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ESTUDIOS


WEAVE Trial

Michael J. Alexander, Alois Zauner, John C. Chaloupka, Blaise Baxter, Richard C. Callison, Rishi Gupta, Shlee S. Song, Wengui Yu and on behalf of the WEAVE Trial Investigators

Abstract Background and Purpose— The WEAVE trial (Wingspan Stent System Post Market Surveillance) is a postmarket surveillance trial mandated by the Food and Drug Administration to assess the periprocedural safety of the Wingspan Stent system in the treatment of symptomatic intracranial atherosclerotic disease.

Impact of Endovascular Therapy in Patients With Large Ischemic Core

Hiroto Kakita, Shinichi Yoshimura, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Takeshi Morimoto and RESCUE-Japan Registry 2 Investigators

Abstract Background and Purpose— Endovascular therapy (EVT) is strongly recommended for acute cerebral large vessel occlusion with the Alberta Stroke Program Early CT Score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of EVT for patients who have ischemic core with ASPECTS ≤5 (0–5) was not established. The purpose of this study was to elucidate the outcomes of EVT for patients with large ischemic core.

IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

Manuel Cappellari, Salvatore Mangiafico, Valentina Saia, Giovanni Pracucci, Sergio Nappini, Patrizia Nencini, Daniel Konda, Fabrizio Sallustio, Stefano Vallone, Andrea Zini, Sandra Bracco, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Antonio Pitrone, Francesco Grillo, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Chiara Comelli, Enrica Duc, Alessio Comai, Enrica Franchini, Mirco Cosottini, Michelangelo Mancuso, Simone Peschillo, Manuela De Michele, Andrea Giorgianni, Maria Luisa Delodovici, Elvis Lafe, Maria Federica Denaro, Nicola Burdi, Saverio Internò, Nicola Cavasin, Adriana Critelli, Luigi Chiumarulo, Marco Petruzzellis, Marco Doddi, Antonio Carolei, William Auteri, Alfredo Petrone, Riccardo Padolecchia, Tiziana Tassinari, Marco Pavia, Paolo Invernizzi, Gianni Turcato, Stefano Forlivesi, Elisa Francesca Maria Ciceri, Bruno Bonetti, Domenico Inzitari, Danilo Toni and on behalf of the IER Collaborators

Abstract Background and Purpose— As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set).

Hypoperfusion Intensity Ratio Is Correlated With Patient Eligibility for Thrombectomy

Adrien Guenego, David G. Marcellus, Blake W. Martin, Soren Christensen, Gregory W. Albers, Maarten G. Lansberg, Michael P. Marks, Max Wintermark and Jeremy J. Heit

Abstract Background and Purpose— Hypoperfusion intensity ratio (HIR) is associated with collateral status in acute ischemic stroke patients with anterior circulation large vessel occlusion. We assessed whether HIR was correlated to patient eligibility for mechanical thrombectomy (MT).

Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Esmee Venema, Adrien E. Groot, Hester F. Lingsma, Wouter Hinsenveld, Kilian M. Treurniet, Vicky Chalos, Sanne M. Zinkstok, Maxim J.H.L. Mulder, Inger R. de Ridder, Henk A. Marquering, Wouter J. Schonewille, Marieke J.H. Wermer, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos, Diederik W.J. Dippel, Jonathan M. Coutinho, Bob Roozenbeek and for the MR CLEAN Registry Investigators

Abstract Background and Purpose— To assess the effect of inter-hospital transfer on time to treatment and functional outcome after endovascular treatment (EVT) for acute ischemic stroke, we compared patients transferred from a primary stroke center to patients directly admitted to an intervention center in a large nationwide registry.

Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients

Ajay Malhotra, Xiao Wu, Seyedmehdi Payabvash, Charles C. Matouk, Howard P. Forman, Dheeraj Gandhi, Pina Sanelli and Joseph Schindler

Abstract Background and Purpose— Strokes in patients aged ≥80 years are common, and advanced age is associated with relatively poor poststroke functional outcome. The current guidelines do not recommend an upper age limit for endovascular thrombectomy (EVT). The purpose of this study is to evaluate the effectiveness of EVT in acute stroke because of large vessel occlusion for elderly patients >age 80 years.

Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions

Syed F. Zaidi, Alicia C. Castonguay, Mouhammad A. Jumaa, Tim W. Malisch, Italo Linfante, Franklin A. Marden, Michael G. Abraham, Alex Bou Chebl, Roberta Novakovic, M. Asif Taqi, Raul G. Nogueira, Coleman O. Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler, Aamir Badruddin, Thanh N. Nguyen, Albert J. Yoo, Hashem Shaltoni, Vallabh Janardhan, Peng R. Chen, Gavin W. Britz, Ritesh Kaushal, Ashish Nanda, Rishi Gupta and Osama O. Zaidat

Abstract Background and Purpose— Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry.

Familial Cerebral Cavernous Malformations

Atif Zafar, Syed A. Quadri, Mudassir Farooqui, Asad Ikram, Myranda Robinson, Blaine L. Hart, Marc C. Mabray, Catherine Vigil, Alan T. Tang, Mark L. Kahn, Howard Yonas, Michael T. Lawton, Helen Kim and Leslie Morrison

Cerebral cavernous malformations (CCM) or cavernomas are collections of structurally abnormal slow-flow capillaries predominantly in the central nervous system.1,2 These are multiple mulberry-like distended caverns of dilated thin-walled capillaries without the normal intervening brain parenchymal architecture. Often, individual cavernomas are surrounded by hemosiderin representing remote oozing due to the abnormal capillaries.

Rapid Neurologic Improvement Predicts Favorable Outcome 90 Days After Thrombectomy in the DEFUSE 3 Study

Jeremy J. Heit, Michael Mlynash, Stephanie M. Kemp, Maarten G. Lansberg, Soren Christensen, Michael P. Marks, Santiago Ortega-Gutierrez and Gregory W. Albers

Abstract Background and Purpose— Thrombectomy in late time windows leads to improved outcomes in patients with ischemic stroke due to large vessel occlusion. We determined whether patients with rapid neurological improvement (RNI) 24 hours after thrombectomy were more likely to have a favorable clinical outcome in the DEFUSE 3 study (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3).

Acute Stroke With Large Ischemic Core Treated by Thrombectomy

Pietro Panni, Benjamin Gory, Yu Xie, Arturo Consoli, Jean-Philippe Desilles, Mikael Mazighi, Julien Labreuche, Michel Piotin, Francis Turjman, Omer Faruk Eker, Serge Bracard, René Anxionnat, Sébastien Richard, Gabriela Hossu, Raphael Blanc, Bertrand Lapergue and on behalf of the ETIS (Endovascular Treatment in Ischemic Stroke) Investigators

Abstract Background and Purpose— Acute stroke patients with a large ischemic core may still benefit from mechanical thrombectomy (MT), but the predictors of clinical outcome are not well known after MT. We investigated the clinical and imaging factors associated with good outcome and mortality at 90 days in acute stroke patients with a large baseline ischemic core treated with MT.

Per-Pass Analysis of Thrombus Composition in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Sharon Duffy, Ray McCarthy, Michael Farrell, Sunitha Thomas, Paul Brennan, Sarah Power, Alan O’Hare, Liam Morris, Eleanor Rainsford, Eugene MacCarthy, John Thornton and Michael Gilvarry

Abstract Background and Purpose— Mechanical thrombectomy may involve multiple attempts to retrieve the occluding thrombus. This study examined the composition of thrombus fragments retrieved with each pass of a device during the thrombectomy procedure. Second, the per-pass composition was compared with procedural and clinical data including angiographic outcome and stroke etiology.

Blood Flow Lateralization and Collateral Compensatory Mechanisms in Patients With Carotid Artery Stenosis

Laleh Zarrinkoob, Anders Wåhlin, Khalid Ambarki, Richard Birgander, Anders Eklund and Jan Malm

Abstract Background and Purpose— Four-dimensional phase-contrast magnetic resonance imaging enables quantification of blood flow rate (BFR; mL/min) in multiple cerebral arteries simultaneously, making it a promising technique for hemodynamic investigation in patients with stroke. The aim of this study was to quantify the hemodynamic disturbance and the compensatory pattern of collateral flow in patients with symptomatic carotid stenosis.

Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion

Philipp Hendrix, Nelson Sofoluke, Matthew D. Adams, Saran Kunaprayoon, Ramin Zand, Amy N. Kolinovsky, Thomas N. Person, Mudit Gupta, Oded Goren, Clemens M. Schirmer, Natalia S. Rost, James E. Faber and Christoph J. Griessenauer

Abstract Background and Purpose— Accurate prediction of acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) that is amendable to mechanical thrombectomy remains a challenge. We developed and validated a prediction model for anterior circulation LVO stroke using past medical history elements present on admission and neurological examination.

Comparison of Rupture Risk of Intracranial Aneurysms Between Familial and Sporadic Patients

Liselore A. Mensing, Jacoba P. Greving, Tessa A. Verhoeff, Gabriel J.E. Rinkel and Ynte M. Ruigrok

Abstract Background and Purpose A much higher rupture rate for patients with familial intracranial aneurysms (IA) compared with patients with sporadic IA has been reported in a study with highly selected familial aneurysms using sporadic patients from other populations a controls. We aimed to validate these findings in a large independent series of Dutch patients with familial and sporadic IA.

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