16 enero 2014

STROKE. Advances in Stroke. Advances in Interventional Radiology 2013

Ajay K. Wakhloo, MD, PhD, FAHA; Matthew J. Gounis, PhD; Ju-Yu Chueh, PhD; Laurent Pierot, MD, PhD

The simultaneous publication of 3 randomized control trials comparing intravenous thrombolysis therapy to the endovascular treatment (EVT) of acute ischemic stroke might have lead to the erroneous conclusion that EVT has no place in the management of acute ischemic stroke.1–3 However, careful analysis of these studies shows that these reports have shortcomings because of changes in imaging and device technology and to study designs.

12 diciembre 2013

STROKE. Clinical Sciences. Alberta Stroke Program Early Computed Tomography Score to Select Patients for Endovascular Treatment

Michael D. Hill, MD, FRCPC; Andrew M. Demchuk, MD, FRCPC; Mayank Goyal, MD, FRCPC; Tudor G. Jovin, MD; Lydia D. Foster, MSc; Thomas A. Tomsick, MD; Rüdiger von Kummer, MD; Sharon D. Yeatts, PhD; Yuko Y. Palesch, PhD; Joseph P. Broderick, MD for the IMS3 Investigators

Background and Purpose: The Interventional Management of Stroke (IMS)-III trial randomized patients with acute ischemic stroke to intravenous tissue-type plasminogen activator (tPA) plus endovascular therapy versus intravenous tPA therapy alone within 3 hours from symptom onset. A predefined secondary hypothesis was that subjects with significant early ischemic change on the baseline scan would not respond to endovascular therapy.

09 enero 2014

STROKE. Clinical Sciences. Addition of Hyperacute MRI Aids in Patient Selection, Decreasing the Use of Endovascular Stroke Therapy

Dolora Wisco, MD; Ken Uchino, MD; Maher Saqqur, MD; James M. Gebel, MD; Junya Aoki, MD; Shazia Alam, DO; Pravin George, DO; Christopher R. Newey, DO; Shumei Man, MD; Yohei Tateishi, MD; Julie McNeil, RN; Michelle Winfield, RN; Esteban Cheng-Ching, MD; Ferdinand K. Hui, MD; Gabor Toth, MD; Mark Bain, MD; Peter A. Rasmussen, MD; Thomas Masaryk, MD; Paul Ruggieri, MD; Muhammad Shazam Hussain, MD

Background and Purpose: The failure of recent trials to show the effectiveness of acute endovascular stroke therapy (EST) may be because of inadequate patient selection. We implemented a protocol to perform pretreatment MRI on patients with large-vessel occlusion eligible for EST to aid in patient selection.

16 enero 2014

STROKE. Clinical Sciences. Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke

Katja Piironen, MD; Marjaana Tiainen, MD, PhD; Satu Mustanoja, MD, PhD; Kirsi-Maija Kaukonen, MD, PhD; Atte Meretoja, MD, PhD; Turgut Tatlisumak, MD, PhD; Markku Kaste, MD, PhD

Background and Purpose: Hypothermia improves outcome in resuscitated patients and newborns with hypoxic brain injury. We studied the safety and feasibility of mild hypothermia in awake patients with stroke after intravenous thrombolysis.

17 diciembre 2013

STROKE. Clinical Sciences. Carotid Stenting. Is There an Operator Effect? A Pooled Analysis From the Carotid Stenting Trialists’ Collaboration

David Calvet, MD, PhD; Jean-Louis Mas, MD; Ale Algra, MD, PhD; Jean-Pierre Becquemin, MD; Leo H. Bonati, MD, PhD; Joanna Dobson, MSc; Gustav Fraedrich, MD; Olav Jansen, MD; Willem P. Mali, MD; Peter A. Ringleb, MD, PhD*; Gilles Chatellier, MD, PhD*; Martin M. Brown, MD, FRCP*†

Background and Purpose: Randomized clinical trials show higher 30-day risk of stroke or death after carotid artery stenting compared with surgery. We examined whether operator experience is associated with 30-day risk of stroke or death in the Carotid Stenting Trialists’ Collaboration database.

26 diciembre 2013

STROKE. Basic Sciences. Roles of Hypertension in the Rupture of Intracranial Aneurysms

Yoshiteru Tada, MD, PhD*; Kosuke Wada, MD*; Kenji Shimada, MD, PhD; Hiroshi Makino, MD; Elena I. Liang, BS; Shoko Murakami, MD, PhD; Mari Kudo, MD; Keiko T. Kitazato, BS; Shinji Nagahiro, MD, PhD; Tomoki Hashimoto, MD

Background and Purpose: Systemic hypertension has long been considered a risk factor of aneurysmal rupture. However, a causal link between systemic hypertension and the development of aneurysmal rupture has not been established. In this study, using a mouse model of intracranial aneurysm rupture, we examined the roles of systemic hypertension in the development of aneurysmal rupture.

24 diciembre 2013

STROKE. Brief Report. Predictors of Acute and Persisting Ischemic Brain Lesions in Patients Randomized to Carotid Stenting or Endarterectomy

Ayda Rostamzadeh, MD; Thomas Zumbrunn, PhD; Lisa M. Jongen, MD, PhD; Paul J. Nederkoorn, PhD, MD; Sumaira Macdonald, FRCR; Philippe A. Lyrer, MD; L. Jaap Kappelle, MD; Willem P. Th. M. Mali, MD; Martin M. Brown, FRCP; H. Bart van der Worp, PhD, MD; Stefan T. Engelter, MD; Leo H. Bonati, MD on behalf of the ICSS-MRI Substudy Investigators

Background and Purpose: We investigated predictors for acute and persisting periprocedural ischemic brain lesions among patients with symptomatic carotid stenosis randomized to stenting or endarterectomy in the International Carotid Stenting Study.

17 diciembre 2013

STROKE. Brief Report. Reperfusion Injury on Magnetic Resonance Imaging After Carotid Revascularization

A-Hyun Cho, MD, PhD; Yong-Pil Cho, MD, PhD; Deok Hee Lee, MD, PhD; Tae-Won Kwon, MD, PhD; Sun U. Kwon, MD, PhD; Dae-Chul Suh, MD, PhD; Jong S. Kim, MD, PhD; Dong-Wha Kang, MD, PhD

Background and Purpose: Reperfusion injury can be revealed as delayed gadolinium enhancement in the subarachnoid space on a fluid-attenuated inversion recovery image, which is designated as a hyperintense acute reperfusion marker (HARM). We sought to investigate the occurrence and predictors of HARM and its association with new ischemic infarcts after carotid revascularization.

16 octubre 2014

STROKE. Clinical Sciences. Evolution of Practice During the Interventional Management of Stroke III Trial and Implications for Ongoing Trials

Joseph P. Broderick, MD; Yuko Y. Palesch, PhD; Andrew M. Demchuk, MD; Sharon D. Yeatts, PhD; Pooja Khatri, MD; Michael D. Hill, MD; Edward C. Jauch, MD; Tudor G. Jovin, MD; Bernard Yan, MD; Rüdiger von Kummer, MD; Carlos A. Molina, MD; Mayank Goyal, MD; Mikael Mazighi, MD, PhD; Wouter J. Schonewille, MD; Stefan T. Engelter, MD; Craig Anderson, MD, PhD; Judith Spilker, RN, BSN; Janice Carrozzella, MSN, APRN, RT(R); L. Scott Janis, PhD; Lydia D. Foster, MS; Thomas A. Tomsick, MD; for the Interventional Management of Stroke III Investigators

Background and Purpose: We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial.

05 febrero 2015

STROKE. Clinical Sciences. Regional Availability of Mechanical Embolectomy for Acute Ischemic Stroke in California, 2009 to 2010

Jay Chol Choi, MD, PhD; Renee Y. Hsia, MD, MSc; Anthony S. Kim, MD, MAS

Background and Purpose: We sought to assess the geographic proximity of patients with stroke in California to centers that performed specific threshold volumes of mechanical embolectomy procedures each year.

25 noviembre 2014

STROKE. Clinical Sciences. Early Outcomes After Carotid Artery Stenting Compared With Endarterectomy for Asymptomatic Carotid Stenosis

Jay Chol Choi, MD; S. Claiborne Johnston, MD, PhD; Anthony S. Kim, MD, MAS

Background and Purpose: Despite the absence of definitive data from randomized clinical trials on the comparative effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic carotid stenosis, the use of CAS has been expanding and seems to be displacing the use of CEA in some parts of the United States.

08 agosto 2013

STROKE. Clinical Sciences. Optimizing Prediction Scores for Poor Outcome After Intra-Arterial Therapy in Anterior Circulation Acute Ischemic Stroke

Amrou Sarraj, MD; Karen Albright, DO, MPH; Andrew D. Barreto, MD; Amelia K. Boehme, MSPH; Clark W. Sitton, MD; Jeanie Choi, MD; Steven L. Lutzker, MD; Chung-Huan J. Sun, MB; Wafi Bibars, MD; Claude B. Nguyen, MD; Osman Mir, MD; Farhaan Vahidy, MD; Tzu-Ching Wu, MD; George A. Lopez, MD, PhD; Nicole R. Gonzales, MD; Randall Edgell, MD; Sheryl Martin-Schild, MD, PhD; Hen Hallevi, MD; Peng Roc Chen, MD; Mark Dannenbaum, MD; Jeffrey L. Saver, MD; David S. Liebeskind, MD; Raul G. Nogueira, MD; Rishi Gupta, MD; James C. Grotta, MD; Sean I. Savitz, MD

Background and Purpose: Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions.

30 octubre 2013

STROKE. Clinical Sciences. Vasa Vasorum Enhancement on Computerized Tomographic Angiography Correlates With Symptomatic Patients With 50% to 70% Carotid Artery Stenosis

Javier M. Romero, MD; Raffaella Pizzolato, MD; Wendy Atkinson, BA; Anna Meader, BSc; Camilo Jaimes, MD; Glenn Lamuraglia, MD; Michael R. Jaff, DO; Ferdinando Buonanno, MD; Josser Delgado Almandoz, MD; Ramon G. Gonzalez, MD, PhD

Background and Purpose: Significant stenosis of the internal carotid artery (ICA) is an established stroke risk factor. Recent evidence suggests that features within the atherosclerotic plaque also have prognostic value. The purpose of this study was to correlate the enhancement of the vasa vasorum (VV) overlying the carotid artery plaque with acute neurological symptoms in patients with 50% to 70% ICA stenosis.

26 septiembre 2013

STROKE. Clinical Sciences. THRIVE Score Predicts Outcomes With a Third-Generation Endovascular Stroke Treatment Device in the TREVO-2 Trial

Alexander C. Flint, MD, PhD; Bin Xiang, PhD; Rishi Gupta, MD; Raul G. Nogueira, MD; Helmi L. Lutsep, MD; Tudor G. Jovin, MD; Gregory W. Albers, MD; David S. Liebeskind, MD; Nerses Sanossian, MD; Wade S. Smith, MD, PhD for the TREVO-2 Trialists

Background and Purpose: Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device).

17 octubre 2013

STROKE. Clinical Sciences. A Clinical Rule (Sex, Contralateral Occlusion, Age, and Restenosis) to Select Patients for Stenting Versus Carotid Endarterectomy

Emmanuel Touzé, MD, PhD*; Ludovic Trinquart, PhD*; Rui Felgueiras, MD; Kittipan Rerkasem, MD, PhD; Leo H. Bonati, MD, PhD; Gayané Meliksetyan, MD; Peter A. Ringleb, MD, PhD; Jean-Louis Mas, MD; Martin M. Brown, MD, FRCP; Peter M. Rothwell, MD, PhD, FRCP, FMedSci in collaboration with the Carotid Stenting Trialists’ Collaboration

Background and Purpose: Compared with carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS) is associated with a higher risk of procedural stroke or death especially in patients with symptomatic stenosis. However, after the perioperative period, risk is similar with both treatments, suggesting that CAS could be an acceptable option in selected patients.