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ESTUDIOS


28 febrero 2013

STROKE. Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies. Propensity Score Analysis of Clipping Versus Coiling

Jennifer S. McDonald, PhD; Robert J. McDonald, MD, PhD; Jiaquan Fan, PhD; David F. Kallmes, MD; Giuseppe Lanzino, MD; Harry J. Cloft, MD, PhD

Background and Purpose: Endovascular therapy has increasingly become the most common treatment for unruptured cerebral aneurysms in the United States. We evaluated a national, multi-hospital database to examine recent utilization trends and compare periprocedural outcomes between clipping and coiling treatments of unruptured aneurysms.

13 febrero 2013

STROKE. Asymptomatic Carotid Artery Stenosis and the Risk of Ischemic Stroke According to Subtype in Patients With Clinical Manifest Arterial Disease

Anne G. den Hartog, MD; Sefanja Achterberg, MD; Frans L. Moll, MD, PhD; L. Jaap Kappelle, MD, PhD; Frank L.J. Visseren, MD, PhD; Yolanda van der Graaf, MD, PhD; Ale Algra, MD, PhD; Gert Jan de Borst, MD, PhD; on behalf of the SMART Study Group

Background and Purpose: Because best medical treatment is improving, the risk of stroke in asymptomatic carotid artery stenosis (ACAS) may decline. We evaluated the risk of ischemic stroke and stratified it according to stroke subtype in patients with ACAS during long-term follow-up.

26 febrero 2013

STROKE. Safety of Thrombolysis in Stroke Mimics. Results From a Multicenter Cohort Study

Sanne M. Zinkstok, MD; Stefan T. Engelter, MD; Henrik Gensicke, MD; Philippe A. Lyrer, MD; Peter A. Ringleb, MD; Ville Artto, MD, PhD; Jukka Putaala, MD, PhD; Elena Haapaniemi, MD, PhD; Turgut Tatlisumak, MD, PhD; Yaohua Chen, MD; Didier Leys, MD, PhD; Hakan Sarikaya, MD; P. Michel, MD; Céline Odier, MD; Jörg Berrouschot, MD; Marcel Arnold, MD; Mirjam R. Heldner, MD; Andrea Zini, MD; Valentina Fioravanti, MD; Visnja Padjen, MD; Ljiljana Beslac-Bumbasirevic, MD, PhD; Alessandro Pezzini, MD; Yvo B. Roos, MD, PhD; Paul J. Nederkoorn, MD, PhD

Background and Purpose: Intravenous thrombolysis for acute ischemic stroke is beneficial within 4.5 hours of symptom onset, but the effect rapidly decreases over time, necessitating quick diagnostic in-hospital work-up. Initial time strain occasionally results in treatment of patients with an alternate diagnosis (stroke mimics). We investigated whether intravenous thrombolysis is safe in these patients.

29 abril 2014

FRONTIERS. Clinical outcome after intra-arterial stroke therapy in the very elderly: why is it so heterogeneous?

Ronil V. Chandra1*, Thabele M. Leslie-Mazwi2, Brijesh P. Mehta2, Albert J. Yoo3 and Claus Z. Simonsen4

Very elderly patients (i.e., ≥80 years) are disproportionally affected by acute ischemic stroke. They account for a third of hospital stroke admissions, but two-thirds of overall stroke-related morbidity and mortality. There is some evidence of clinical benefit in treating selected very elderly patients with intravenous thrombolysis (IVT). For very elderly patients ineligible or non-responsive to IVT, intra-arterial therapy (IAT) may have promise in improving clinical outcome. However, its unequivocal efficacy in the general population remains to be proven in randomized trials. Small cohort studies reveal that the rate of good clinical outcome for very elderly patients after IAT is highly variable, ranging from 0 to 28%. In addition, they experience higher rates of futile reperfusion than younger patients. Thus, it is imperative to understand the factors that impact on clinical outcome in very elderly patients after IAT. The aim of this review is to examine the factors that may be responsible for the heterogeneous clinical response of the very elderly to IAT. This will allow the reader to integrate the current available evidence to individualize intra-arterial stroke therapy in very elderly patients. Placing emphasis on pre-stroke independent living, smaller infarct core size, short procedure times, and avoiding general anesthesia where feasible, will help improve rates of good clinical outcome.

08 junio 2013

JOURNAL OF NEUROINTERVENTIONAL SURGERY. New devices. Original research. Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience

Albert Ho Yuen Chiu1,2, Grace Aw1, Jason David Wenderoth1

Background: Dural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen.

20 marzo 2013

JOURNAL OF NEUROINTERVENTIONAL SURGERY. Ischemic stroke. Original research. Learning curve of Wingspan stenting for intracranial atherosclerosis: single-center experience of 95 consecutive patients

Simon Chun Ho Yu1, Thomas Wai Hong Leung2, Kwok Tung Lee1, Lawrence Ka Sing Wong2

Background: Symptomatic brain hemorrhage was a significant cause of periprocedural stroke or death following stenting in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, which called into question the safety of Wingspan stenting for intracranial atherosclerosis. This study analyzed the role of a learning curve in the safety and outcome of Wingspan stenting from the experience of 95 consecutive patients at a single center.

20 marzo 2014

BMJ OPEN. Acute ischaemic stroke outcomes following mechanical thrombectomy in the elderly versus their younger counterpart: a retrospective cohort study

Mark R Villwock, Amit Singla, David J Padalino, Eric M Deshaies

Objectives: Many physicians debate the efficacy of mechanical thrombectomy for ischaemic stroke, but most agree that to establish potential benefit, patient selection must be examined further. People >80 years are a growing population of patients with ischaemic stroke but are largely excluded from clinical trials. The benefit of thrombectomy for them may be greatly reduced due to diminishing neuroplasticity and a larger number of medical comorbidities. To address this knowledge gap, we examined clinical and economic outcomes after mechanical thrombectomy in the ischaemic stroke population from the Nationwide Inpatient Sample. Our null hypotheses were that elderly patients (>80 years) would have a similar rate of inpatient mortality in comparison to their younger counterparts and incur a similar economic expense.

19 marzo 2013

JOURNAL OF NEUROINTERVENTIONAL SURGERY. Ischemic stroke. Original research. Angioplasty and stenting of intracranial atherosclerosis with the Wingspan system: 1-year clinical and radiological outcome in a single Asian center

Simon Chun Ho Yu1, Thomas Wai Hong Leung2, Kwok Tung Lee1, Lawrence Ka Sing Wong2

Background: This study aimed to evaluate the 1-year clinical and angiographic outcome of angioplasty and stenting of intracranial atherosclerosis using Wingspan and Gateway system

12 diciembre 2013

AMERICAN JOURNAL OF NEURORADIOLOGY. DWI Reversal Is Associated with Small Infarct Volume in Patients with TIA and Minor Stroke

N. Asdaghi, B.C.V. Campbell, K.S. Butcher, J.I. Coulter, J. Modi, A. Qazi, M. Goyal, A.M. Demchuk, and S.B. Coutts

Background and Purpose: More than half of patients with TIA/minor stroke have ischemic lesions on early DWI, which represent irreversibly damaged tissue. The presence and volume of DWI lesions predict early deterioration in this population. We aimed to study the rate and implications of DWI reversal in patients with TIA/minor stroke

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