with a review of the development of early clinical tests for ischemic stroke, illustrating challenges relevant to future field tests for large vessel occlusion. Second, we discuss aspects of diagnosis, eligibility, feasibility, and system organization that are potentially relevant to the development and implementation of field tests and diversion criteria...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28767806/extracranial-carotid-stenosis-evidence-based-review
#15
Carolina Dutra Queiroz Flumignan, Ronald Luiz Gomes Flumignan, Túlio Pinho Navarro
Extracranial cerebrovascular disease is one of the most important causes of death and disability worldwide and its treatment is based on clinical and surgical strategies, the latter being performed by conventional or endovascular techniques. The management of stenosis of the carotid bifurcation is mainly aimed at preventing stroke and has been the subject of extensive investigation. The role of clinical treatment has been re-emphasized, but carotid endarterectomy remains the first-line treatment for symptomatic patients with 50% to 99% stenosis and for asymptomatic patients with 60% to 99% stenosis...
May 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28767503/neuroendovascular-surgery-for-the-treatment-of-ischemic-stroke
#16
Arthur Wang, Meic H Schmidt
This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Advanced perfusion imaging helps identify patients with a low ratio of ischemic core to salvageable penumbra...
June 22, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28765288/association-of-computed-tomography-ischemic-lesion-location-with-functional-outcome-in-acute-large-vessel-occlusion-ischemic-stroke
#17
Marielle Ernst, Anna M M Boers, Annette Aigner, Olvert A Berkhemer, Albert J Yoo, Yvo B Roos, Diederik W J Dippel, Aad van der Lugt, Robert J van Oostenbrugge, Wim H van Zwam, Jens Fiehler, Henk A Marquering, Charles B L M Majoie
BACKGROUND AND PURPOSE: Ischemic lesion volume (ILV) assessed by follow-up noncontrast computed tomography correlates only moderately with clinical end points, such as the modified Rankin Scale (mRS). We hypothesized that the association between follow-up noncontrast computed tomography ILV and outcome as assessed with mRS 3 months after stroke is strengthened when taking the mRS relevance of the infarct location into account. METHODS: An anatomic atlas with 66 areas was registered to the follow-up noncontrast computed tomographic images of 254 patients from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)...
August 1, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28763550/effect-of-endovascular-contact-aspiration-vs-stent-retriever-on-revascularization-in-patients-with-acute-ischemic-stroke-and-large-vessel-occlusion-the-aster-randomized-clinical-trial
#18
RANDOMIZED CONTROLLED TRIAL
Bertrand Lapergue, Raphael Blanc, Benjamin Gory, Julien Labreuche, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin
Importance: The benefits of endovascular revascularization using the contact aspiration technique vs the stent retriever technique in patients with acute ischemic stroke remain uncertain because of lack of evidence from randomized trials. Objective: To compare efficacy and adverse events using the contact aspiration technique vs the standard stent retriever technique as a first-line endovascular treatment for successful revascularization among patients with acute ischemic stroke and large vessel occlusion...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28763432/endovascular-treatment-of-acute-ischemic-stroke-under-general-anesthesia-predictors-of-good-outcome
#19
Umeshkumar Athiraman, Ali Sultan-Qurraie, Bala Nair, David L Tirschwell, Basavaraj Ghodke, Adam D Havenon, Danial K Hallam, Louis J Kim, Kyra J Becker, Deepak Sharma
BACKGROUND: The choice of anesthetic technique, general anesthesia (GA) versus Monitored Anesthesia Care, may impact the outcome of patients undergoing endovascular treatment of acute ischemic stroke (AIS). The aim of this study was to identify the factors associated with good discharge outcome in patients receiving GA for AIS. MATERIALS AND METHODS: Electronic medical records of patients above 18 years old who underwent endovascular treatment of AIS under GA at a Comprehensive Stroke Center from 2010 to 2014 were reviewed...
July 31, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28761627/acute-management-of-stroke-in-iran-obstacles-and-solutions
#20
Shima Shahjouei, Reza Bavarsad-Shahripour, Farhad Assarzadegan, Reza Rikhtegar, Masoud Mehrpour, Babak Zamani, Georgios Tsivgoulis, Andrei Alexandrov, Anne Alexandrov, Ramin Zand
Background: Stroke is among the leading causes of mortality and permanent disability in the world. Iran is located in the stroke belt and has a high age-adjusted stroke incidence rate. In this multistep prospective qualitative study, we aimed at investigating the status and challenges of stroke management in Iran and explore possible solutions. Methods: In the first and second phase, we attempted to define the status of stroke management in Iran by searching the relevant literature and conducting semi-structured interviews with health-care providers in thirteen hospitals located in seven large cities in Iran...
April 4, 2017: Iranian Journal of Neurology
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