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ESTUDIOS


14 agosto 2019

Predicting Clinical Outcomes of Large Vessel Occlusion Before Mechanical Thrombectomy Using Machine Learning

Hidehisa Nishi, Naoya Oishi, Akira Ishii, Isao Ono, Takenori Ogura, Tadashi Sunohara, Hideo Chihara, Ryu Fukumitsu, Masakazu Okawa, Norikazu Yamana, Hirotoshi Imamura, Nobutake Sadamasa, Taketo Hatano, Ichiro Nakahara, Nobuyuki Sakai and Susumu Miyamoto

Abstract Background and Purpose— The clinical course of acute ischemic stroke with large vessel occlusion (LVO) is a multifactorial process with various prognostic factors. We aimed to model this process with machine learning and predict the long-term clinical outcome of LVO before endovascular treatment and to compare our method with previously developed pretreatment scoring methods.

22 julio 2019

Predictors of Parenchymal Hematoma After Mechanical Thrombectomy

William Boisseau, Robert Fahed, Bertrand Lapergue, Jean-Philippe Desilles, Kevin Zuber, Naim Khoury, Jeanne Garcia, Benjamin Maïer, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Simon Escalard, Guillaume Taylor, Mikael Mazighi, Michel Piotin, Benjamin Gory, Raphaël Blanc and on behalf of ETIS Investigators

Abstract Background and Purpose— Parenchymal hematoma (PH) is a rare but dreadful complication of acute ischemic stroke with unclear underlying mechanisms. We aimed to study the incidence and predictors of PH after mechanical thrombectomy.

10 julio 2019

Derivo Embolization Device for the Treatment of Intracranial Aneurysms

Felipe Padovani Trivelato, Daniel Giansante Abud, Alexandre Cordeiro Ulhôa, Eduardo Siqueira Waihrich, Thiago Giansante Abud, Luis Henrique Castro Afonso, Guilherme Seizem Nakiri, Guilherme Duarte de Castro, Bruno de Sousa Mendes Parente, Rodrigo dos Santos Silva, Luciano Bambini Manzato, Lucas Eduardo Bonadio, Dinark Conceição Viana, José Ricardo Vanzin, Carlos Eduardo Baccin and Marco Túlio Salles Rezende

Abstract Background and Purpose— Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms.

10 junio 2019

Biomaterials for Stroke Therapy

Christopher J. Love, Magdy Selim, Myron Spector and Eng H. Lo

The goal of stroke treatment is to minimize the amount of brain damage resulting from ischemia or hemorrhage in the cerebrovascular network. Some standard acute-phase interventions—tPA (tissue-type plasminogen activator) and mechanical thrombectomy—exist for ischemic stroke with dramatically improved outcomes.1,2 For hemorrhagic stroke, the interventions3 focus on stabilizing temperature and blood pressure and aggressively managing and preventing complications, including rising intracranial pressure and cerebral edema. Ongoing clinical trials4 are investigating pharmacological agents and early removal of the hematoma.

05 julio 2019

Reversible Cerebral Vasoconstriction Syndrome

Tina M. Burton and Cheryl D. Bushnell

Reversible cerebral vasoconstriction syndrome (RCVS) is used to describe a multitude of pathologies encompassing the clinical terms Call-Fleming syndrome, thunderclap headache (TCH) with reversible vasospasm, benign angiopathy of the central nervous system, postpartum angiopathy, migrainous vasospasm or migraine angiitis, drug-induced cerebral arteritis or angiopathy, and sexual headache.

17 junio 2017

Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes

Mohammad Anadani, Alejandro M. Spiotta, Ali Alawieh, Francis Turjman, Michel Piotin, Diogo C. Haussen, Raul G. Nogueira, Panagiotis Papanagiotou, Adnan H. Siddiqui, Bertrand Lapergue, Franziska Dorn, Christophe Cognard, Marc Ribo, Marios N. Psychogios, Marc Antoine Labeyrie, Mikael Mazighi, Alessandra Biondi, René Anxionnat, Serge Bracard, Sébastien Richard and Benjamin Gory

Abstract Background and Purpose— Emergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic stroke patients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in stroke patient population treated with prior IVT.

26 junio 2019

Frequency of Blood-Brain Barrier Disruption Post-Endovascular Therapy and Multiple Thrombectomy Passes in Acute Ischemic Stroke Patients

Marie Luby, Amie W. Hsia, Zurab Nadareishvili, Kaylie Cullison, Noorie Pednekar, Malik Muhammad Adil and Lawrence L. Latour

Abstract Background and Purpose— The high prevalence of hyperintense acute reperfusion marker (HARM) seen after endovascular therapy is suggestive of blood-brain barrier disruption and hemorrhage risk and may be attributable to multiple thrombectomy passes needed to achieve recanalization.

09 julio 2019

Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke

Rob A. van de Graaf, Vicky Chalos, Adriaan C.G.M. van Es, Bart J. Emmer, Geert J. Lycklama à Nijeholt, H. Bart van der Worp, Wouter J. Schonewille, Aad van der Lugt, Diederik W.J. Dippel, Hester F. Lingsma, Bob Roozenbeek and on behalf of the MR CLEAN Registry Investigators

Abstract Background and Purpose— Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety.

20 junio 2019

True First-Pass Effect

Omid Nikoubashman, Sven Dekeyzer, Alexander Riabikin, Annika Keulers, Arno Reich, Anastasios Mpotsaris and Martin Wiesmann

Abstract Background and Purpose— It has been hypothesized that in stroke patients, complete reperfusion (modified Thrombolysis in Cerebral Infarction; mTICI 3) after a single thrombectomy pass is a predictor for favorable outcome (modified Rankin Scale score, 0–2), but a true first-pass effect defined as improved clinical outcome after complete reperfusion with one versus multiple passes has not yet been specifically addressed in the literature.

18 junio 2019

Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke

Kavelin Rumalla, Malte Ottenhausen, Peter Kan and Jan-Karl Burkhardt

Abstract Background and Purpose— The treatment of patients with acute ischemic stroke has been revolutionized by endovascular mechanical thrombectomy (MT), leading to dramatically improved outcomes. Here, we analyzed the impact of recent changes in stroke management on nationwide trends in patient characteristics, treatment modalities, and outcomes.

15 julio 2019

Patterns and Outcomes of Endovascular Therapy in Mild Stroke

Negar Asdaghi, Dileep R. Yavagal, Kefeng Wang, Nils Mueller-Kronast, Nirav Bhatt, Hannah E. Gardener, Carolina M. Gutierrez, Erika Marulanda-Londoño, Sebastian Koch, Chuanhui Dong, Sophia A. Oluwole, Ricardo Hanel, Brijesh Mehta, Mary Robichaux, Ulises Nobo, Juan C. Zevallos, Tatjana Rundek, Ralph L. Sacco and Jose G. Romano

Abstract Background and Purpose— We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms

20 julio 2019

Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

Bruna G. Dutra, Manon L. Tolhuisen, Heitor C.B.R. Alves, Kilian M. Treurniet, Manon Kappelhof, Albert J. Yoo, Ivo G.H. Jansen, Diederik W.J. Dippel, Wim H. van Zwam, Robert J. van Oostenbrugge, Antônio J. da Rocha, Hester F. Lingsma, Aad van der Lugt, Yvo B.W.E.M. Roos, Henk A. Marquering, Charles B.L.M. Majoie and the MR CLEAN Registry Investigators

Abstract Background and Purpose— Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment.

11 junio 2019

Angioedema in Stroke Patients With Thrombolysis

Kilian Fröhlich, Kosmas Macha, Stefan T. Gerner, Tobias Bobinger, Manuel Schmidt, Arnd Dörfler, Max J. Hilz, Stefan Schwab, Frank Seifert, Bernd Kallmünzer and Klemens Winder

Abstract Background and Purpose— Oral angioedema (OA) is a rare but life-threatening complication in patients with ischemic stroke receiving intravenous thrombolysis with r-tPA (recombinant tissue-type plasminogen activator). This study intended to determine associations between thrombolysis-related OA and ischemic stroke lesion sites using a voxel-wise lesion analysis.

05 junio 2019

Revascularization of High-Grade Carotid Stenosis Restores Global Cerebral Energy Metabolism

Alexander Seiler, Sara Kammerer, Alexander Gühl, Jan Rüdiger Schüre, Ralf Deichmann, Ulrike Nöth, Waltraud Pfeilschifter, Elke Hattingen, Michael Keese, Ulrich Pilatus and Marlies Wagner

Abstract Background and Purpose— Chronic cerebral hemodynamic impairment due to high-grade occlusive carotid disease may lead to compromised energy metabolism. This might result in chronic subtle tissue damage, even in patients without overt brain infarction. The aim of this study was to investigate hypoperfusion-related changes of cerebral energy metabolism and their potential restitution after revascularization. For this purpose, 3-dimensional 31P magnetic resonance spectroscopy and oxygenation-sensitive T2′ magnetic resonance imaging were used (with 1/T2′=1/T2*−1/T2), which were expected to cross-validate each other.

10 junio 2019

When to Stop

Álvaro García-Tornel, Manuel Requena, Marta Rubiera, Marian Muchada, Jorge Pagola, David Rodriguez-Luna, Matias Deck, Jesus Juega, Noelia Rodríguez-Villatoro, Sandra Boned, Marta Olivé-Gadea, Alejandro Tomasello, David Hernández, Carlos A. Molina and Marc Ribo

Abstract Background and Purpose— Substantial proportion of patients who achieve successful recanalization of acute ischemic stroke due to large vessel occlusion do not achieve good functional outcome. We aim to analyze the effect of number of thrombectomy device passes and degree of the recanalization (by modified Thrombolysis in Cerebral Infarction) on the clinical and functional outcome.

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