06 octubre 2015

STROKE. Brief Report. Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Celine S. Gathier, MD; Jan Willem Dankbaar, MD, PhD; Mathieu van der Jagt, MD, PhD; Bon H. Verweij, MD, PhD; Annemarie W. Oldenbeuving, MD, PhD; Gabriel J.E. Rinkel, MD, FRCPE; Walter M. van den Bergh, MD, PhD; Arjen J.C. Slooter, MD, PhD, for the HIMALAIA Study Group

Background and Purpose: The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid hemorrhage patients with delayed cerebral ischemia in a randomized clinical trial.

17 septiembre 2015

STROKE. Brief Report. Ultrasound and Clinical Predictors of Recurrent Ischemia in Symptomatic Internal Carotid Artery Occlusion

Juliane Schneider, MD; Beate Sick, PhD; Andreas R. Luft, MD; Susanne Wegener, MD

Background and Purpose: Occlusion of the internal carotid artery puts patients at risk of recurrent ischemic events because of hemodynamic compromise. Our goal was to characterize clinical and duplex parameters indicating patients at risk of recurrent ischemia.

08 octubre 2015

STROKE. Brief Report. Early Loss of Immediate Reperfusion While Stent Retriever in Place Predicts Successful Final Reperfusion in Acute Ischemic Stroke Patients

Masakazu Okawa, MD; Satoshi Tateshima, MD; David Liebeskind, MD; Neal Rao, MD; Reza Jahan, MD; Nestor Gonzalez, MD; Viktor Szeder, MD; Latisha Ali, MD; Doojin Kim, MD; Jeffrey Saver, MD; Gary Duckwiler, MD

Background and Purpose: Degree of stent retriever engagement with target thrombi may be reflected by (1) immediate reperfusion (IR) on first deployment, indicating displacement of clot toward the vessel wall, and (2) by early loss of IR (ELOIR), indicating penetration of retriever struts through the thrombus. The relation of these early findings to final reperfusion and clinical outcomes has not been well delineated.

08 octubre 2015

STROKE. Clinical Sciences. Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event

Michal Karlinski, MD, PhD; Adam Kobayashi, MD, PhD; Anna Czlonkowska, MD, PhD; Robert Mikulik, MD, PhD; Daniel Vaclavik, MD, PhD; Miroslav Brozman, MD, PhD; Zuzana Gdovinova, MD, PhD; Viktor Švigelj, MD; Laszlo Csiba, MD, PhD; Klara Fekete, MD; Janika Kõrv, MD, PhD; Vida Demarin, MD, PhD; Vanja Bašic-Kes, MD; Aleksandras Vilionskis, MD; Dalius Jatuzis, MD, PhD; Yakup Krespi, MD; Nikolay Shamalov, MD, PhD; Silva Andonova, MD, PhD; Niaz Ahmed, MD, PhD; Nils Wahlgren, MD, PhD, for the Safe Implementation of Treatments in Stroke–East Registry (SITS-EAST) Investigators

Background and Purpose: According to the European license, alteplase can be given no sooner than 3 months after previous stroke. However, it is not known whether past history of stroke influences the effect of treatment. Our aim was to evaluate safety and functional outcome after intravenous thrombolysis administered in everyday practice to patients with previous stroke ≤3 months compared with those with first-ever stroke.

29 septiembre 2015

STROKE. Clinical Sciences. Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

George Kwok Chu Wong, MD; Ryan Chi Hang Nung, FRCR; Jacqueline Ching Man Sitt, FRCR; Vincent Chung Tong Mok, MD; Adrian Wong, PhD; Faith Lok Yan Ho, MRCS; Wai Sang Poon, FRCR; Defeng Wang, PhD; Jill Abrigo, MD; Deyond Yun Woon Siu, FRCR

Background and Purpose: Aneurysmal subarachnoid hemorrhage is a serious disease with high case fatality and morbidity. Delayed cerebral infarction (DCI) is an important surrogate marker. How location and infarct load affected outcomes was unclear. We aimed to assess the effects of load and location of DCI on outcomes of aneurysmal subarachnoid hemorrhage at 3 months.

15 septiembre 2015

STROKE. Clinical Sciences. Optimizating Clot Retrieval in Acute Stroke

Diogo C. Haussen, MD; Leticia C. Rebello, MD; Raul G. Nogueira, MD

Background and Purpose: We aimed to investigate the safety and efficacy of the Push and Fluff technique (PFT) as compared with the standard unsheathing technique for closed-cell stent retrievers in acute ischemic stroke.

18 agosto 2015

STROKE. Clinical Sciences. Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting

Marion Boulanger, MD; Lucie Camelière, MD; Rui Felgueiras, MD; Ludovic Berger, PhD; Kittipan Rerkasem, PhD; Peter M. Rothwell, PhD; Emmanuel Touzé, PhD

Background and Purpose: Carotid angioplasty and stenting (CAS) is associated with higher risk of periprocedural stroke and death when compared with carotid endarterectomy (CEA). By contrast, the risk of myocardial infarction (MI) was higher after CEA than after CAS in randomized trials. However, numbers were small, and risk factors are unknown.

20 agosto 2015

STROKE. Clinical Sciences. Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures

Marc Ribo, MD; Alejandro Tomasello, MD; Miguel Lemus, MD; Marta Rubiera, MD; Carla Vert, MD; Alan Flores, MD; Pilar Coscojuela, MD; Jorge Pagola, MD; David Rodriguez-Luna, MD; Sandra Bonet, MD; Marian Muchada, MD; Alex Rovira, MD; Carlos A. Molina, MD

Background and Purpose: Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM).

08 septiembre 2015

STROKE. Clinical Sciences. Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Jenifer H. Voeks, PhD; George Howard, DrPH; Gary Roubin, MD, PhD; Richard Farb, MD; Donald Heck, MD; William Logan, MD; Mary Longbottom, BA; Alice Sheffet, PhD; James F. Meschia, MD; Thomas G. Brott, MD

Background and Purpose: There is higher combined risk of stroke or death (S+D) at older ages with carotid stenting. We assess whether this can be attributed to patient or arterial characteristics that are in the pathway between older age and higher risk.

01 septiembre 2015

STROKE. Brief Report. Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion

Woong Yoon, MD; Seul Kee Kim, MD; Tae Wook Heo, MD; Byung Hyun Baek, MD; Yun Young Lee, MD; Heoung Keun Kang, MD

Background and Purpose: Factors related to prognosis after a modern mechanical thrombectomy in patients with acute basilar artery occlusion remain unclear. This study investigated the prognostic factors for patients with acute basilar artery occlusion who underwent a stent-retriever thrombectomy.

25 agosto 2015

STROKE. Clinical Sciences. Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque

Jin Hee Yu, MD; Hyo Sung Kwak, MD, PhD; Gyung Ho Chung, MD, PhD; Seung Bae Hwang, MD; Mi Sung Park, MD, PhD; Seong Hoon Park, MD, PhD

Background and Purpose: High-resolution magnetic resonance imaging (HRMRI) is ideal for serial examination of diseased arterial walls because it is noninvasive and has superior capability of discriminating tissue characteristics. The aim of this study is to evaluate the prevalence and clinical relevance of intraplaque hemorrhage (IPH) in patients with basilar artery (BA) atherosclerosis using HRMRI.

18 agosto 2015

STROKE. Clinical Sciences. Thirty-Day Outcome of a Multicenter Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China

Zhongrong Miao, MD; Yong Zhang, MD; Jie Shuai, MD; Changchun Jiang, MD; Qiyi Zhu, MD; Kangning Chen, MD; Li Liu, MD; Baomin Li, MD; Xiangqun Shi, MD; Lianbo Gao, MD; Yajie Liu, MD; Feng Wang, MD; Yongli Li, MD; Tieyan Liu, MD; Hongbo Zheng, MD; Yilong Wang, MD; Yongjun Wang, MD; the Study Group of Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China

Background and Purpose: Although recent trials have suggested that stenting is worse than medical therapy for patients with severe symptomatic intracranial atherosclerotic stenosis, it is not clear whether this conclusion applies to a subset of patients with hypoperfusion symptoms. To justify for a new trial in China, we performed a multicenter prospective registry study to evaluate the safety and efficacy of endovascular stenting within 30 days for patients with severe symptomatic intracranial atherosclerotic stenosis.

01 junio 2015

NEUROSURGERY. Intraoperative Flow Measurement by Microflow Probe During Surgery for Brain Arteriovenous Malformations

Della Puppa, Alessandro MD; Rustemi, Oriela MD; Scienza, Renato MD

BACKGROUND: Intraoperative quantitative flow measurement by a microvascular ultrasonic flow probe is an established methodology in aneurysm surgery.

01 octubre 2015

NEUROSURGERY. High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection: Buffalo Risk Assessment Scale (BRASS)

Fanous, Andrew A. MD*,‡; Natarajan, Sabareesh K. MD, MS*,‡; Jowdy, Patrick K. BS*,‡; Dumont, Travis M. MD*,‡,§; Mokin, Maxim MD, PhD*,‡,¶; Yu, Jihnhee PhD‖; Goldstein, Adam*,‡; Wach, Michael M. BS*,‡; Budny, James L. MD*,‡; Hopkins, L. Nelson MD*,‡,#,**,‡‡; Snyder, Kenneth V. MD, PhD*,‡,#,**,§§; Siddiqui, Adnan H. MD, PhD*,‡,#,**,‡‡; Levy, Elad I. MD, MBA*,‡,#,**

BACKGROUND: Demographics and vascular anatomy may play an important role in predicting periprocedural complications in symptomatic patients undergoing carotid artery stenting (CAS).

01 octubre 2015

NEUROSURGERY. Endovascular Therapy for Ruptured Cerebral Aneurysms in the Elderly: Poor Accessibility of the Guiding Catheter and Use of Local Anesthesia as the Predictors of Procedure-Related Rupture

Fukuda, Hitoshi MD*; Handa, Akira MD*; Koyanagi, Masaomi MD*; Yoshida, Kazumichi MD*; Lo, Benjamin W. Y. MD‡; Yamagata, Sen MD*

BACKGROUND: Endovascular therapy is favored for ruptured intracranial aneurysms in the elderly. However, poor accessibility to the aneurysm through the parent artery and use of local anesthesia in this age group may predispose to intraprocedural complications.