22 diciembre 2020

Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

Mostafa Jafari, MD Thanh N. Nguyen, MD Santiago Ortega-Gutierrez, MD, MSc Muhammad Shazam Hussain, MD Ameer E. Hassan, DO Asad Ikram, MD Javed Khader Eliyas, MD, FRCSC Gustavo J. Rodriguez, MD Afshin A. Divani, PhD, FAHA

Objectives/Background Medical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect.

30 diciembre 2020

White Matter Acute Infarct Volume After Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke is Associated with Long Term Outcomes

Robert W. Regenhardt, MD,PhD Mark R. Etherton, MD,PhD Alvin S. Das, MD Markus D. Schirmer, PhD Joshua A. Hirsch, MD Christopher J. Stapleton, MD Aman B. Patel, MD Thabele M. Leslie-Mazwi, MD Natalia S. Rost, MD,MPH

Objectives Despite the proven efficacy of endovascular thrombectomy (EVT) for large vessel occlusion stroke, over half treated remain functionally disabled or die. Infarct topography may have implications for prognostication, patient selection, and the development of tissue-specific neuroprotective agents. We sought to quantify white matter injury in anterior circulation acute infarcts post-EVT to understand its significance and identify its determinants.

15 diciembre 2020

Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors

Isabel Siow Keng Siang Lee John J.Y. Zhang Seyed Ehsan Saffari Adeline Ng Barnaby Young

Introduction COVID-19 is a multi-system infection which predominantly affects the respiratory system, but also causes systemic inflammation, endothelialitis and thrombosis. The consequences of this include renal dysfunction, hepatitis and stroke. In this systematic review, we aimed to evaluate the epidemiology, clinical course, and outcomes of patients who suffer from stroke as a complication of COVID-19.

09 diciembre 2020

Transcranial Doppler Ultrasound Evidence of Active Cerebral Embolization in COVID-19

Ayush Batra, MD # Jeffrey R. Clark, BA # Katie LaHaye, BS Nathan A. Shlobin, BA Steven C. Hoffman, BS Zachary S. Orban, BS Katharine Colton, MD Jane E. Dematte, MD Farzaneh A. Sorond, MD, PhD Igor J. Koralnik, MD Eric M. Liotta, MD, MS

Objective To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke.

11 diciembre 2020

Functional Outcome After Mechanical Thrombectomy with or without Previous Thrombolysis

Manuel Machado, MD Marta Alves, MSc Alberto Fior, MD Isabel Fragata, MD, PhD Ana Luísa Papoila, PhD João Reis, MD Ana Paiva Nunes, MD Show less

Introduction Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned.

24 noviembre 2020

Endovascular Therapy of Acute Ischemic Stroke in Patients with Large-Vessel Occlusion Associated with Active Malignancy

Tomohiko Ozaki Patrick Nicholson 1 Joanna D. Schaafsma 2 Ronit Agid 3 Timo Krings 4 Aleksandra Pikula 5 Vitor Mendes Pereira Show less Show footnotes

Purpose There is limited data on the effectiveness of endovascular therapy (EVT) in stroke patients with active malignancy. In this study, we investigated the outcome of EVT for acute ischemic stroke for patients with active malignancy compared to those without malignancy.

26 noviembre 2020

Treatment Approaches and Outcomes for Acute Anterior Circulation Stroke Patients with Tandem Lesions

Neal M. Nolan, MD 1 Robert W. Regenhardt, MD, PhD 1 Matthew J. Koch, MD Scott B. Raymond, MD Christopher J. Stapleton, MD James D. Rabinov, MD Scott B. Silverman, MD Thabele M. Leslie-Mazwi, MD Aman B. Patel, MD

Objectives Endovascular thrombectomy (EVT) has revolutionized stroke care for large vessel occlusions (LVOs). However, over half treated remain functionally disabled or die. Patients with tandem lesions, or severe stenosis/occlusion of the cervical internal carotid artery (ICA) with intracranial LVO, may have technical EVT challenges and worse outcomes. We sought to compare treatments and outcomes for patients with anterior circulation tandem lesions versus isolated LVOs.

27 noviembre 2020

Conventional Angiography in the Assessment of Recently Symptomatic Patients with Ipsilateral Carotid Stenosis

Daniel A. Tonetti, MD Shashvat M. Desai, MD Gautam Nayar, MD Brian T. Jankowitz, MD Ashutosh P. Jadhav, MD PhD Tudor G. Jovin, MD Show all authors

Background and Purpose Benefits of revascularization for moderate and severe (≥50%) carotid stenosis were established based on digital subtraction angiography (DSA). We aimed to assess the discrepancy between invasive and non-invasive angiography in a consecutive, prospective cohort of patients with recent stroke and non-invasive imaging suggesting ≥50% ipsilateral carotid stenosis.

01 diciembre 2020

Intravenous Thrombolysis before Thrombectomy may Increase the Incidence of Intracranial Hemorrhage inTreating Carotid T Occlusion

Mingyang Du, MD 1 Shun Li, MD 1 Xianjun Huang, MD Shuai Zhang, MD Yongjie Bai, MD Bin Yan, MD Hongquan Guo, MD Gelin Xu, MD, PhD Xinfeng Liu, MD, PhD

Background and Purpose Current evidence does not agree on the merits of direct and bridging thrombectomy. This study aimed to compare the safety and efficacy of direct thrombectomy (DT) and bridging thrombectomy (BT) in treating patients with acute ischaemic stroke due to carotid T occlusion.

01 diciembre 2020

National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly

Amol Mehta, MD 1 Johanna T Fifi, MD 2 Hazem Shoirah, MD 2 I.Paul Singh, MD, MPH 2 Tomoyoshi Shigematsu, MD, PhD 2 Christopher P Kellner, MD, PhD 2 Reade De Leacy, MD 2 J Mocco, MD 2 Shahram Majidi, MD Show less Show footnotes

Objective Octogenarians were excluded and/or underrepresented in the major endovascular thrombectomy (EVT) randomized controlled trials, but continue to make up a growing proportion of stroke patients. To evaluate real-world trends in utilization and outcome of EVT in patients ≥80 years in a large nationally representative database.

02 diciembre 2020

Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes

Sanjana Salwi, BA Katherine A. Kelly, BA Pious D. Patel, BA Eva A. Mistry, MBBS Akshitkumar M. Mistry, MD Rohan V. Chitale, MD

Background/Purpose Our study aimed to assess the impacts of neighborhood socioeconomic status on mechanical thrombectomy (MT) outcomes for acute ischemic stroke (AIS).

08 diciembre 2020

Number of Patients with Ischemic Stroke did not Decline in a Regional Stroke Unit After the Implementation of Mechanical Thrombectomy

Stephan Scherzer, MD Andrea Robledo Karin Stahl Sami Nasri, MD Peter Kraft, MD

Abstract Objectives: Since the implementation of mechanical thrombectomy (MT) in 2015 for patients with ischemic stroke and large-vessel occlusion, the question arose as to whether patients should be primarily admitted to the nearest regional stroke unit (SU) for prompt intravenous thrombolysis (IVT) or to a more distant supraregional SU performing MT, to avoid secondary-transfer delays in MT. Although an evidence-based answer is still lacking, a discrepant discussion with potential consequences for the regional flow of stroke patients arose. We aimed to assess if MT implementation was associated with the number and characteristics of patients with stroke/transient ischemic attack (TIA) admitted to a regional SU not offering endovascular treatment.

09 diciembre 2020

Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies

François Delvoye, MD Benjamin Maier, MD Simon Escalard, MD Julien Labreuche, BST Laurie-Anne Thion, MD Soufiane Aknouche, MSc Solène Hebert, MD Hocine Redjem, MD Stanislas Smajda, MD Gabriele Ciccio, MD Julien Allard, MD Candice Sabben, MD Michael Obadia, MD Alain Maertens de Noordhout, MD, PhD Jean-Marc Olivot, MD, PhD Raphael Blanc, MD Michel Piotin, MD, PhD Jean-Philippe Desilles, MD, PhD Mikael Mazighi, MD, PhD Show less

Introduction Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting.

06 noviembre 2020

Endovascular Treatment of Symptomatic Intracranial Vertebrobasilar Stenosis: A 10-Year Single Centre Experience Using Balloon-Expandable Coronary Artery Stents

Mariangela Piano, MD Luca Milonia, MD Amedeo Cervo, MD Beatrice Modello, MD Antonio Macera, MD Guglielmo Pero, MD Luca Quilici, MD Edoardo Boccardi, MD Luca Valvassori, MD

Background Symptomatic intracranial vertebro-basilar stenoses (SIVBS) are associated with high risk of recurrent ischemic stroke, even in patients receiving the best medical treatment. Although medical treatment is still the standard of care, non-responding patients may require endovascular treatment; balloon-mounted coronary stents (BMCS) could be successfully employed. This study aims to retrospectively analyze our high volume Interventional Neurovascular center ten-year experience in the off-label use of BMCS for the treatment of SIVBS, in order to assess its feasibility and safety.

11 noviembre 2020

Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center

Hyun Jin Lee Hyo Sung Kwak, MD, PhD Gyung Ho Chung, MD, PhD Jung-Soo Park, MD, PhD

Background Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion (LVO). The purpose of this study is to report the frequency, timing, and outcomes of rEVT in a single center.