Intravenous recombinant tissue plasminogen activator (t-PA) is the standard treatment for acute ischemic stroke, but more than half the treated patients do not recover completely or die.1 Alternative treatments, such as endovascular treatment, have been used for many years. As compared with endovascular treatment, intravenous thrombolysis is associated with a lower probability of recanalization2-9 (46% of cases with intravenous t-PA vs. >80% with endovascular treatment10-15). Nevertheless, the two approaches have not been directly compared, recanalization is not invariably associated with a favorable clinical outcome,16 and it is not known whether clinical outcomes are superior with endovascular therapy as compared with intravenous t-PA.
Intravenous alteplase administered within 4.5 hours after symptom onset is the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke.1 However, well-recognized limitations of this therapy include the narrow therapeutic time window and contraindications such as recent surgery, coagulation abnormalities, and a history of intracranial hemorrhage.2 Moreover, intravenous alteplase appears to be much less effective at opening proximal occlusions of the major intracranial arteries, which account for more than one third of cases of acute anterior-circulation stroke.3,4 Early recanalization after intravenous alteplase is seen in only about one third of patients with an occlusion of the internal-carotid-artery terminus,5 and the prognosis without revascularization is generally poor for such patients.6 For these reasons, intraarterial treatment is regarded as a potentially important component of the therapeutic armamentarium.
Three-dimensional (3D) rotational digital subtraction angiography (DSA) currently is considered the “gold standard” for the detection of cerebral aneurysms (1,2). However the technique is invasive, time consuming, technically demanding, relatively expensive, and has a 0.12% rate of permanent neurologic complication according to results of a previous prospective, randomized trial (3). Thus, developing an accurate, noninvasive diagnostic imaging modality for aneurysms is an important issue.
Background—Meaningful delays occurred in the Interventional Management of Stroke (IMS) III trial. Analysis of the work flow will identify factors contributing to the in-hospital delays.
A blood clot in the veins that drain the blood from the brain is called a sinus or cerebral vein thrombosis. It is an uncommon type of clot, affecting about 1500 people in the United States per year.
Background—Limited long-term follow-up data exist on the impact of appropriate secondary prevention therapies on cognitive function in patients after first-ever stroke. The aim of this study is to determine the effect of secondary prevention of vascular events on cognitive function after stroke.
Background and Purpose: National registration studies (the Japanese Registry of Neuroendovascular Therapy [JR-NET] and JR-NET2) have determined the current status and outcomes of neuroendovascular therapy (neuro-EVT). We analyzed short-term outcomes of EVT for asymptomatic unruptured intracranial aneurysms (UIAs).
Background and Purpose: Mechanical thrombectomy using stent retriever devices have been advocated to increase revascularization in intracranial vessel occlusion. We present the results of a large prospective study on the use of the Solitaire Flow Restoration in patients with acute ischemic stroke.
Background and Purpose: Reliable data concerning prognosis of patients with intracranial in-stent restenosis (ISR) is lacking. We prospectively studied long-term outcomes of patients with and without a catheter angiography-verified ISR.
Background and Purpose: According to the International Study of Unruptured Intracranial Aneurysms (ISUIA), anterior circulation (AC) aneurysms of <7 mm in diameter have a minimal risk of rupture. It is general experience, however, that anterior communicating artery (AcoA) aneurysms are frequent and mostly rupture at <7 mm. The aim of the study was to assess whether AcoA aneurysms behave differently from other AC aneurysms.
Background and Purpose. The natural history of small unruptured intracranial aneurysms of the anterior circulation in the European population is unclear. Therefore, the management of unruptured intracranial aneurysms <7 mm in the anterior circulation is controversial.
Background and Purpose: Several studies have assessed the possible increased risk of hemorrhagic stroke in migraineurs, drawing differing conclusions. No meta-analysis on the topic has been published to date.
Background and Purpose: MRI characterization of carotid plaque has been studied recently as a potential tool to predict stroke caused by carotid atherosclerosis. We performed a systematic review and meta-analysis to summarize the association of MRI-determined intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap with subsequent ischemic events.
Background and Purpose: Prehospital redirection of stroke patients to a regional center is used as a strategy to maximize the provision of intravenous thrombolysis. We developed a model to quantify the benefit of redirection away from local services that were already providing thrombolysis.
Background and Purpose: Intracerebral hemorrhage is a serious potential complication of stroke thrombolysis. We investigated the optimal computed tomography perfusion (CTP) parameter to predict cerebral parenchymal hematoma (PH) in acute ischemic stroke.
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