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https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#1
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906117/carotid-artery-stenting-versus-no-stenting-assisting-thrombectomy-for-acute-ischaemic-stroke-protocol-for-a-systematic-review-of-randomised-clinical-trials-with-meta-analyses-and-trial-sequential-analyses
#2
Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Gluud, Derk Wolfgang Krieger
BACKGROUND: In patients with intracranial large vessel arterial occlusion, ipsilateral extracranial carotid artery occlusions or near-occlusions pose a significant hurdle in endovascular management of acute ischaemic stroke. Stenting of the carotid lesion may be beneficial in this situation to provide a stable access for introducing catheters through the carotid lesion into the intracranial vasculature and the target occlusion. Furthermore, carotid stenting may ensure ample blood flow for wash-out of clot material and reperfusion of the ischaemic penumbral tissue...
December 1, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27903022/-recanalization-techniques-for-venous-outflow-obstruction
#3
Michael K W Lichtenberg, Houman Jalaie
Deep vein thrombosis (DVT) is associated with a high cost burden for health care systems because of secondary cost intensive complications like pulmonary embolism and especially the post thrombotic syndrome (PTS). The current standard therapy of anticoagulation for DVT therapy has not changed through the years leaving patients especially with iliofemoral vein thrombus on a high-risk situation for developing PTS. Current study situation for endovascular treatment of iliofemoral DVT treatment gives a rationale for active thrombus removal using catheter directed therapy (CDT) or pharmacomechanical thrombectomy (PMT) which improves valvular vein function and luminal patency reducing the potential complication of PTS...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27899517/endovascular-management-of-cerebral-septic-embolism-three-recent-cases-and-review-of-the-literature
#4
Eugene L Scharf, Tia Chakraborty, Alejandro Rabinstein, Amrendra S Miranpuri
Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27896413/endovascular-revascularization-of-hemodialysis-thrombosed-grafts-with-the-hydrodynamic-thrombectomy-catheter-our-7-year-experience
#5
Patrícia Bermudez, Nestor Fontseré, Gaspar Mestres, Andres García-Gámez, Marta Barrufet, Marta Burrel, Rosa Gilabert, Fernando Gómez, Juan Macho
PURPOSE: To evaluate the efficacy and safety of the hydrodynamic thrombectomy catheter (AngioJet DVX) in the salvage of thrombosed hemodialysis vascular grafts. MATERIALS AND METHODS: A retrospective study was designed, including all patients with occluded arteriovenous grafts treated with the AngioJet system between 2007 and 2014 in our institution. Outcomes included technical success, clinical success, complications, and primary and secondary patencies. Procedural success was defined as angiographic confirmation of flow restoration, the presence of a pulsatile thrill along the graft, and successful resumption of at least one hemodialysis session...
November 28, 2016: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27895242/availability-of-endovascular-therapies-for-cerebrovascular-disease-at-primary-stroke-centers
#6
Mark J Alberts, Jean Range, William Spencer, Vicki Cantwell, M J Hampel
BACKGROUND: Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. METHODS: We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes...
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27876658/stenting-for-carotid-web-a-case-report
#7
R Martínez-Pérez, S P Lownie, S Pandey, M R Boulton
BACKGROUND: The carotid web is an intraluminal shelf-like projection arising from the posterior wall of the carotid bifurcation, and is an uncommon etiology of ischemic strokes. Our objective is to describe the feasibility of endovascular stenting to treat this condition CASE REPORT: In a 47-year-old female with a sudden occlusion of her right middle cerebral artery. CT angiogram and digital subtraction angiography showed the presence of a carotid web in the ipsilateral carotid bifurcation...
November 19, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27871458/eligibility-for-mechanical-thrombectomy-in-acute-ischemic-stroke-a-phase-iv-multi-center-screening-log-registry
#8
Georgios Tsivgoulis, Nitin Goyal, Robert Mikulik, Vijay K Sharma, Aristeidis H Katsanos, Ramin Zand, Prakash R Paliwal, Andromachi Roussopoulou, Ondrej Volny, Abhi Pandhi, Christina Zompola, Lucas Elijovich, Apostolos Safouris, Jason Chang, Andrei V Alexandrov, Anne W Alexandrov
No eligibility screening logs were kept in recent mechanical thrombectomy (MT) RCTs establishing safety and efficacy of endovascular reperfusion therapies for acute ischemic stroke (AIS). We sought to evaluate the potential eligibility for MT among consecutive AIS patients in a prospective international multicenter study. We prospectively evaluated consecutive AIS patients admitted in four tertiary-care stroke centers during a twelve-month period. Potential eligibility for MT was evaluated using inclusion criteria from MR CLEAN & REVASCAT...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27865097/etiology-and-treatment-of-acute-inferior-vena-cava-thrombosis
#9
REVIEW
Wanyin Shi, Joshua D Dowell
Inferior vena cava thrombosis (IVCT) is a rare but severe disease that is associated with a high rate of mortality. IVCT can be categorized into primary versus secondary thrombosis dependent upon the underlying pathophysiology. The diagnosis includes both clinical probability assessment as well as the imaging evaluation. The optimal therapeutic strategy remains the target of continued research. Although anticoagulation therapy remains fundamental in treating IVCT, its inherent limitations have led to the use of minimally invasive, endovascular treatment options, including transcatheter thrombolysis, mechanical thrombectomy or a combination of these techniques...
July 21, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27856819/corrigendum-to-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials-of-endovascular-thrombectomy-compared-to-best-medical-treatment-for-acute-ischemic-stroke
#10
(no author information available yet)
No abstract text is available yet for this article.
November 17, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27814432/pharmacomechanical-thrombectomy-for-iliofemoral-deep-vein-thrombosis
#11
REVIEW
Lindsay Robertson, Olivia McBride, Anne Burdess
BACKGROUND: Deep venous thrombosis (DVT) occurs in approximately one in 1000 adults every year, and has an annual mortality of 14.6%. In particular, iliofemoral DVT can lead to recurrent thrombosis and post-thrombotic syndrome (PTS), a painful condition which can lead to chronic venous insufficiency, oedema, and ulceration. It causes significant disability, impaired quality of life, and economic burden. Early thrombus removal techniques have been advocated in patients with an iliofemoral DVT in order to improve vein patency, prevent valvular dysfunction, and reduce future complications, such as post-thrombotic syndrome and venous ulceration...
November 4, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27811306/comparison-of-stroke-volume-evolution-on-diffusion-weighted-imaging-and-fluid-attenuated-inversion-recovery-following-endovascular-thrombectomy
#12
Christian Federau, Soren Christensen, Michael Mlynash, Jenny Tsai, Sun Kim, Greg Zaharchuk, Manabu Inoue, Matus Straka, Nishant K Mishra, Stephanie Kemp, Maarten G Lansberg, Gregory W Albers
BACKGROUND: To compare the evolution of the infarct lesion volume on both diffusion-weighted imaging and fluid-attenuated inversion recovery in the first five days after endovascular thrombectomy. METHODS: We included 109 patients from the CRISP and DEFUSE 2 studies. Stroke lesion volumes obtained on diffusion-weighted imaging and fluid-attenuated inversion recovery images both early post-procedure (median 18 h after symptom onset) and day 5, were compared using median, interquartile range, and correlation plots...
November 3, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27811134/impact-of-modified-tici-3-versus-modified-tici-2b-reperfusion-score-to-predict-good-outcome-following-endovascular-therapy
#13
C Dargazanli, A Consoli, M Barral, J Labreuche, H Redjem, G Ciccio, S Smajda, J P Desilles, G Taylor, C Preda, O Coskun, G Rodesch, M Piotin, R Blanc, B Lapergue
BACKGROUND AND PURPOSE: The TICI score is widely used to evaluate cerebral perfusion before and after the endovascular treatment of stroke. Recent studies showing the effectiveness and safety of mechanical thrombectomy combine modified TICI 2b and modified TICI 3 to assess the technical success of endovascular treatment. The purpose of this study was to determine how much clinical outcomes differ between patients achieving modified TICI 2b and modified TICI 3 reperfusion. MATERIALS AND METHODS: We analyzed 222 consecutive patients with acute large intracranial artery occlusion of the anterior circulation having achieved modified TICI 2b or modified TICI 3 reperfusion after thrombectomy...
November 3, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27801353/endovascular-treatment-of-iliofemoral-deep-vein-thrombosis-in-pregnancy-using-us-guided-percutaneous-aspiration-thrombectomy
#14
Murat Gedikoglu, Levent Oguzkurt
PURPOSE: We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. METHODS: This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis...
November 1, 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/27798324/intentional-subintimal-carotid-stenting-of-internal-carotid-dissection-in-a-patient-with-acute-ischaemic-stroke
#15
Nicola Limbucci, Sergio Nappini, Andrea Rosi, Leonardo Renieri, Arturo Consoli, Salvatore Mangiafico
Carotid artery dissection is a common cause of juvenile stroke. Endovascular treatment of acute stroke due to carotid dissection can be challenging, and endoluminal crossing of the dissection is sometimes impossible. We describe a case of intentional subintimal recanalisation of a cervical carotid dissection followed by intracranial thrombectomy and stenting. We report the case of a young woman with severe acute ischaemic stroke due to carotid artery dissection and intracranial embolism. After failure of endoluminal crossing of the dissected segment, intentional subintimal crossing with re-entry distally to the dissection was achieved and a stent was deployed...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27796447/endovascular-treatment-of-acute-internal-carotid-artery-dissections-technical-considerations-clinical-and-angiographic-outcome
#16
Wiebke Kurre, Kai Bansemir, Marta Aguilar Pérez, Rosa Martinez Moreno, Elisabeth Schmid, Hansjörg Bäzner, Hans Henkes
INTRODUCTION: In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet. METHODS: From an institutional database, we retrospectively selected consecutive patients treated for a-ICAD between January 2007 and July 2015...
October 29, 2016: Neuroradiology
https://www.readbyqxmd.com/read/27789787/initial-experience-with-sofia-as-an-intermediate-catheter-in-mechanical-thrombectomy-for-acute-ischemic-stroke
#17
Johnny H Y Wong, Huy M Do, Nicholas A Telischak, Adrienne M Moraff, Robert L Dodd, Michael P Marks, Shreya M Ingle, Jeremy J Heit
BACKGROUND: The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated...
October 27, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27789151/acute-cerebral-artery-occlusion-by-a-calcified-embolus-with-false-patency-sign-on-computed-tomographic-angiography
#18
Atsuhito Uneda, Takahiro Kanda, Kenta Suzuki, Koji Hirashita, Masatoshi Yunoki, Kimihiro Yoshino
Computed tomographic angiography (CTA) is a quick and accurate method in triage to determine recanalization therapies for acute ischemic stroke. To minimize delay in the start of recanalization therapies, performance of CTA immediately after unenhanced brain computed tomography (CT) is recommended as the minimum standard. However, there are some pitfalls related to image interpretation of CTA in acute stroke, such as false patency sign. We describe the case of a 66-year-old man who presented with acute middle cerebral artery (MCA) occlusion by a calcified embolus with false patency sign on CTA after coronary angiography...
October 24, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27785516/effect-of-conscious-sedation-vs-general-anesthesia-on-early-neurological-improvement-among-patients-with-ischemic-stroke-undergoing-endovascular-thrombectomy-a-randomized-clinical-trial
#19
Silvia Schönenberger, Lorenz Uhlmann, Werner Hacke, Simon Schieber, Sibu Mundiyanapurath, Jan C Purrucker, Simon Nagel, Christina Klose, Johannes Pfaff, Martin Bendszus, Peter A Ringleb, Meinhard Kieser, Markus A Möhlenbruch, Julian Bösel
Importance: Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from randomized trials. Objective: To assess whether conscious sedation is superior to general anesthesia for early neurological improvement among patients receiving stroke thrombectomy. Design, Setting, and Participants: SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment), a single-center, randomized, parallel-group, open-label treatment trial with blinded outcome evaluation conducted at Heidelberg University Hospital in Germany (April 2014-February 2016) included 150 patients with acute ischemic stroke in the anterior circulation, higher National Institutes of Health Stroke Scale (NIHSS) score (>10), and isolated/combined occlusion at any level of the internal carotid or middle cerebral artery...
November 15, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27781115/unexpected-rupture-of-a-giant-lobulated-thrombotic-middle-cerebral-artery-aneurysm-and-emergency-surgical-treatment-with-thrombectomy-a-case-report-and-review-of-the-literature
#20
Vaner Koksal, Selim Kayaci
INTRODUCTION: The treatment of giant intracranial aneurysms is one of the most challenging cerebrovascular problems of neurosurgery. We report the rupture of a giant, lobulated, and almost completely thrombosed middle cerebral artery (MCA) aneurysm that is the ninth such report in the literature. We also investigated additional solutions used in the treatment of this patient. CASE PRESENTATION: A 58-year-old man had been admitted with headache 8 years previously (in 2005), and a giant MCA aneurysm was detected...
August 2016: Iranian Red Crescent Medical Journal
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