Intracranial atherosclerotic disease is associated with up to 10% of ischemic strokes and a high risk of recurrence. Endovascular treatments including percutaneous transluminal angioplasty and stenting have failed to demonstrate improved outcomes compared with medical therapy alone. Drug-coated balloon (DCB) angioplasty has emerged as a promising alternative, though its safety and durability remain uncertain.
Recent randomized controlled trials of endovascular treatment (EVT) for distal and medium vessel occlusion (DMVO) stroke did not demonstrate clinical benefit over best medical therapy and suggested potential safety concerns. We aimed to compare baseline characteristics of patients with DMVO stroke enrolled in these trials with those treated with EVT in routine clinical practice (RCP)
The RESCUE-ICAS study (Registry of Emergent Large-Vessel Occlusion due to Intracranial Stenosis) demonstrated that patients undergoing acute stenting of intracranial atherosclerosis with large-vessel occlusion after mechanical thrombectomy had better outcomes than those undergoing mechanical thrombectomy alone. We present 2 secondary analyses of RESCUE-ICAS to evaluate intracranial stenting among patients who achieved successful reperfusion. METHODS:
Endovascular therapy has revolutionized the treatment of acute ischemic stroke with large vessel occlusion, becoming the standard of care across anterior and posterior circulation. With expanding indications, including large infarct cores, extended time windows, and older patients, the number and complexity of procedures are steadily increasing worldwide. Although overall rates of successful reperfusion approach 90%, the remaining 10% of failed endovascular therapy highlight the technical challenges still confronting interventionalists.
Recent randomized clinical trials have demonstrated that endovascular thrombectomy (EVT) improves outcomes in patients with large ischemic cores. Despite these findings, hyperacute decision-making in large-core acute ischemic stroke remains challenging, as patients continue to face high rates of disability and mortality. Clear communication of risks and benefits is essential, and visual aids may improve comprehension in emergency settings
The Anterior Inferior Cerebellar Artery‐Posterior Inferior Cerebellar Artery (AICA‐PICA) complex refers to an arterial anomaly in which a single vessel supplies both the AICA and PICA territories. This variant has a prevalence of up to 20%. Despite its relatively high occurrence, aneurysms associated with the AICA‐PICA complex are rare. The rupture of aneurysms arising from such vascular anomalies can be challenging to detect on CT angiography (CTA). Digital subtraction angiography (DSA) can provide superior visualization and aid in both diagnosis and management
Spasticity and related motor disorders are common and often disabling complications after stroke, affecting an estimated 30% to 80% of survivors. Spasticity can impair functional mobility, reduce independence, and increase caregiver burden. Secondary complications, including pain, restricted range of motion, skin breakdown, and joint contractures, further degrade quality of life, limit rehabilitation outcomes, and increase health care costs. Despite the availability of options to manage spasticity and mitigate its effects, timely diagnosis and intervention remain key challenges
Maternal stroke is an uncommon but serious complication of pregnancy. This study assessed the incidence, temporal trends, and outcomes of maternal stroke in the United States using the Cosmos Epic database
About 10% to 15% of patients with ischemic stroke have a history of cancer, half of whom have active malignancy at the time of stroke. With improved cancer treatments extending patient survival, the coprevalence of these diseases has increased steadily since 2000. This has sparked considerable growth in research and knowledge on this topic. Approximately half of ischemic strokes in patients with active cancer are due to conventional mechanisms, although cancer-related factors may contribute
Intraplaque hemorrhage (IPH) represents a potent atherogenic stimulus in atherosclerotic coronary lesions regardless of their severity (1,2). This may explain the finding of mild nonobstructive lesions on angiography in the context of myocardial infarction. Recently, IPH has also been increasingly recognized as a vulnerable feature of carotid artery atherosclerotic lesions, and a potential cause of stroke. A recent study showed that IPH is associated with 2-fold increased stroke risk at 5-year follow-up (3). Herein, we illustrate a case of recurrent unexplained strokes caused by a nonobstructive carotid plaque with IPH.
Background Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.
Purpose Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data.
Abstract Objectives Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy).
Abstract Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA – radial artery – A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.
Abstract Background In all of randomized controlled trials of mechanical thrombectomy, the target vessels were proximal. Herein we report a clinical trial of the Tron FX stent retriever, including the smallest size of 2/15 mm for distal intracranial large vessel occlusion (LVO).
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