07 abril 2015

STROKE. Clinical Sciences. Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke

Lucie A. van den Berg, MD; Diederik L.H. Koelman, BSc; Olvert A. Berkhemer, MD; Anouk D. Rozeman, MD; Puck S.S. Fransen, MD; Debbie Beumer, MD; Diederik W. Dippel, MD, PhD; Aad van der Lugt, MD, PhD; Robert J. van Oostenbrugge, MD, PhD; Wim H. van Zwam, MD, PhD; Patrick A. Brouwer, MD; Sjoerd Jenniskens, MD; Jelis Boiten, MD, PhD; Geert A. Lycklama à Nijeholt, MD, PhD; Jan Albert Vos, MD, PhD; Wouter J. Schonewille, MD, PhD; Charles B.L.M. Majoie, MD, PhD; Yvo B.W.E.M. Roos, MD, PhD; for the MR CLEAN pretrial study group

Background and Purpose: Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT.

18 marzo 2014

STROKE. Clinical Sciences. Incident Stroke Is Associated With Common Carotid Artery Diameter and Not Common Carotid Artery Intima-Media Thickness

Joseph F. Polak, MD, MPH; Ralph L. Sacco, MD, MS; Wendy S. Post, MD, MS; Dhananjay Vaidya, MBBS, PhD, MPH; Martinson Kweku Arnan, MD, MPA; Daniel H. O’Leary, MD

Background and Purpose: The common carotid artery interadventitial diameter is measured on ultrasound images as the distance between the media-adventitia interfaces of the near and far walls. It is associated with common carotid intima-media thickness (IMT) and left ventricular mass and might therefore also have an association with incident stroke.

08 abril 2014

STROKE. Clinical Sciences. Volume of Carotid Artery Ulceration as a Predictor of Cardiovascular Events

Mariya Kuk; Thapat Wannarong, MD; Vadim Beletsky, MD; Grace Parraga, PhD; Aaron Fenster, PhD; J. David Spence, MD

Background and Purpose: Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).

03 abril 2014

STROKE. Clinical Sciences. Challenges of Decision Making Regarding Futility in a Randomized Trial. The Interventional Management of Stroke III Experience

Sharon D. Yeatts, PhD; Renee H. Martin, PhD; Christopher S. Coffey, PhD; Patrick D. Lyden, MD; Lydia D. Foster, MS; Robert F. Woolson, PhD; Joseph P. Broderick, MD; Marco R. Di Tullio, MD; Charles A. Jungreis, MD; Yuko Y. Palesch, PhD; for the IMS III Investigators

Background and Purpose: Interventional Management of Stroke (IMS) III is a randomized, parallel arm trial comparing the approach of intravenous tissue-type plasminogen activator followed by endovascular treatment with intravenous tissue-type plasminogen activator alone in patients with acute ischemic stroke presenting <3 hours of symptom onset. The trial intended to enroll 900 subjects to ensure adequate statistical power to detect an absolute 10% difference in the percentage of subjects with good outcome, defined as modified Rankin Scale score of 0 to 2 at 3 months. In April 2012, after 656 subjects were randomized, further enrollment was terminated by the National Institute of Neurological Disorders and Stroke based on the prespecified criterion for futility using conditional power <20%

03 abril 2014

STROKE. Clinical Sciences. Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Simon C.H. Yu, MD; Winnie X.Y. Zou, PhD; Yannie O.Y. Soo, MD; Lily Wang, MD; Joyce Wai Yi Hui, FRCR; Anne Y.Y. Chan, MD; Kwok Tung Lee, MSc; Vincent H.L. Ip, MD; Florence S.Y. Fan, MD; Annie L.C. Chan, MSc; Lawrence K.S. Wong, MD; Thomas W. Leung, MD

Background and Purpose: We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control.

25 marzo 2014

STROKE. Clinical Sciences. North American SOLITAIRE Stent-Retriever Acute Stroke Registry Choice of Anesthesia and Outcomes

Alex Abou-Chebl, MD; Ossama O. Zaidat, MD, MS; Alicia C. Castonguay, PhD; Rishi Gupta, MD; Chung-Huan J. Sun, MD; Coleman O. Martin, MD; William E. Holloway, MD; Nils Mueller-Kronast, MD; Joey D. English, MD; Italo Linfante, MD; Guilherme Dabus, MD; Timothy W. Malisch, MD; Franklin A. Marden, MD; Hormozd Bozorgchami, MD; Andrew Xavier, MD; Ansaar T. Rai, MD; Micahel T. Froehler, MD, PhD; Aamir Badruddin, MD; Thanh N. Nguyen, MD, FRCPC; Muhammad Taqi, MD; Michael G. Abraham, MD; Vallabh Janardhan, MD; Hashem Shaltoni, MD; Roberta Novakovic, MD; Albert J. Yoo, MD; Peng R. Chen, MD; Gavin W. Britz, MD; Ritesh Kaushal, MD; Ashish Nanda, MD; Mohammad A. Issa, MD; Raul G. Nogueira, MD

Background and Purpose: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy.

03 abril 2014

STROKE. Clinical Sciences. Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy

Nishant K. Mishra, MBBS, PhD, FESO; Gregory W. Albers, MD; Søren Christensen, PhD; Michael Marks, MD; Scott Hamilton, PhD; Matus Straka, PhD; John T.P. Liggins, MSc; Stephanie Kemp, BS; Michael Mlynash, MD, MS; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 Investigators

Background and Purpose: The Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) study has shown that clinical response to endovascular reperfusion differs between patients with and without perfusion–diffusion (perfusion-weighted imaging–diffusion-weighted imaging, PWI–DWI) mismatch: patients with mismatch have a favorable clinical response to reperfusion, whereas patients without mismatch do not. This study examined whether alternative mismatch criteria can also differentiate patients according to their response to reperfusion.

01 abril 2014

STROKE. Clinical Sciences. Early Intensive Versus Minimally Invasive Approach to Postoperative Hemodynamic Management After Subarachnoid Hemorrhage

Tatsushi Mutoh, MD, DVM, PhD; Ken Kazumata, MD; Shunsuke Terasaka, MD; Yasuyuki Taki, MD, PhD; Akifumi Suzuki, MD; Tatsuya Ishikawa, MD

Background and Purpose: The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but the effects of EGDT on clinical outcomes are still unclear. This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy.

20 marzo 2014

STROKE. Clinical Sciences. Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms

Daan Backes, MD; Mervyn D.I. Vergouwen, MD, PhD; Birgitta K. Velthuis, MD, PhD; Irene C. van der Schaaf, MD, PhD; A. Stijntje E. Bor, MD; Ale Algra, MD, PhD; Gabriel J.E. Rinkel, MD, FRCPE

Background and Purpose: Prediction of the risk of rupture of unruptured intracranial aneurysms is mainly based on aneurysm size and location. Previous studies identified features of aneurysm shape and flow angles as additional risk factors for aneurysm rupture, but these studies were at risk for confounding by patient-specific risk factors such as hypertension and age. In this study, we avoided this risk by comparing characteristics of ruptured and unruptured aneurysms in patients with both aneurysmal subarachnoid hemorrhage and multiple intracranial aneurysms.

20 febrero 2014

STROKE. Clinical Sciences. Early Diffusion-Weighted Imaging Reversal After Endovascular Reperfusion Is Typically Transient in Patients Imaged 3 to 6 Hours After Onset

Manabu Inoue, MD, PhD; Michael Mlynash, MD, MS; Soren Christensen, PhD; Hayley M. Wheeler, BS; Matus Straka, PhD; Aaryani Tipirneni, MS; Stephanie M. Kemp, BS; Greg Zaharchuk, MD, PhD; Jean-Marc Olivot, MD, PhD; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; Gregory W. Albers, MD; for the DEFUSE 2 Investigators

Background and Purpose: The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient.

25 febrero 2014

STROKE. Clinical Sciences. Increasing Use of Computed Tomographic Perfusion and Computed Tomographic Angiograms in Acute Ischemic Stroke From 2006 to 2010

Achala Vagal, MD; Karthikeyan Meganathan, MS; Dawn O. Kleindorfer, MD; Opeolu Adeoye, MD, MS; Richard Hornung, PhD; Pooja Khatri, MD, MSc

Background and Purpose: Our objective was to study nationwide utilization trends of computed tomographic (CT) angiogram (CTA) and CT perfusion (CTP) in acute ischemic stroke and particularly in the context of use of reperfusion therapies.

25 febrero 2014

STROKE. Clinical Sciences. Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

Michael P. Marks, MD; Maarten G. Lansberg, MD; Michael Mlynash, MD; Jean-Marc Olivot, MD; Matus Straka, PhD; Stephanie Kemp, BS; Ryan McTaggart, MD; Manabu Inoue, MD; Greg Zaharchuk, MD, PhD; Roland Bammer, PhD; Gregory W. Albers, MD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Investigators

Background and Purpose: Our aim was to determine the relationships between angiographic collaterals and diffusion/perfusion findings, subsequent infarct growth, and clinical outcome in patients undergoing endovascular therapy for ischemic stroke.

04 marzo 2014

STROKE. Clinical Sciences. Outcomes of a Contemporary Cohort of 536 Consecutive Patients With Acute Ischemic Stroke Treated With Endovascular Therapy

Sònia Abilleira, MD, PhD; Pere Cardona, MD; Marc Ribó, MD, PhD; Mònica Millán, MD, PhD; Víctor Obach, MD, PhD; Jaume Roquer, MD, PhD; David Cánovas, MD; Joan Martí-Fàbregas, MD, PhD; Francisco Rubio, MD, PhD; José Álvarez-Sabín, MD, PhD; Antoni Dávalos, MD, PhD; Ángel Chamorro, MD, PhD; Maria Angeles de Miquel, MD, PhD; Alejandro Tomasello, MD, PhD; Carlos Castaño, MD, PhD; Juan M. Macho, MD, PhD; Aida Ribera, BSc, PhD; Miquel Gallofré, MD, PhD; on behalf of the Catalan Stroke Code and Reperfusion Consortium

Background and Purpose: We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome.

13 abril 2014

STROKE. Clinical Sciences. Stroke Thrombolysis. Save a Minute, Save a Day

Atte Meretoja, MD; Mahsa Keshtkaran, MSc; Jeffrey L. Saver, MD; Turgut Tatlisumak, MD; Mark W. Parsons, MD; Markku Kaste, MD; Stephen M. Davis, MD; Geoffrey A. Donnan, MD; Leonid Churilov, PhD

Background and Purpose: Stroke thrombolysis is highly time-critical, but data on long-term effects of small reductions in treatment delays have not been available. Our objective was to quantify patient lifetime benefits gained from faster treatment.

13 marzo 2014

STROKE. Basic Sciences. Extravascular Optical Coherence Tomography. Evaluation of Carotid Atherosclerosis and Pravastatin Therapy

Robert T. Wicks, MD*; Yong Huang, PhD*; Kang Zhang, PhD; Mingtao Zhao, PhD; Betty M. Tyler, BA; Ian Suk, CMI; Lee Hwang, MD; Jacob Ruzevick, BS; George Jallo, MD; Henry Brem, MD; Gustavo Pradilla, MD; Jin U. Kang, PhD

Background and Purpose: Extravascular optical coherence tomography (OCT), as a noninvasive imaging methodology with micrometer resolution, was evaluated in a murine model of carotid atherosclerosis by way of assessing the efficacy of pravastatin therapy.