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ESTUDIOS


Frequency of Blood-Brain Barrier Disruption Post-Endovascular Therapy and Multiple Thrombectomy Passes in Acute Ischemic Stroke Patients

Marie Luby, Amie W. Hsia, Zurab Nadareishvili, Kaylie Cullison, Noorie Pednekar, Malik Muhammad Adil and Lawrence L. Latour

Abstract Background and Purpose— The high prevalence of hyperintense acute reperfusion marker (HARM) seen after endovascular therapy is suggestive of blood-brain barrier disruption and hemorrhage risk and may be attributable to multiple thrombectomy passes needed to achieve recanalization.

Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke

Rob A. van de Graaf, Vicky Chalos, Adriaan C.G.M. van Es, Bart J. Emmer, Geert J. Lycklama à Nijeholt, H. Bart van der Worp, Wouter J. Schonewille, Aad van der Lugt, Diederik W.J. Dippel, Hester F. Lingsma, Bob Roozenbeek and on behalf of the MR CLEAN Registry Investigators

Abstract Background and Purpose— Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety.

True First-Pass Effect

Omid Nikoubashman, Sven Dekeyzer, Alexander Riabikin, Annika Keulers, Arno Reich, Anastasios Mpotsaris and Martin Wiesmann

Abstract Background and Purpose— It has been hypothesized that in stroke patients, complete reperfusion (modified Thrombolysis in Cerebral Infarction; mTICI 3) after a single thrombectomy pass is a predictor for favorable outcome (modified Rankin Scale score, 0–2), but a true first-pass effect defined as improved clinical outcome after complete reperfusion with one versus multiple passes has not yet been specifically addressed in the literature.

Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke

Kavelin Rumalla, Malte Ottenhausen, Peter Kan and Jan-Karl Burkhardt

Abstract Background and Purpose— The treatment of patients with acute ischemic stroke has been revolutionized by endovascular mechanical thrombectomy (MT), leading to dramatically improved outcomes. Here, we analyzed the impact of recent changes in stroke management on nationwide trends in patient characteristics, treatment modalities, and outcomes.

Patterns and Outcomes of Endovascular Therapy in Mild Stroke

Negar Asdaghi, Dileep R. Yavagal, Kefeng Wang, Nils Mueller-Kronast, Nirav Bhatt, Hannah E. Gardener, Carolina M. Gutierrez, Erika Marulanda-Londoño, Sebastian Koch, Chuanhui Dong, Sophia A. Oluwole, Ricardo Hanel, Brijesh Mehta, Mary Robichaux, Ulises Nobo, Juan C. Zevallos, Tatjana Rundek, Ralph L. Sacco and Jose G. Romano

Abstract Background and Purpose— We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms

Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

Bruna G. Dutra, Manon L. Tolhuisen, Heitor C.B.R. Alves, Kilian M. Treurniet, Manon Kappelhof, Albert J. Yoo, Ivo G.H. Jansen, Diederik W.J. Dippel, Wim H. van Zwam, Robert J. van Oostenbrugge, Antônio J. da Rocha, Hester F. Lingsma, Aad van der Lugt, Yvo B.W.E.M. Roos, Henk A. Marquering, Charles B.L.M. Majoie and the MR CLEAN Registry Investigators

Abstract Background and Purpose— Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment.

Angioedema in Stroke Patients With Thrombolysis

Kilian Fröhlich, Kosmas Macha, Stefan T. Gerner, Tobias Bobinger, Manuel Schmidt, Arnd Dörfler, Max J. Hilz, Stefan Schwab, Frank Seifert, Bernd Kallmünzer and Klemens Winder

Abstract Background and Purpose— Oral angioedema (OA) is a rare but life-threatening complication in patients with ischemic stroke receiving intravenous thrombolysis with r-tPA (recombinant tissue-type plasminogen activator). This study intended to determine associations between thrombolysis-related OA and ischemic stroke lesion sites using a voxel-wise lesion analysis.

Revascularization of High-Grade Carotid Stenosis Restores Global Cerebral Energy Metabolism

Alexander Seiler, Sara Kammerer, Alexander Gühl, Jan Rüdiger Schüre, Ralf Deichmann, Ulrike Nöth, Waltraud Pfeilschifter, Elke Hattingen, Michael Keese, Ulrich Pilatus and Marlies Wagner

Abstract Background and Purpose— Chronic cerebral hemodynamic impairment due to high-grade occlusive carotid disease may lead to compromised energy metabolism. This might result in chronic subtle tissue damage, even in patients without overt brain infarction. The aim of this study was to investigate hypoperfusion-related changes of cerebral energy metabolism and their potential restitution after revascularization. For this purpose, 3-dimensional 31P magnetic resonance spectroscopy and oxygenation-sensitive T2′ magnetic resonance imaging were used (with 1/T2′=1/T2*−1/T2), which were expected to cross-validate each other.

When to Stop

Álvaro García-Tornel, Manuel Requena, Marta Rubiera, Marian Muchada, Jorge Pagola, David Rodriguez-Luna, Matias Deck, Jesus Juega, Noelia Rodríguez-Villatoro, Sandra Boned, Marta Olivé-Gadea, Alejandro Tomasello, David Hernández, Carlos A. Molina and Marc Ribo

Abstract Background and Purpose— Substantial proportion of patients who achieve successful recanalization of acute ischemic stroke due to large vessel occlusion do not achieve good functional outcome. We aim to analyze the effect of number of thrombectomy device passes and degree of the recanalization (by modified Thrombolysis in Cerebral Infarction) on the clinical and functional outcome.

Interhospital Transfers for Endovascular Therapy for Acute Ischemic Stroke

Laura K. Stein, Stanley Tuhrim, Johanna Fifi, J. Mocco and Mandip S. Dhamoon

Abstract Background and Purpose— Multiple randomized clinical trials have demonstrated the superiority of endovascular therapy (ET) for large vessel occlusion acute ischemic stroke (AIS). Few centers can provide ET, and significant debate exists about the most efficient and effective ways to provide ET. We sought to assess real-world utilization of ET, the extent to which patients are transferred from one hospital to another for therapy and the implications of transfer status on outcomes.

Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome

Nils H. Petersen, Santiago Ortega-Gutierrez, Anson Wang, Gloria V. Lopez, Sumita Strander, Sreeja Kodali, Andrew Silverman, Binbin Zheng-Lin, Sudeepta Dandapat, Lauren H. Sansing, Joseph L. Schindler, Guido J. Falcone, Emily J. Gilmore, Hardik Amin, Branden Cord, Ryan M. Hebert, Charles Matouk and Kevin N. Sheth

Abstract Background and Purpose— After large-vessel intracranial occlusion, the fate of the ischemic penumbra, and ultimately final infarct volume, largely depends on tissue perfusion. In this study, we evaluated whether blood pressure reduction and sustained relative hypotension during endovascular thrombectomy are associated with infarct progression and functional outcome.

One-Year Healthcare Utilization for Patients That Received Endovascular Treatment Compared With Control

Noreen Kamal, Edwin Rogers, Jillian Stang, Balraj Mann, Kenneth S. Butcher, Jeremy Rempel, Thomas Jeerakathil, Ashfaq Shuaib, Mayank Goyal, Bijoy K. Menon, Andrew M. Demchuk and Michael D. Hill

Abstract Background and Purpose— Endovascular therapy has been shown to be highly efficacious based on 90-day modified Rankin Scale score. We examined actual daily healthcare utilization from stroke onset to 1 year afterward from the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Time) and registry data.

Vessel Wall Imaging of Evolving Unruptured Intracranial Aneurysms

Toshinori Matsushige, Koji Shimonaga, Daizo Ishii, Shigeyuki Sakamoto, Masahiro Hosogai, Yukishige Hashimoto, Mayumi Kaneko, Chiaki Ono, Tatsuya Mizoue and Kaoru Kurisu

Abstract Background and Purpose— Unruptured intracranial aneurysms (UIAs) have various scenarios of growth and rupture. Magnetic resonance vessel wall imaging can detect aneurysmal wall thickening with inflammation and neovascularization. This study was performed to explore the vessel wall imaging findings of UIAs with consecutive follow-up

Short-Term Double Layer Mesh Stent Patency for Emergent or Elective Carotid Artery Stenting

Evelien E. de Vries, Evert J. Vonken, L. Jaap Kappelle, Raechel J. Toorop and Gert J. de Borst

Abstract Background and Purpose— Novel double layer micromesh stents have recently been introduced for treatment of patients with significant carotid stenosis. Strict evaluation of safety and patency of such novel devices is required both in elective and in emergency interventions. We report a single center experience with double layer mesh stents for carotid artery revascularization.

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