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Keywords
Stroke, intracerebral hemorrha...
Stroke, intracerebral hemorrhage, thrombolysis, thrombectomy, clinical trials
#1
JOURNAL ARTICLE
Mariangela Piano, Olav Jansen, Gaultier Marnat, Benjamin Gory, Hannes Nordmeyer, Bernd Eckert, Alessandro Pedicelli, Christophe Cognard, Christian Loehr, Matteo Zanoni, Axel Schaefer, Antonio Macera, Jens Fiehler, Karen Doyle, Kyriakos Lobotesis
BACKGROUND: A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes. METHODS: PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled across 11 European centers between October 2020 and July 2022...
April 12, 2024: Journal of Neurointerventional Surgery
#2
JOURNAL ARTICLE
Michael Chen, Krishna C Joshi, Bradley Kolb, Clark W Sitton, Deep Kiritbhai Pujara, Michael G Abraham, Santiago Ortega-Gutierrez, Scott E Kasner, Shazam M Hussain, Leonid Churilov, Spiros Blackburn, Sophia Sundararajan, Yin C Hu, Nabeel Herial, Juan F Arenillas, Jenny P Tsai, Ronald F Budzik, William Hicks, Osman Kozak, Bernard Yan, Dennis Cordato, Nathan W Manning, Mark Parsons, Ricardo A Hanel, Amin Aghaebrahim, Teddy Wu, Pere Cardona Portela, Chirag D Gandhi, Fawaz Al-Mufti, Natalia Perez de la Ossa, Joanna Schaafsma, Jordi Blasco, Navdeep Sangha, Steven Warach, Timothy J Kleinig, Hannah Johns, Faris Shaker, Mohammad A Abdulrazzak, Abhishek Ray, Jeffery Sunshine, Amanda Opaskar, Kelsey R Duncan, Wei Xiong, Faisal K Al-Shaibi, Edgar A Samaniego, Thanh N Nguyen, Johanna T Fifi, Stavropoula I Tjoumakaris, Pascal Jabbour, Vitor Mendes Pereira, Maarten G Lansberg, Cathy Sila, Nicholas C Bambakidis, Stephen Davis, Lawrence Wechsler, Gregory W Albers, James C Grotta, Marc Ribo, Ameer E Hassan, Bruce Campbell, Michael D Hill, Amrou Sarraj
BACKGROUND: The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. METHODS: SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. RESULTS: Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0...
March 12, 2024: Journal of Neurointerventional Surgery
#3
JOURNAL ARTICLE
Li-Na Yang, Yi Sun, Yu-Zhu Wang, Jing Wang, Yi-Sha Qi, Shan-Shan Mu, Yun-Peng Liu, Zi-Qing Zhang, Zi-Mo Chen, Xiao-Jie Wang, Wu-Xiang Xie, Chang-Wei Wei, Yang Wang, An-Shi Wu
BACKGROUND: Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion. Hypertension and increased blood pressure variability within the first 24 h after successful reperfusion are related to a higher risk of symptomatic intracerebral hemorrhage and higher mortality. AIS patients might suffer from ischemia-reperfusion injury following reperfusion, especially within 24 h. Dexmedetomidine (DEX), a sedative commonly used in EVT, can stabilize hemodynamics by inhibiting the sympathetic nervous system and alleviate ischemia-reperfusion injury through anti-inflammatory and antioxidative properties...
March 4, 2024: Trials
#4
REVIEW
Ari D Kappel, Hillary B Nguyen, Kai U Frerichs, Nirav J Patel, Mohammad A Aziz-Sultan, Rose Du
There has been an exponential increase in randomized controlled trials (RCTs) on cerebrovascular disease within neurosurgery. The goal of this study was to review, outline the scope, and summarize all phase 2b and phase 3 RCTs impacting cerebrovascular neurosurgery practice since 2018. We searched PubMed, MEDLINE, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases for relevant RCTs published between January 1, 2018, and July 1, 2022. We searched for studies related to eight major cerebrovascular disorders relevant to neurosurgery, including acute ischemic stroke, cerebral aneurysms and subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematomas, cerebral venous thrombosis, arteriovenous malformations, Moyamoya disease and extracranial-intracranial bypass, and carotid and intracranial atherosclerosis...
January 2024: Curēus
#5
REVIEW
David-Dimitris Chlorogiannis, Theodoros Mavridis, Anastasia Adamou, Ioannis Kyriakoulis, Iliana Stamatiou, Polyxeni Botou, Hui-Sheng Chen, George Ntaios
Current treatment options for acute ischemic stroke, including intravenous thrombolysis (IVT) and mechanical thrombectomy, have undoubtedly revolutionized stroke care. The need for additional treatment options has brought into the light direct thrombin inhibitors (DTIs) and, specifically, argatroban as a promising candidate. However, there is uncertainty regarding the safety of adding argatroban to IVT, mainly due to the increased hemorrhagic risk. In this study, we performed a systematic review and meta-analysis examining the safety and efficacy of argatroban as an add-on treatment for IVT...
January 18, 2024: Journal of Clinical Medicine
#6
JOURNAL ARTICLE
Imad Derraz, Solène Moulin, Benjamin Gory, Maéva Kyheng, Caroline Arquizan, Vincent Costalat, Bertrand Lapergue
Background Whether intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) provides additional benefits in patients with acute ischemic stroke (AIS) and a large infarct core (LIC) remains unclear. Purpose To examine whether treatment with IVT before EVT is beneficial in patients with LIC identified with CT or MRI (Alberta Stroke Program Early CT score 0-5). Materials and Methods This retrospective study included consecutive adult patients diagnosed with AIS due to large vessel occlusion (LVO) and LIC treated with EVT who were enrolled in the ETIS (Endovascular Treatment in Ischemic Stroke) Registry in France between January 2015 and January 2022...
October 2023: Radiology
#7
JOURNAL ARTICLE
Federica Rizzo, Michele Romoli, Luigi Simonetti, Mauro Gentile, Stefano Forlivesi, Laura Piccolo, Federica Naldi, Matteo Paolucci, Simone Galluzzo, Francesco Taglialatela, Ciro Princiotta, Ludovica Migliaccio, Marco Petruzzellis, Giancarlo Logroscino, Andrea Zini
INTRODUCTION: Medium vessel occlusion (MeVO) accounts for 30% of acute ischemic stroke cases. The risk/benefit profile of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) or the combination of the two (bridging therapy (BT)) is still unclear in MeVO. Here, we compare reperfusion strategies in MeVO for clinical and radiological outcomes. METHODS: This prospective single center study enrolled consecutive patients with AIS due to primary MeVO undergoing IVT, EVT, or BT at a comprehensive stroke center...
October 6, 2023: Neurological Sciences
#8
RANDOMIZED CONTROLLED TRIAL
Hyo Suk Nam, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jae Wook Jung, Jin Kyo Choi, Il Hyung Lee, In Hwan Lim, Soon-Ho Hong, Minyoul Baik, Byung Moon Kim, Dong Joon Kim, Na-Young Shin, Bang-Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Craig S Anderson, Ji Hoe Heo
IMPORTANCE: Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear. OBJECTIVE: To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023)...
September 5, 2023: JAMA
#9
JOURNAL ARTICLE
Frederik Geisler, Lisa Haacke, Maren Lorenz, Eugen Schwabauer, Matthias Wendt, Lydia Bernhardt, Eman Dashti, Erik Freitag, Alexander Kunz, Christina Hofmann-Shen, Martina Zuber, Carolin Waldschmidt, Farid I Kandil, Kai Kappert, Chantip Dang-Heine, Irina Lorenz-Meyer, Heinrich J Audebert, Joachim E Weber
INTRODUCTION: Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are well-established, evidence-based, time-critical therapies that reduce morbidity and mortality in acute ischemic stroke (AIS) patients. The exclusion of intracerebral hemorrhage (ICH) is mandatory and has been performed by cerebral imaging to date. Mobile stroke units (MSUs) have been shown to improve functional outcomes by bringing cerebral imaging and IVT directly to the patient, but they have limited coverage...
2023: Frontiers in Neurology
#10
JOURNAL ARTICLE
Vincent Costalat, Bertrand Lapergue, J F Albucher, Julien Labreuche, Hilde Henon, Benjamin Gory, Igor Sibon, Grégoire Boulouis, Christophe Cognard, Nasreddine Nouri, Sebastien Richard, Gauthier Marnat, Federico Di Maria, Mariam Annan, Alain Duhamel, Federico Cagnazzo, Tudor Jovin, Caroline Arquizan
RATIONALE: Mechanical thrombectomy (MT), the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO), is generally not offered to patients with large baseline infarct (core). Recent studies demonstrated MT benefit in patients with anterior circulation stroke and large core (i.e. Alberta Stroke Program Early Computed Tomography Score, ASPECTS 3-5). However, its benefit in patients with the largest core (ASPECTS 0-2) remains unproven. AIM: To compare the efficacy and safety of MT plus best medical treatment (BMT) and of BMT alone in patients with ASPECTS 0-5 (baseline computed tomography (CT) or magnetic resonance imaging (MRI)) and anterior circulation LVO within 7 h of last-seen-well...
July 31, 2023: International Journal of Stroke: Official Journal of the International Stroke Society
#11
RANDOMIZED CONTROLLED TRIAL
Fouzi Bala, Nishita Singh, Brian Buck, Ayoola Ademola, Shelagh B Coutts, Yan Deschaintre, Houman Khosravani, Ramana Appireddy, Francois Moreau, Stephen Phillips, Gord Gubitz, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, George Medvedev, Jennifer Mandzia, Aleksandra Pikula, Jai Jai Shankar, Heather Williams, Thalia S Field, Alejandro Manosalva Alzate, Muzaffar Siddiqui, Atif Zafar, Oje Imoukhoude, Gary Hunter, Ibrahim Alhabli, Faysal Benali, MacKenzie Horn, Michael D Hill, Michel Shamy, Tolulope T Sajobi, Richard H Swartz, Bijoy K Menon, Mohammed Almekhlafi
IMPORTANCE: It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke. OBJECTIVE: To examine the safety and efficacy of tenecteplase compared to alteplase among patients with large vessel occlusion (LVO) stroke. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified analysis of the Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada (ACT) randomized clinical trial that enrolled patients from 22 primary and comprehensive stroke centers across Canada between December 10, 2019, and January 25, 2022...
August 1, 2023: JAMA Neurology
#12
JOURNAL ARTICLE
Aaron Rodriguez-Calienes, Milagros Galecio-Castillo, Juan Vivanco-Suarez, Ghada A Mohamed, Gabor Toth, Amrou Sarraj, Deep Pujara, Aj A Chowdhury, Mudassir Farooqui, Malik Ghannam, Edgar A Samaniego, Tudor G Jovin, Santiago Ortega-Gutierrez
BACKGROUND: Different studies have demonstrated the benefit of endovascular treatment (EVT) up to 24 hours after acute ischemic stroke (AIS) onset. Recent cohort observational studies suggest that patients with large vessel occlusion AIS may benefit from EVT beyond 24 hours from the last known well (LKW) when adequately selected. We aimed to examine the safety and efficacy of EVT beyond 24 hours from LKW using a meta-analysis of all the literature available. METHODS: A systematic search from inception to April 2023 was conducted for studies including AIS patients with EVT beyond 24 hours from LKW in Medline, Embase, Scopus, and Web of Science...
June 24, 2023: Journal of Neurointerventional Surgery
#13
REVIEW
Wenbo Liu, Jingge Zhao, Huan Liu, Tianxiao Li, Tengfei Zhou, Yanyan He, Liangfu Zhu, Yonghong Ding, Ferdinand K Hui, Yingkun He
OBJECTIVE: This study aims to conduct a meta-analysis of published randomized controlled trials (RCTs) comparing safety and efficacy of direct thrombectomy(DT) and bridging therapy(BT) for intravenous thrombolysis (IVT) eligible patients. METHODS: A comprehensive search of PubMed, Cochrane Library, EMBASE, and Web of Science up to July 11, 2022 was performed. RCTs comparing DT and BT were enrolled. Relative risk (RR) or rate difference (RD) and their 95% confidence intervals in Mantel-Haenszel fixed-effects model were used as the effect index of each outcome...
April 9, 2023: World Neurosurgery
#14
Katharina Kneer, Adedolapo Kamaldeen Adeyemi, Jennifer Sartor-Pfeiffer, Vera Wilke, Corinna Blum, Ulf Ziemann, Sven Poli, Annerose Mengel, Katharina Feil
BACKGROUND AND AIMS: Intravenous thrombolysis (IVT) is standard of care for disabling acute ischemic stroke (AIS) within a time window of ⩽ 4.5 h. Some AIS patients cannot be treated with IVT due to limiting contraindications, including heparin usage in an anticoagulating dose within the past 24 h or an elevated activated prothrombin time (aPTT) > 15 s. Protamine is a potent antidote to unfractionated heparin. OBJECTIVES: The objective of this study was to investigate the safety and efficacy of IVT in AIS patients after antagonization of unfractionated heparin with protamine...
2023: Therapeutic Advances in Neurological Disorders
#15
JOURNAL ARTICLE
Amir Shaban, Sami Al Kasab, Reda M Chalhoub, Eric Bass, Ilko Maier, Marios-Nikos Psychogios, Ali Alawieh, Stacey Q Wolfe, Adam S Arthur, Travis M Dumont, Peter Kan, Joon-Tae Kim, Reade De Leacy, Joshua W Osbun, Ansaar T Rai, Pascal Jabbour, Min S Park, Roberto Javier Crosa, Justin R Mascitelli, Michael R Levitt, Adam J Polifka, Walter Casagrande, Shinichi Yoshimura, Charles Matouk, Richard Williamson, Benjamin Gory, Maxim Mokin, Isabel Fragata, Daniele G Romano, Shakeel Chowdry, Mark Moss, Daniel Behme, Kaustubh Limaye, Alejandro M Spiotta, Edgar A Samaniego
BACKGROUND: Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window. METHODS: A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours...
January 2, 2023: Journal of Neurointerventional Surgery
#16
JOURNAL ARTICLE
Boonrerk Sangpetngam, Suwit Maicharoen, Pattarawit Withayasuk, Anchalee Churojana, Ekawut Chankaew, Thaweesak Aurboonyawat, Atthaporn Roongsitthichai, Jirapong Vongsfak
Objective The benefits of mechanical thrombectomy (MT) in patients with acute posterior circulation stroke remain unclear. Currently, there is no evidence from randomized control trials to show the safety and effectiveness of MT in patients with posterior circulation stroke. This study was to evaluate the treatment outcomes of MT in posterior circulation stroke patients enrolling in our hospital during 2010 to 2020. Materials and Methods Between January 2010 and December 2020, 66 patients with acute posterior circulation stroke underwent MT...
December 2022: Asian Journal of Neurosurgery
#17
REVIEW
Sherief Ghozy, Nicole Hardy, Daniel J Sutphin, Kevin M Kallmes, Ramanathan Kadirvel, David F Kallmes
BACKGROUND: New trials are planned regularly to provide the highest quality of evidence and invade new occlusion territories, which requires a pre-defined reporting strategy with consistent, common data elements for more straightforward collective evidence synthesis. We sought to review all active endovascular thrombectomy trials to investigate their patient selection criteria, intervention description, and reported outcomes. METHODS: A literature search was systematically conducted on clinicaltrials...
December 7, 2022: Brain Sciences
#18
JOURNAL ARTICLE
Kuo-Wei Chen, Chih-Hao Chen, Yen-Heng Lin, Chung-Wei Lee, Kun-Chang Tsai, Li-Kai Tsai, Sung-Chun Tang, Jiann-Shing Jeng
BACKGROUND: Patients with end-stage renal disease (ESRD) are often excluded from clinical trials of endovascular thrombectomy (EVT). This study investigated the outcome in these patients. METHODS: From September 2014 to July 2021, all patients undergoing EVT for anterior circulation stroke in two stroke centers in Taiwan were included. They were divided into no renal dysfunction (non-RD, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 ), RD (eGFR <60 mL/min/1...
December 20, 2022: Journal of Neurointerventional Surgery
#19
MULTICENTER STUDY
Gabriel Broocks, Uta Hanning, Matthias Bechstein, Sarah Elsayed, Tobias D Faizy, Caspar Brekenfeld, Fabian Flottmann, Helge Kniep, Milani Deb-Chatterji, Gerhard Schön, Götz Thomalla, André Kemmling, Jens Fiehler, Lukas Meyer
IMPORTANCE: Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction. OBJECTIVE: To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019...
October 3, 2022: JAMA Network Open
#20
RANDOMIZED CONTROLLED TRIAL
Chunrong Tao, Raul G Nogueira, Yuyou Zhu, Jun Sun, Hongxing Han, Guangxiong Yuan, Changming Wen, Peiyang Zhou, Wenhuo Chen, Guoyong Zeng, Yuwen Li, Zhengfei Ma, Chuanqing Yu, Junfeng Su, Zhiming Zhou, Zhongjun Chen, Geng Liao, Yaxuan Sun, Youquan Ren, Hui Zhang, Jie Chen, Xincan Yue, Guodong Xiao, Li Wang, Rui Liu, Wenhua Liu, Yong Liu, Li Wang, Chao Zhang, Tianlong Liu, Jianlong Song, Rui Li, Pengfei Xu, Yamei Yin, Guoping Wang, Blaise Baxter, Adnan I Qureshi, Xinfeng Liu, Wei Hu
BACKGROUND: Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS: We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control)...
October 13, 2022: New England Journal of Medicine
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