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.

13 febrero 2014

STROKE. Clinical Sciences. Serial Alberta Stroke Program Early CT Score From Baseline to 24 Hours in Solitaire Flow Restoration With the Intention for Thrombectomy Study

David S. Liebeskind, MD; Reza Jahan, MD; Raul G. Nogueira, MD; Tudor G. Jovin, MD; Helmi L. Lutsep, MD; Jeffrey L. Saver, MD for the SWIFT Investigators

Background and Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of acute ischemic stroke outcomes. We analyzed change on serial ASPECTS at baseline and 24-hour imaging in the Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT) study to determine prognostic value and to identify subgroups with extensive injury after intervention.

06 febrero 2014

STROKE. Clinical Sciences. Impact of Pretreatment Noncontrast CT Alberta Stroke Program Early CT Score on Clinical Outcome After Intra-Arterial Stroke Therapy

Albert J. Yoo, MD; Osama O. Zaidat, MD, MS; Zeshan A. Chaudhry, MD; Olvert A. Berkhemer, MD; R. Gilberto González, MD, PhD; Mayank Goyal, MD; Andrew M. Demchuk, MD; Bijoy K. Menon, MD; Elan Mualem, BA; Dawn Ueda, MD; Hope Buell, MS; Siu Po Sit, PhD; Arani Bose, MD on behalf of the Penumbra Pivotal and Penumbra Imaging Collaborative Study (PICS) Investigators

Background and Purpose: The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT.

28 enero 2014

STROKE. Clinical Sciences. Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial

David S. Liebeskind, MD; Thomas A. Tomsick, MD; Lydia D. Foster, MS; Sharon D. Yeatts, PhD; Janice Carrozzella, MSN, NP, RT(R); Andrew M. Demchuk, MD; Tudor G. Jovin, MD; Pooja Khatri, MD; Ruediger von Kummer, MD; Rebecca M. Sugg, MD; Osama O. Zaidat, MD; Syed I. Hussain, MD; Mayank Goyal, MD; Bijoy K. Menon, MD; Firas Al Ali, MD; Bernard Yan, MD; Yuko Y. Palesch, PhD; Joseph P. Broderick, MD for the IMS III Investigators

Background and Purpose: Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion, and clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III trial.

13 febrero 2014

STROKE. Clinical Sciences. Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Linn Koraen-Smith, MD; Thomas Troëng, MD, PhD; Martin Björck, MD, PhD; Björn Kragsterman, MD, PhD; Carl-Magnus Wahlgren, MD, PhD; on behalf of the Swedish Vascular Registry and the Riks-Stroke Collaboration

Background and Purpose: Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke.

01 marzo 2015

Guest Editorial: Endovascular Treatment of Acute Ischemic Stroke: What´s Next?

Mokin, Maxim MD, PhD*,‡,§; Levy, Elad I. MD, MBA*,‡,¶,‖

Stroke remains the leading cause of long-term disability in the United States.1 Strokes resulting from large-vessel occlusion are especially associated with poor prognosis and neurological outcomes. Currently, <1% of all stroke cases are treated with endovascular therapies. Intravenous thrombolysis is the only US Food and Drug Administration-approved treatment for acute ischemic stroke in the United States.

01 febrero 2015

JOURNAL OF NEUROSURGERY. Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes

Jaechan Park, MD, PhD1,3, Hyunjin Woo, MD1, Dong-Hun Kang, MD1,2, Yong-Sun Kim, MD, PhD2, Min Young Kim, PhD3, Im Hee Shin, PhD4, and Sang Gyu Kwak, PhD4

OBJECT: While the incidence of a recurrent hemorrhage is highest within 24 hours of subarachnoid hemorrhage (SAH) and increases with the severity of the clinical grade, a recurrent hemorrhage can occur anytime after the initial SAH in patients with both good and poor clinical grades. Therefore, the authors adopted a 24-hour-a-day, formal protocol, emergency treatment strategy for patients with ruptured aneurysms to secure the aneurysms as early as possible. The incidences of in-hospital rebleeding and clinical outcomes were investigated and compared with those from previous years when broadly defined early treatment was used (< 3 days of SAH).