In this issue, Lockau et al. retrospectively analyze different approaches for endovascular recanalization of tandem occlusions in acute stroke [1]. Starting with stent angioplasty of the carotid occlusion as the first step (stent-first group), they reversed the order of their techniques and performed intracranial thrombectomy prior to stenting of the carotid occlusion (thrombectomy-first group, the so-called upside-down approach). They found advantages and disadvantages with both techniques; however, time of intervention was shorter for the thrombectomy-first group. A higher percentage of thrombectomy-first patients had favorable outcomes after 3 months but the difference was not statistically significant. As discussed in this paper, one of the reasons may be that the thrombectomy-first technique allows mobilization and removal of the intracranial thrombus during flow arrest, whereas the thrombus becomes more compressed due to increased perfusion pressure following stenting of the carotid artery.
Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke.
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. Manifestations have a uniphasic course, and vary from pure cephalalgic forms to rare catastrophic forms associated with several haemorrhagic and ischaemic strokes, brain oedema, and death. Diagnosis can be hampered by the dynamic nature of clinicoradiological features. Stroke can occur a few days after initial normal imaging, and cerebral vasoconstriction is at a maximum on angiograms 2–3 weeks after clinical onset. The calcium channel blocker nimodipine seems to reduce thunderclap headaches within 48 h of administration, but has no proven effect on haemorrhagic and ischaemic complications.
Background: Brain scans are essential to exclude haemorrhage in patients with suspected acute ischaemic stroke before treatment with alteplase. However, patients with early ischaemic signs could be at increased risk of haemorrhage after alteplase treatment, and little information is available about whether pre-existing structural signs, which are common in older patients, affect response to alteplase. We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase.
BACKGROUND AND PURPOSE: 3D FSE T1WI has recently been used for carotid plaque imaging, given the potential advantages in contrast and spatial resolutions. However, its diagnostic performance remains unclear. Hence, we compared the ability of this technique to readily assess plaque characteristics with that of conventional images and validated the results with histologic classification.
A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), the first randomized clinical trial for brain arteriovenous malformations (bAVMs), was planned as a straightforward simple attempt to learn whether deferring intervention for a bAVM that had not bled would prove superior to incurring the risks of intervention needed to eradicate the lesion. The trial was justified by longitudinal data on true natural history (ie, for those receiving no intervention to eradicate the bAVM), reports of mild syndromes from many who had bled, and literature with treatment outcomes that were a mix of those who had bled before treatment versus those who had not. Having no wish to disturb current established interventional practice, the investigators offered randomization only to those whose bAVMs were considered suitable for eradication; none whose bAVMs were deemed too daunting for intervention would be eligible. Medical management for headaches and seizures is well-established, but no standards have yet appeared dictating interventional management. Widely misquoted literature citing annual hemorrhage rates approximating 4% and estimates of low risks for intervention allowed the assumption that the trial might well end within 5 years with a win for intervention.1 Moreover, more insight would be gained for the true natural history.
BACKGROUND AND PURPOSE: Developmental venous anomalies are the most common intracranial vascular malformation and are typically regarded as inconsequential, especially when small. While there are data regarding the prevalence of MR imaging findings associated with developmental venous anomalies, FDG-PET findings have not been well-characterized.
BACKGROUND AND PURPOSE: The relationship between reperfusion and clinical outcome is time-dependent, and the effect of reperfusion on outcome can vary on the basis of the extent of collateral flow. We aimed to identify the impact of time-to-reperfusion on outcome relative to baseline angiographic collateral grade in patients successfully treated with endovascular revascularization for acute large-vessel anterior circulation stroke.
BACKGROUND AND PURPOSE: Rupture risk assessment for intracranial aneurysms remains challenging, and risk factors, including wall shear stress, are discussed controversially. The primary purpose of the presented challenge was to determine how consistently aneurysm rupture status and rupture site could be identified on the basis of computational fluid dynamics.
BACKGROUND AND PURPOSE: A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches.
BACKGROUND AND PURPOSE: Intervertebral disk biochemical composition could be accessed in vivo by T1ρ and T2 relaxometry. We found no studies in the literature comparing different segmentation methods for data extraction using these techniques. Our aim was to compare different manual segmentation methods used to extract T1ρ and T2 relaxation times of intervertebral disks from MR imaging. Seven different methods of partial-disk segmentation techniques were compared with whole-disk segmentation as the reference standard.
Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke.
Background: Brain scans are essential to exclude haemorrhage in patients with suspected acute ischaemic stroke before treatment with alteplase. However, patients with early ischaemic signs could be at increased risk of haemorrhage after alteplase treatment, and little information is available about whether pre-existing structural signs, which are common in older patients, affect response to alteplase. We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase.
Background: The American Heart Association´s Life´s Simple 7 metric is being used to track the population´s cardiovascular health (CVH) toward a 2020 goal for improvement. The metric includes body mass index (BMI), blood pressure, cholesterol, glucose, physical activity (PA), cigarette smoking, and diet. We hypothesized a lower risk of venous thromboembolism (VTE) with favorable Life´s Simple 7 scores.
In the late 1970s, Gruentzig’s groundbreaking reports on a series of successfully performed coronary angioplasties created the field of endovascular medicine, setting the precedent for the Food and Drug Administration’s 510(k) approval of the procedure in 1981.
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