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Endovascular treatment of stroke

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https://www.readbyqxmd.com/read/29351610/orthotopic-branched-endovascular-aortic-arch-repair-in-patients-who-cannot-undergo-classical-surgery
#1
Martin Czerny, Bartosz Rylski, Julia Morlock, Holger Schröfel, Friedhelm Beyersdorf, Bertrand Saint Lebes, Olivier Meyrignac, Fatima Mokrane, Mario Lescan, Christian Schlensak, Constatijn Hazenberg, Trijntje Bloemert-Tuin, Sue Braithwaite, Joost van Herwaarden, Herve Rousseau
OBJECTIVES: Our goal was to assess the results after orthotopic branched endovascular aortic arch repair using a new double-branch endoprosthesis in patients with thoracic aortic disease affecting the aortic arch who cannot undergo classical surgery. METHODS: Within a 4-year period, 15 patients with thoracic aortic disease affecting the aortic arch were treated with the Bolton Relay plus double-branch endoprosthesis (Bolton Medical, Sunrise, FL, USA). We assessed clinical outcome, occurrence of endoleaks and the need for secondary interventions...
January 16, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29340574/effect-of-general-anesthesia-and-conscious-sedation-during-endovascular-therapy-on-infarct-growth-and-clinical-outcomes-in-acute-ischemic-stroke-a-randomized-clinical-trial
#2
Claus Z Simonsen, Albert J Yoo, Leif H Sørensen, Niels Juul, Søren P Johnsen, Grethe Andersen, Mads Rasmussen
Importance: Endovascular therapy (EVT) is the standard of care for select patients who had a stroke caused by a large vessel occlusion in the anterior circulation, but there is uncertainty regarding the optimal anesthetic approach during EVT. Observational studies suggest that general anesthesia (GA) is associated with worse outcomes compared with conscious sedation (CS). Objective: To examine the effect of type of anesthesia during EVT on infarct growth and clinical outcome...
January 16, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29338866/the-repair-of-a-type-ia-endoleak-following-thoracic-endovascular-aortic-repair-using-a-stented-elephant-trunk-procedure
#3
Rui-Dong Qi, Jun-Ming Zhu, Yong-Min Liu, Lei Chen, Cheng-Nan Li, Xiao-Yan Xing, Li-Zhong Sun
BACKGROUND: Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. METHODS: From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure...
December 14, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29338750/reperfusion-therapy-in-acute-ischemic-stroke-dawn-of-a-new-era
#4
REVIEW
Sonu Bhaskar, Peter Stanwell, Dennis Cordato, John Attia, Christopher Levi
Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed...
January 16, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29336360/early-neurological-deterioration-after-recanalization-treatment-in-patients-with-acute-ischemic-stroke-a-retrospective-study
#5
Ying-Bo Zhang, Ying-Ying Su, Yan-Bo He, Yi-Fei Liu, Gang Liu, Lin-Lin Fan
BACKGROUND: Early neurological deterioration (END) is a prominent issue after recanalization treatment. However, few studies have reported the characteristics of END after endovascular treatment (EVT) as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator (IV rt-PA) and EVT of acute ischemic stroke, and identified risk factors for END. METHODS: Medical records of patients who received recanalization treatment between January 1, 2014, and December 31, 2015 were reviewed...
January 20, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29335886/effect-of-actual-age-on-outcome-at-discharge-in-patients-by-surgical-clipping-and-endovascular-coiling-for-ruptured-cerebral-aneurysm-in-japan
#6
Fusao Ikawa, Masaru Abiko, Daizo Ishii, Jyumpei Ohshita, Takahito Okazaki, Shigeyuki Sakamoto, Shotai Kobayashi, Kaoru Kurisu
The Japanese population features the highest rate of elderly individuals worldwide. However, the difference of actual age indication for surgical clipping (SC) and endovascular coiling (EC) has never reported. We clarified the effect of actual age on poor outcome at discharge in patients by each treatment for ruptured cerebral aneurysm according to the Japanese Stroke Data Bank. A total of 3593 patients with ruptured saccular cerebral aneurysm were treated by SC and/or EC between 2000 and 2013. The effect of actual age on poor outcome (modified Rankin scale [mRS] score > 2) at discharge was evaluated by the cutoff age using receiver operating characteristic analysis for each treatment...
January 15, 2018: Neurosurgical Review
https://www.readbyqxmd.com/read/29333567/predictors-for-intracranial-hemorrhage-following-intravenous-thrombolysis-in-posterior-circulation-stroke
#7
Dorňák Tomáš, Král Michal, Sedláčková Zuzana, Šaňák Daniel, Čecháková Eva, Divišová Petra, Zapletalová Jana, Kaňovský Petr
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90...
January 15, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29331206/mechanical-thrombectomy-determining-the-proportion-of-eligible-acute-ischemic-stroke-patients-in-the-cohort-of-single-academic-stroke-center
#8
Marcin Wiącek, Rafał Kaczorowski, Bartosz Sieczkowski, Natalia Kanas, Halina Bartosik-Psujek
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. METHODS: We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016)...
December 26, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29329730/mechanical-thrombectomy-in-acute-ischaemic-stroke-a-review-of-the-different-techniques
#9
REVIEW
V Leung, A Sastry, S Srivastava, D Wilcock, A Parrott, S Nayak
Endovascular mechanical thrombectomy (MT) is reserved for acute ischaemic stroke secondary to large vessel occlusion. The various MT techniques employed in the treatment of hyperacute strokes are constantly evolving with new devices and improvisation of existing technology (Wahlgren, et al 2016). In this review, we describe a variety of MT techniques gained from our experience of performing over 350 procedures in 7 years of providing a 24/7 service within the national framework of a hyperacute stroke centre...
January 9, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29327997/mechanical-thrombectomy-in-basilar-artery-occlusion-influence-of-reperfusion-on-clinical-outcome-and-impact-of-the-first-line-strategy-adapt-vs-stent-retriever
#10
Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, Bertrand Lapergue
OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29321339/detection-of-anterior-circulation-large-artery-occlusion-in-ischemic-stroke-using-noninvasive-cerebral-oximetry
#11
Alexander C Flint, Shiv G Bhandari, Sean P Cullen, Adhikari V Reddy, Daniel P Hsu, Vivek A Rao, Minal Patel, Jasmeen Pombra, Nancy J Edwards, Sheila L Chan
BACKGROUND AND PURPOSE: Large artery occlusion (LAO) in ischemic stroke requires recognition and triage to an endovascular stroke treatment center. Noninvasive LAO detection is needed to improve triage. METHODS: Prospective study to test whether noninvasive cerebral oximetry can detect anterior circulation LAO in acute stroke. Interhemispheric ΔBrSO2 in LAO was compared with controls. RESULTS: In LAO stroke, mean interhemispheric ΔBrSO2 was -8...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29321337/associations-between-collateral-status-and-thrombus-characteristics-and-their-impact-in-anterior-circulation-stroke
#12
Heitor C Alves, Kilian M Treurniet, Bruna G Dutra, Ivo G H Jansen, Anna M M Boers, Emilie M M Santos, Olvert A Berkhemer, Diederik W J Dippel, Aad van der Lugt, Wim H van Zwam, Robert J van Oostenbrugge, Hester F Lingsma, Yvo B W E M Roos, Albert J Yoo, Henk A Marquering, Charles B L M Majoie
BACKGROUND AND PURPOSE: Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome. METHODS: Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195)...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29310519/intranasal-stem-cell-treatment-as-a-novel-therapy-for-subarachnoid-hemorrhage
#13
Cora H Nijboer, Elke Kooijman, Cindy T van Velthoven, Erik Van Tilborg, Ivo A Tiebosch, Niels Eijkelkamp, Rick M Dijkhuizen, Jozef Kesecioglu, Cobi Heijnen
Subarachnoid hemorrhage (SAH) represents a major health problem in Western society due to high mortality and morbidity, and the relative young age of patients. Currently, efficacious therapeutic options are very limited. Mesenchymal stem cell (MSC) administration has been shown to improve functional outcome and lesion size in experimental models of stroke and neonatal hypoxic-ischemic brain injury. Here we studied the therapeutic potential of intranasally administered bone marrow-derived MSCs relatively late post-insult using a rat endovascular puncture model for SAH...
January 8, 2018: Stem Cells and Development
https://www.readbyqxmd.com/read/29305274/combination-of-24-hour-and-7-day-relative-neurological-improvement-strongly-predicts-90-day-functional-outcome-of-endovascular-stroke-therapy
#14
Jie Pu, Huaiming Wang, Mingyi Tu, Wenjie Zi, Yonggang Hao, Dong Yang, Wenhua Liu, Yue Wan, Yu Geng, Min Lin, Ping Jin, Yunyun Xiong, Gelin Xu, Qin Yin, Xinfeng Liu
BACKGROUND AND PURPOSE: Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. METHODS: We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected...
January 3, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29303452/different-learning-curves-between-stent-retrieval-and-a-direct-aspiration-first-pass-technique-for-acute-ischemic-stroke
#15
Hidehisa Nishi, Akira Ishii, Ichiro Nakahara, Shoji Matsumoto, Nobutake Sadamasa, Yasutoshi Kai, Ryota Ishibashi, Michio Yamamoto, Satoshi Morita, Izumi Nagata
OBJECTIVE The clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods. METHODS In each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29303110/-role-of-thrombectomy-in-acute-ischemic-stroke
#16
Albert Pall Sigurdsson
This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources...
January 2018: Læknablađiđ
https://www.readbyqxmd.com/read/29298860/pre-hospital-detection-of-acute-ischemic-stroke-secondary-to-emergent-large-vessel-occlusion-lessons-learned-from-electrocardiogram-and-acute-myocardial-infarction
#17
REVIEW
Alexander G Chartrain, Christopher Paul Kellner, J Mocco
Currently, there is no device capable of detecting acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO) in the pre-hospital setting. The inability to reliably identify patients that would benefit from primary treatment with endovascular thrombectomy remains an important limitation to optimizing emergency medical services (EMS) triage models and time-to-treatment. Several clinical grading scales that rely solely on clinical examination have been proposed and have demonstrated only moderate predictive ability for ELVO...
January 3, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29298459/embolisation-for-pulmonary-arteriovenous-malformation
#18
REVIEW
Charlie C-T Hsu, Gigi Nc Kwan, Hannah Evans-Barns, Mieke L van Driel
BACKGROUND: Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting...
January 4, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29297102/endovascular-stroke-treatment-on-single-plane-vs-bi-plane-angiography-suites-technical-considerations-and-evaluation-of-treatment-success
#19
Benjamin Friedrich, Christian Maegerlein, Donald Lobsien, Sebastian Mönch, Maria Berndt, Dennis Hedderich, Silke Wunderlich, Dominik Michalski, Manuel Lehm, Tobias Boeckh-Behrens, Claus Zimmer, Kornelia Kreiser
INTRODUCTION: Endovascular stroke therapy is mostly available in comprehensive stroke centers with state of the art bi-plane angiography suites. The aim of the present study was to analyze if it is justifiable to treat patients with alternative x‑ray machines in the case of capacity constraints, or if it is mandatory to refer patients in such cases. Secondly, we wanted to draw conclusions for the feasibility of different logistic approaches in stroke treatment, such as a "helistroke" concept...
January 2, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29296623/clarion-call-for-histopathological-clot-analysis-in-cryptogenic-ischemic-stroke-implications-for-diagnosis-and-treatment
#20
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
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