31 marzo 2016

AMERICAN JOURNAL OF NEURORADIOLOGY. Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume

I.R. van den Wijngaard, G. Holswilder, M.J.H. Wermer, J. Boiten, A. Algra, D.W.J. Dippel, J.W. Dankbaar, B.K. Velthuis, A.M.M. Boers,i, C.B.L.M. Majoie and M.A.A. van Walderveen

BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.

11 febrero 2016

AMERICAN JOURNAL OF NEURORADIOLOGY. Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

P. Gao, D. Wang, Z. Zhao, Y. Cai, T. Li, H. Shi, W. Wu, W. He, L. Yin, S. Huang, F. Zhu, L. Jiao, X. Ji, A.I. Qureshi and F. Ling

BACKGROUND AND PURPOSE: On the basis of the high 1-month stroke and/or death (14.7%) rates associated with stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death.

18 febrero 2016

AMERICAN JOURNAL OF NEURORADIOLOGY. Thinner Regions of Intracranial Aneurysm Wall Correlate with Regions of Higher Wall Shear Stress: A 7T MRI Study

R. Blankena, R. Kleinloog, B.H. Verweij, P. van Ooij, B. ten Haken, P.R. Luijten, G.J.E. Rinkel and J.J.M. Zwanenburg

BACKGROUND AND PURPOSE: Both hemodynamics and aneurysm wall thickness are important parameters in aneurysm pathophysiology. Our aim was to develop a method for semi-quantitative wall thickness assessment on in vivo 7T MR images of intracranial aneurysms for studying the relation between apparent aneurysm wall thickness and wall shear stress.

18 febrero 2016

AMERICAN JOURNAL OF NEURORADIOLOGY. C-Arm Conebeam CT Perfusion Imaging in the Angiographic Suite: A Comparison with Multidetector CT Perfusion Imaging

K. Niu, P. Yang, Y. Wu, T. Struffert, A. Doerfler, S. Schafer, K. Royalty, C. Strother and G.-H. Chen

BACKGROUND AND PURPOSE: Perfusion imaging in the angiography suite may provide a way to reduce time from stroke onset to endovascular revascularization of patients with large-vessel occlusion. Our purpose was to compare conebeam CT perfusion with multidetector CT perfusion.

01 octubre 2012

THE LANCET. Neurology. Reversible cerebral vasoconstriction syndrome

Dr Anne Ducros, MD

Summary: Recurrent thunderclap headaches, seizures, strokes, and non-aneurysmal subarachnoid haemorrhage can all reveal reversible cerebral vasoconstriction syndrome. This increasingly recognised syndrome is characterised by severe headaches, with or without other symptoms, and segmental constriction of cerebral arteries that resolves within 3 months. Reversible cerebral vasoconstriction syndrome is supposedly due to a transient disturbance in the control of cerebrovascular tone. More than half the cases occur post partum or after exposure to adrenergic or serotonergic drugs.

21 julio 2016

STROKE. Clinical Sciences. Sex, Smoking, and Risk for Subarachnoid Hemorrhage

Joni Valdemar Lindbohm, MD; Jaakko Kaprio, MD, PhD; Pekka Jousilahti, MD, PhD; Veikko Salomaa, MD, PhD; Miikka Korja, MD, PhD

Background and Purpose: Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.

12 julio 2016

STROKE. Clinical Sciences. Underutilization of Ambulatory ECG Monitoring After Stroke and Transient Ischemic Attack. Missed Opportunities for Atrial Fibrillation Detection

Jodi D. Edwards, PhD; Moira K. Kapral, MD; Jiming Fang, PhD; Gustavo Saposnik, MD; David J. Gladstone, MD, PhD; Investigators of the Registry of the Canadian Stroke Network

Background and Purpose: Detection and treatment of atrial fibrillation is a major goal in secondary stroke prevention. Guidelines recommend at least 24 hours of ECG monitoring after stroke. However, it is unclear how often this is done in routine practice.

30 junio 2016

STROKE. Clinical Sciences. Field Assessment Stroke Triage for Emergency Destination. A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes

Fabricio O. Lima, MD, MPH, PhD; Gisele S. Silva, MD, MPH, PhD; Karen L. Furie, MD, MPH; Michael R. Frankel, MD; Michael H. Lev, MD; Érica C.S. Camargo, MD, PhD, MSc; Diogo C. Haussen, MD; Aneesh B. Singhal, MD; Walter J. Koroshetz, MD; Wade S. Smith, MD; Raul G. Nogueira, MD

Background and Purpose: Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS.

14 julio 2016

STROKE. Brief Report. Prestroke Vascular Pathology and the Risk of Recurrent Stroke and Poststroke Dementia

Marileen L.P. Portegies, MD; Frank J. Wolters, MD; Albert Hofman, MD, PhD; M. Kamran Ikram, MD, PhD; Peter J. Koudstaal, MD, PhD; M. Arfan Ikram, MD, PhD

Background and Purpose: Improved short-term survival after stroke has necessitated quantifying risk and risk factors of long-term sequelae after stroke (ie, recurrent stroke and dementia). This risk may be influenced by exposure to cardiovascular risk factors before the initial stroke. Within the population-based Rotterdam Study, we determined the long-term risk of recurrent stroke and dementia, and the proportion of recurrent strokes and poststroke dementia cases that are attributable to prestroke cardiovascular risk factors (ie, the population attributable risk).

02 junio 2016

STROKE. Clinical Sciences. Postmenopausal Hormone Therapy and Risk of Stroke. Impact of the Route of Estrogen Administration and Type of Progestogen

Marianne Canonico, PhD; Laure Carcaillon, PhD; Geneviève Plu-Bureau, MD, PhD; Emmanuel Oger, MD, PhD; Archana Singh-Manoux, PhD; Pascale Tubert-Bitter, PhD; Alexis Elbaz, MD, PhD; Pierre-Yves Scarabin, MD, MSc

Background and Purpose: The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential association of oral and transdermal estrogens with stroke remains poorly investigated. Furthermore, there are no data regarding the impact of progestogens.

04 junio 2015

STROKE. Basic Sciences Advances for Clinicians. Developing Cellular Therapies for Stroke

Sean I. Savitz, MD

Cell therapies refer to the use of cells or cellular material that exert a treatment effect in animal models of disease. During the past 15 years, a range of different types of cell therapies has emerged as potential new treatments that are under development for stroke and other neurological disorders. The past quarter century has witnessed the success of thrombolytic therapy and the failure of neuroprotective agents for acute ischemic stroke. These therapeutic strategies often target a single pathway (tissue-type plasminogen to dissolve clots in the former case and specific biochemical pathways of injury in the latter). Cell therapies represent an entirely different biopharmaceutical approach.

05 mayo 2015

STROKE. Understanding and Applying the Endovascular Trials. Implication of the Recent Positive Endovascular Intervention Trials for Organizing Acute Stroke Care. European Perspective

Turgut Tatlisumak, MD, PhD

Abstract: Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion ≤6 hours or even beyond from symptom onset and independent of patients’ age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide.

05 mayo 2015

STROKE. Understanding and Applying the Endovascular Trials. Interventionalist Perspective on the New Endovascular Trials

Laurent Pierot, MD, PhD; Colin Derdeyn, MD

Abstract: Three recently published trials have conclusively proven the benefit of mechanical endovascular thrombectomy over best medical therapy for patients with acute ischemic stroke and large vessel occlusion. These trials shared some features and differed in others. These similarities and differences in trial design and execution affect the conclusions and recommendations that can be made from the data. We will examine the implications of these studies for neurointerventionists, both for current practice and for future studies. In particular, we will focus on procedural details such as patient selection, devices, adjunctive therapies, treatment time windows, and performance metrics.

05 mayo 2015

STROKE. Understanding and Applying the Endovascular Trials. Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Kazunori Toyoda, MD; Masatoshi Koga, MD; Mikito Hayakawa, MD; Hiroshi Yamagami, MD

Abstract: The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians.

05 mayo 2015

STROKE. Special Report. State of Acute Endovascular Therapy. Report From the 12th Thrombolysis, Thrombectomy, and Acute Stroke Therapy Conference

Pooja Khatri, MD, MSc; Werner Hacke, MD; Jens Fiehler, MD; Jeffrey L. Saver, MD; Hans-Christoph Diener, MD, PhD; Martin Bendszus, MD; Serge Bracard, MD; Joseph Broderick, MD; Bruce Campbell, MBBS, BmedSc, PhD; Alfonso Ciccone, MD; Antoni Dávalos, MD, PhD; Stephen Davis, MD; Andrew M. Demchuk, MD; Diederik Dippel, MD; Geoffrey Donnan, MD; David Fiorella, MD, PhD; Mayank Goyal, MD; Michael D. Hill, MD, MSc; Edward C. Jauch, MD; Tudor G. Jovin, MD; Chelsea S. Kidwell, MD; Charles Majoie, MD, PhD; Sheila Cristina Ouriques Martins, MD; Peter Mitchell, MD; J Mocco, MD, MS; Keith Muir, MD; Raul G. Nogueira, MD; Wouter J. Schonewille, MD, PhD; Adnan H. Siddiqui, MD, PhD; Götz Thomalla, MD; Thomas A. Tomsick, MD; Aquilla S. Turk, DO; Philip M. White, MD; Osama O. Zaidat, MD; David S. Liebeskind, MD; Rachel Fulton, MD; Kennedy R. Lees, MD; on behalf of the VISTA-Endovascular Collaboration

Acute endovascular therapy for ischemic stroke is at a pivotal juncture. Until recently, on the basis of randomized trials comparing devices, we knew that endovascular treatment options were effective in quickly restoring blood flow and that successful early recanalization was associated with better functional outcome when compared with sustained occlusion.