06 marzo 2014

STROKE. Clinical Sciences. Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Marián Muchada, MD; Marta Rubiera, MD, PhD; David Rodriguez-Luna, MD, PhD; Jorge Pagola, MD, PhD; Alan Flores, MD; Julia Kallas, MD; Estela Sanjuan, RN; Pilar Meler, RN; Jose Alvarez-Sabin, MD, PhD; Marc Ribo, MD, PhD; Carlos A. Molina, MD, PhD

Background and Purpose: The effect of tissue-type plasminogen activator on functional outcome decreases progressively over time. However, given the differential pattern of arterial occlusion, stroke severity, and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aimed to identify the impact of time-to-treatment according to stroke severity on functional outcome in patients with acute ischemic stroke.

10 julio 2014

AMERICAN JOURNAL OF NEURORADIOLOGY. Current and Emerging MR Imaging Techniques for the Diagnosis and Management of CSF Flow Disorders: A Review of Phase-Contrast and Time–Spatial Labeling Inversion Pulse

S. Yamada, K. Tsuchiya, W.G. Bradley, M. Law, M.L. Winkler, M.T. Borzage, M. Miyazaki, E.J. Kelly and J.G. McComb

SUMMARY: This article provides an overview of phase-contrast and time–spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time–spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time–spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns.

01 mayo 2015

RADIOLOGY. Carotid Artery Plaque Morphology and Composition in Relation to Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA)

Anna E. H. Zavodni, MD, Bruce A. Wasserman, MD, Robyn L. McClelland, PhD, Antoinette S. Gomes, MD, Aaron R. Folsom, MD, MPH, Joseph F. Polak, MD, MPH, João A. C. Lima, MD, David A. Bluemke, MD, PhD,

Atherosclerosis is a systemic disease process, and carotid artery imaging provides a useful surrogate marker of generalized vascular health. On the basis of autopsy studies, specific features of an atherosclerotic plaque represent unstable plaque that is prone to rupture (1–4). Features of vulnerable plaque include a lipid core with a thin fibrous cap and ulceration, and identification of a vulnerable plaque may serve as a marker with which to identify the “vulnerable patient” at risk for subsequent cardiovascular events (5,6).

01 abril 2015

RADIOLOGY. Intracranial Dural Arteriovenous Fistulas: Evaluation with 3-T Four-dimensional MR Angiography Using Arterial Spin Labeling

Yasuhiko Iryo, MD, Toshinori Hirai, MD, Yutaka Kai, MD, Masanobu Nakamura, RT, Yoshinori Shigematsu, MD, Mika Kitajima, MD, Minako Azuma, MD, Masanori Komi, RT, Kosuke Morita, RT, Yasuyuki Yamashita, MD

The high spatial and temporal resolution of intraarterial digital subtraction angiography (DSA) facilitates the accurate assessment of intracranial dural arteriovenous fistulas (AVFs) and their location, as well as the identification of their feeders and drainers. DSA, however, is an invasive method that involves exposure to radiation and requires the injection of iodinated contrast medium. Therefore, a noninvasive method is required to diagnose AVFs and follow up patients with intracranial dural AVFs.

01 enero 2015

JOURNAL OF VASCULAR SURGERY. Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Kevin Brown, MD , Dina S. Itum, MD , Joshua Preiss , Yazan Duwayri, MD , Ravi K. Veeraswamy, MD , Atef Salam, MD , Thomas F. Dodson, MD , Luke P. Brewster, MD

Objective: The external carotid artery (ECA) can be an important source of cerebral blood flow in cases of high-grade internal carotid artery stenosis or occlusion. However, the treatment of the ECA is fundamentally different between carotid endarterectomy (CEA) and carotid artery stenting (CAS). CEA is routinely associated with endarterectomy of the ECA, whereas CAS excludes the ECA from direct flow. We hypothesize that these differences make ECA occlusion more common after CAS. Further, the impact of CAS on blood flow into the ECA is interesting because the flow from the stent into the ECA is altered in a way that may promote local inflammation and may influence in-stent restenosis (ISR). Thus, our objective was to use our institutional database to identify whether CAS increased the rate of ECA occlusion and, if it did, whether ECA occlusion was associated with ISR.

01 febrero 2015

ENDOVASCULAR TODAY. Cerebral AVMs and Dural AVFs: Pathology and Management

Vivek A. Kumar, PhD; Ravi R. Vissapragada, MD; Lyahn K. Hwang, BS; Matthew R. Fusco, MD; Christopher S. Ogilvy, MD; And Ajith J. Thomas, MD

The first of a three-part series on diagnosing, treating, and researching management options for intracranial malformations.

19 diciembre 2013

STROKE. Brief Report. Non-ST–Elevation Myocardial Infarction in Patients Undergoing Carotid Endarterectomy or Carotid Artery Stent Placement

Amir Khan, MD; Malik M. Adil, MD; Adnan I. Qureshi, MD

Background and Purpose: The significance of non-ST–elevation myocardial infarction (NSTEMI) after carotid endarterectomy or carotid angioplasty and stent placement is unknown. We performed this study to identify the frequency of NSTEMI and impact on outcomes related to carotid endarterectomy or carotid artery stent placement in patients treated in a large national cohort.

10 diciembre 2013

STROKE. Clinical Sciences. Characteristics and Outcomes of Patients With Multiple Cervical Artery Dissection

Yannick Béjot, MD, PhD; Corine Aboa-Eboulé, MD, PhD; Stéphanie Debette, MD, PhD; Alessandro Pezzini, MD; Turgut Tatlisumak, MD, PhD; Stefan Engelter, MD; Caspar Grond-Ginsbach, PhD; Emmanuel Touzé, MD, PhD; Maria Sessa, MD; Tiina Metso, MD, PhD; Antti Metso, MD, PhD; Manja Kloss, MD; Valeria Caso, MD, PhD; Jean Dallongeville, MD, PhD; Philippe Lyrer, MD; Didier Leys, MD, PhD; Maurice Giroud, MD, PhD; Massimo Pandolfo, MD, PhD; Shérine Abboud, MD, PhD on behalf of the CADISP Group

Background and Purpose: Little is known about factors contributing to multiple rather than single cervical artery dissections (CeAD) and their associated prognosis.

19 noviembre 2013

STROKE. Clinical Sciences. Extending the Indications of Flow Diversion to Small, Unruptured, Saccular Aneurysms of the Anterior Circulation

Nohra Chalouhi, MD; Robert M. Starke, MD; Steven Yang, BS; Cory D. Bovenzi, BS; Stavropoula Tjoumakaris, MD; David Hasan, MD; L. Fernando Gonzalez, MD; Robert Rosenwasser, MD; Pascal Jabbour, MD

Background and Purpose: Flow diverters are currently indicated for treatment of large and complex intracranial aneurysms. The purpose of this study was to determine whether the indications of flow diversion can be safely extended to unruptured, small, saccular aneurysms (<10 mm) of the anterior circulation.

07 noviembre 2013

STROKE. Clinical Sciences. Therapeutic Hypothermia After Recanalization in Patients With Acute Ischemic Stroke

Ji Man Hong, MD, PhD; Jin Soo Lee, MD, PhD; Hee-Jung Song, MD; Hye Seon Jeong, MD; Huimahn Alex Choi, MD; Kiwon Lee, MD

Background and Purpose: Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. We investigated the clinical and radiological effects of therapeutic hypothermia in acute ischemic stroke patients after recanalization.

03 diciembre 2013

STROKE. Clinical Sciences. Balloon Guide Catheter Improves Revascularization and Clinical Outcomes With the Solitaire Device

Thanh N. Nguyen, MD, FRCPC; Timothy Malisch, MD; Alicia C. Castonguay, PhD; Rishi Gupta, MD; Chung-Huan J. Sun, MD; Coleman O. Martin, MD; William E. Holloway, MD; Nils Mueller-Kronast, MD; Joey D. English, MD, PhD; Italo Linfante, MD; Guilherme Dabus, MD; Franklin A. Marden, MD; Hormozd Bozorgchami, MD; Andrew Xavier, MD; Ansaar T. Rai, MD; Michael T. Froehler, MD, PhD; Aamir Badruddin, MD; Muhammad Taqi, MD; Michael G. Abraham, MD; Vallabh Janardhan, MD; Hashem Shaltoni, MD; Roberta Novakovic, MD; Albert J. Yoo, MD; Alex Abou-Chebl, MD; Peng R. Chen, MD; Gavin W. Britz, MD; Ritesh Kaushal, MD; Ashish Nanda, MD; Mohammad A. Issa, MD; Hesham Masoud, MD; Raul G. Nogueira, MD; Alexander M. Norbash, MD; Osama O. Zaidat, MD, MS

Background and Purpose: Efficient and timely recanalization is an important goal in acute stroke endovascular therapy. Several studies demonstrated improved recanalization and clinical outcomes with the stent retriever devices compared with the Merci device. The goal of this study was to evaluate the role of the balloon guide catheter (BGC) and recanalization success in a substudy of the North American Solitaire Acute Stroke (NASA) registry.

21 noviembre 2013

STROKE. Clinical Sciences. Outcome of Standard and High-Risk Patients With Acute Anterior Circulation Stroke After Stent Retriever Thrombectomy

Pascal P. Gratz, MD*; Simon Jung, MD*; Gerhard Schroth, MD; Jan Gralla, MD; Pasquale Mordasini, MD; Kety Hsieh, MD; Mirjam R. Heldner, MD; Heinrich P. Mattle, MD; Marie-Luise Mono, MD; Urs Fischer, MD; Marcel Arnold, MD*; Christoph Zubler, MD*

Background and Purpose: Stent retrievers have become an important tool for the treatment of acute ischemic stroke. The aim of this study was to analyze outcome and complications in a large cohort of patients with stroke treated with the Solitaire stent retriever. The study also included patients who did not meet standard inclusion criteria for endovascular treatment: low or high baseline National Institutes of Health Stroke Scale score, ≥80 years of age, extensive ischemic signs in middle cerebral artery territory, and time from symptom onset to endovascular intervention >8 hours.

26 noviembre 2013

STROKE. Clinical Sciences. Design and Validation of a Prehospital Stroke Scale to Predict Large Arterial Occlusion

Natalia Pérez de la Ossa, MD, PhD; David Carrera, MD; Montse Gorchs, BD; Marisol Querol, BD; Mònica Millán, MD, PhD; Meritxell Gomis, MD, PhD; Laura Dorado, MD, PhD; Elena López-Cancio, MD, PhD; María Hernández-Pérez, MD; Vicente Chicharro, MD; Xavier Escalada, MD; Xavier Jiménez, MD, PhD; Antoni Dávalos, MD, PhD

Background and Purpose: We aimed to develop and validate a simple prehospital stroke scale to predict the presence of large vessel occlusion (LVO) in patients with acute stroke.

28 julio 2011

STROKE. Asymptomatic Carotid Stenosis. Identifying Patients at High Enough Risk to Warrant Endarterectomy or Stenting

J. David Spence, MD, FRCPC; David Pelz, MD, FRCPC; Frank J. Veith, MD, FACS

In this issue of Stroke, Hirt1 reports that substantial progression of carotid stenosis predicted ipsilateral stroke or transient ischemic attack among patients randomized to medical therapy in the Asymptomatic Carotid Surgery Trial (ACST).2 This might be regarded as another justification to perform carotid endarterectomy (CEA) or stenting (CAS) in some patients with asymptomatic carotid stenosis (ACS), and Hirt’s article may help in the selection for invasive treatment of those ACS patients at highest risk of having a stroke.

30 enero 2014

STROKE. Clinical Sciences. Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China

Yongjun Wang, MD; Xingquan Zhao, MD; Liping Liu, MD; Yannie O.Y. Soo, MD; Yuehua Pu, MD; Yuesong Pan, MD; Yilong Wang, MD; Xinying Zou, MD; Thomas W.H. Leung, MD; Yefeng Cai, MD; Qingke Bai, MD; Yiping Wu, MD; Chunxue Wang, MD; Xiaoping Pan, MD; Benyan Luo, MD; Ka Sing Lawrence Wong, MD; for the CICAS Study Group

Background and Purpose: We aimed to establish the prevalence, characteristics, and outcomes of intracranial atherosclerosis (ICAS) in China by a large, prospective, multicenter study.