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Endovascular treatment of stroke

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https://www.readbyqxmd.com/read/28220330/synchronous-cardiocerebral-infarction-in-the-era-of-endovascular-therapy-which-to-treat-first
#1
Leonard L L Yeo, Tommy Andersson, Kong Wan Yee, Benjamin Y Q Tan, Prakash Paliwal, Anil Gopinathan, Mahendran Nadarajah, Eric Ting, Hock L Teoh, Robin Cherian, Erik Lundström, Edgar L W Tay, Vijay K Sharma
A cardiocerebral ischemic attack (CCI) or a concurrent acute ischemic stroke (AIS) and myocardial infarction (AMI) is a severe event with no clear recommendations for ideal management because of the rarity of the scenario. The narrow time window for treatment and complexity of the treatment decision puts immense pressure on the treating physician. We evaluated this challenging situation at our tertiary center. Using our prospective stroke database out of a total of 555 patients with acute ischemic stroke between 2009 and 2014, we identified five consecutive cases with CCI (incidence 0...
February 20, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28217390/management-of-aneurysmal-subarachnoid-hemorrhage-state-of-the-art-and-future-perspectives
#2
REVIEW
Giovanni Grasso, Concetta Alafaci, R Loch Macdonald
BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) accounts for 5% of strokes and carries a poor prognosis. It affects around 6 cases per 100,000 patient years occurring at a relatively young age. METHODS: Common risk factors are the same as for stroke, and only in a minority of the cases, genetic factors can be found. The overall mortality ranges from 32% to 67%, with 10-20% of patients with long-term dependence due to brain damage. An explosive headache is the most common reported symptom, although a wide spectrum of clinical disturbances can be the presenting symptoms...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28216358/outcomes-of-thoracic-endovascular-aortic-repair-using-aortic-arch-chimney-stents-in-high-risk-patients
#3
Igor Voskresensky, Salvatore T Scali, Robert J Feezor, Javairiah Fatima, Kristina A Giles, Rosamaria Tricarico, Scott A Berceli, Adam W Beck
BACKGROUND: Aortic arch disease is a challenging clinical problem, especially in high-risk patients, in whom open repair can have morbidity and mortality rates of 30% to 40% and 2% to 20%, respectively. Aortic arch chimney (AAC) stents used during thoracic endovascular aortic repair (TEVAR) are a less invasive treatment strategy than open repair, but the current literature is inconclusive about the role of this technology. The focus of this analysis is on our experience with TEVAR and AAC stents...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28213758/influence-of-a-combined-ct-c-arm-system-on-periprocedural-workflow-and-procedure-times-in-mechanical-thrombectomy
#4
Johannes Pfaff, Silvia Schönenberger, Christian Herweh, Mirko Pham, Simon Nagel, Peter Arthur Ringleb, Sabine Heiland, Martin Bendszus, Markus Alfred Möhlenbruch
OBJECTIVE: To achieve the fastest possible workflow in ischaemic stroke, we developed a CT/C-arm system, which allows imaging and endovascular treatment on the same patient table. METHODS: This prospective, monocentric trial was conducted between October 2014 and August 2016. Patients received stroke imaging and mechanical thrombectomy under general anaesthesia (GA) or conscious sedation (CS) using our combined setup comprising a CT-scanner and a mobile C-arm X-ray device...
February 17, 2017: European Radiology
https://www.readbyqxmd.com/read/28213478/endovascular-mechanical-thrombectomy-for-cerebral-venous-sinus-thrombosis-a-systematic-review
#5
REVIEW
Adeel Ilyas, Ching-Jen Chen, Daniel M Raper, Dale Ding, Thomas Buell, Panogiotis Mastorakos, Kenneth C Liu
BACKGROUND: Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. OBJECTIVE: To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. METHODS: A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT...
February 17, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28210239/flow-diversion-for-the-treatment-of-mca-bifurcation-aneurysms-a-single-centre-experience
#6
Pervinder Bhogal, Muhammad AlMatter, Hansjörg Bäzner, Oliver Ganslandt, Hans Henkes, Marta Aguilar Pérez
BACKGROUND: Intracranial aneurysms located at the bifurcation of the middle cerebral artery (MCA) can often be challenging for the neurointerventionalist. We aimed to evaluate the efficacy and safety of flow diverting stents (FDS) in the treatment of these aneurysms. MATERIALS AND METHODS: We retrospectively reviewed our prospectively maintained database to collect information for all patients with unruptured saccular bifurcation MCA aneurysms treated with FDS between January 2010 and January 2016...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28203369/is-endovascular-treatment-with-multilayer-flow-modulator-stent-insertion-a-safe-alternative-to-open-surgery-for-high-risk-patients-with-thoracoabdominal-aortic-aneurysm
#7
Carolline Pinto, George Garas, Leanne Harling, Ara Darzi, Roberto Casula, Thanos Athanasiou
A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated...
March 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28194477/maximizing-first-pass-complete-reperfusion-with-save
#8
Volker Maus, Daniel Behme, Christoph Kabbasch, Jan Borggrefe, Ioannis Tsogkas, Omid Nikoubashman, Martin Wiesmann, Michael Knauth, Anastasios Mpotsaris, Marios Nikos Psychogios
BACKGROUND: Endovascular techniques for treatment of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) have advanced in recent years. We report a multicenter experience using a combined aspiration and stent retriever technique for mechanical thrombectomy (MT). METHODS: We retrospectively analyzed 32 consecutive MT patients using a novel, combined approach of Stent retriever Assisted Vacuum-locked Extraction (SAVE) by 3 operators at 3 stroke centers...
February 13, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#9
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28185973/management-of-iatrogenic-direct-carotid-cavernous-fistula-occurring-during-endovascular-treatment-of-strokes
#10
Nima Alan, Enyinna Nwachuku, Tudor J Jovin, Brian T Jankowitz, Ashutosh P Jadhav, Andrew F Ducruet
No abstract text is available yet for this article.
February 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28185942/the-effects-of-pharmaceutical-thrombolysis-and-multi-modal-therapy-on-patients-with-acute-posterior-circulation-ischemic-stroke-results-of-a-one-center-retrospective-study
#11
Yang Yang, Chunyang Liang, Chunsen Shen, Hao Tang, Shang Ma, Qiang Zhang, Mou Gao, Qin Dong, Ruxiang Xu
BACKGROUND: The treatment method for acute ischemic stroke is rapidly developing, and the effects of endovascular modalities, when used alone or in combination, needs to be studied. We aimed to identify the difference between pharmaceutical thrombolysis and multi-modal therapy (MMT) used in acute posterior circulation ischemic stroke (APCIS) patients and also to detect the predictors for successful recanalization and favorable outcomes. METHODS: A retrospective analysis of patients with APCIS who received thrombolytic pharmaceuticals and MMT from 2011 to 2016 was performed at the stroke center...
February 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28182585/anesthetic-neuroprotection-in-experimental-stroke-in-rodents-a-systematic-review-and-meta-analysis
#12
David P Archer, Andrew M Walker, Sarah K McCann, Joanna J Moser, Ramana M Appireddy
BACKGROUND: Patients undergoing endovascular therapy for acute ischemic stroke may require general anesthesia to undergo the procedure. At present, there is little clinical evidence to guide the choice of anesthetic in this acute setting. The clinical implications of experimental studies demonstrating anesthetic neuroprotection are poorly understood. Here, the authors evaluated the impact of anesthetic treatment on neurologic outcome in experimental stroke. METHODS: Controlled studies of anesthetics in stroke using the filament occlusion model were identified in electronic databases up to December 15, 2015...
February 9, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28178411/computed-tomography-based-thrombus-imaging-for-the-prediction-of-recanalization-after-reperfusion-therapy-in-stroke
#13
REVIEW
Ji Hoe Heo, Kyeonsub Kim, Joonsang Yoo, Young Dae Kim, Hyo Suk Nam, Eung Yeop Kim
The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2(*)-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28176499/ct-angiography-of-collateral-vessels-and-outcomes-in-endovascular-treated-acute-ischemic-stroke-patients
#14
Beom Joon Kim, Jong Won Chung, Hong Kyun Park, Jun Yup Kim, Mi Hwa Yang, Moon Ku Han, Cheolkyu Jeong, Gyojun Hwang, O Ki Kwon, Hee Joon Bae
BACKGROUND AND PURPOSE: Measuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment. METHODS: Of 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event...
January 12, 2017: Journal of Clinical Neurology
https://www.readbyqxmd.com/read/28168068/treatment-challenges-of-a-primary-vertebral-artery-aneurysm-causing-recurrent-ischemic-strokes
#15
Davide Strambo, Luca Peruzzotti-Jametti, Aurora Semerano, Giovanna Fanelli, Franco Simionato, Roberto Chiesa, Enrico Rinaldi, Vittorio Martinelli, Giancarlo Comi, Marco Bacigaluppi, Maria Sessa
Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28165757/cerebral-regions-preserved-by-successful-endovascular-recanalization-of-acute-m1-segment-occlusions-a-voxel-based-analysis
#16
Seyedmehdi Payabvash, Shayandokht Taleb, Adnan I Qureshi
OBJECTIVES: To identify cerebral regions preserved by successful recanalization of middle cerebral artery (MCA) M1 segment, and their association with early clinical outcome. METHODS: Forty-seven patients who underwent endovascular treatment for acute unilateral M1 segment occlusion were included. Successful recanalization was defined by a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Final infarct volumes were segmented on follow-up MRI/CT, 2-7 days post symptom onset...
February 6, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28157821/blood-pressure-control-for-acute-severe-ischemic-and-hemorrhagic-stroke
#17
Julian Bösel
PURPOSE OF REVIEW: Severe ischemic or hemorrhagic stroke is a devastating cerebrovascular disease often demanding critical care. Optimal management of blood pressure (BP) in the acute phase is controversial. The purpose of this review is to display insights from recent studies on BP control in both conditions. RECENT FINDINGS: BP control in acute ischemic stroke has recently been investigated with regard to endovascular recanalizing therapies. Decreases from baseline BP and hypotension during the intervention have been found detrimental...
February 2, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28157746/prevention-and-management-of-poststroke-complications
#18
Josephine F Huang
PURPOSE OF REVIEW: This article provides a synopsis of the immediate and delayed medical complications of stroke, with an emphasis on prevention and management of these complications. RECENT FINDINGS: Meta-analysis of the trials for endovascular treatment of acute stroke shows no significant increase in hemorrhagic events. Rehabilitation guidelines published by the American Heart Association and American Stroke Association in 2016 aid in providing the best clinical practice for patients with stroke, from the time of their initial hospitalization to their return to the community...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28156253/severe-carotid-stenosis-and-delay-of-reperfusion-in-endovascular-stroke-treatment-an-interventional-management-of-stroke-iii-study
#19
Steven L Gogela, Yair M Gozal, Bin Zhang, Thomas A Tomsick, Andrew J Ringer, Joseph P Broderick, Pooja Khatri, Todd A Abruzzo
OBJECTIVE The impact of extracranial carotid stenosis on interventional revascularization of acute anterior circulation stroke is unknown. The authors examined the effects of high-grade carotid stenosis on the results of endovascular treatment of patients in the Interventional Management of Stroke (IMS)-III trial. METHODS The 278 patients in the endovascular arm of the IMS-III trial were categorized according to the degree of carotid stenosis as determined by angiography. In comparing patients with severe stenosis or occlusion (≥ 70%) to those without severe stenosis (< 70%), the authors evaluated the time to endovascular reperfusion, modified Thrombolysis in Cerebrovascular Infarction (mTICI) scores, 24-hour mean infarct volumes, symptomatic intracerebral hemorrhage rates, and modified Rankin Scale (mRS) scores at 90 days...
February 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28144702/endovascular-thrombectomy-in-acute-ischemic-stroke-outcome-in-referred-versus-directly-admitted-patients
#20
Philipp Bücke, Marta Aguilar Pérez, Elisabeth Schmid, Christian H Nolte, Hansjörg Bäzner, Hans Henkes
PURPOSE: Endovascular mechanical thrombectomy (mTE) in acute ischemic stroke due to large cerebral artery occlusion is effective and safe. The procedure is currently offered by specialized hospitals. Physicians from smaller hospitals need to refer patients to stroke centers. Secondary referrals involve delays for transportation. Little is known about effects of distant referrals on outcome and complications as compared to direct admittance. METHODS: To evaluate the effects of referral patterns on outcome and safety, we analyzed 941 patients with anterior circulation stroke receiving mTE between January 2010 and December 2015...
January 31, 2017: Clinical Neuroradiology
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