A number of landmark trials have proven the efficacy of thrombolysis by intravenous recombinant tissue plasminogen activator in the acute phase of the ischemic stroke. Despite the recently extended time window of 4.5 hours, the number of people who are being treated in most centers is low. Several reasons seem to account for this, including poor recognition of symptoms, delays in emergency transport, low levels of public awareness, or age limits originally imposed by drug regulatory rules. Trials are ongoing to possibly extend the indications to the treatment. A major effort is to extend the time window by bridging the treatment with neuroprotective approaches, or by identifying subgroups that may particularly benefit from recanalization and reperfusion. Procedures using ultrasounds or alternative intravenous compounds are also being investigated with promising results. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 10-18, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
Recanalization rates with the administration of intravenous tissue plasminogen activator in acute ischemic stroke are low. Adjuvant endovascular techniques that achieve recanalization by direct intra-arterial (IA) delivery of thrombolytics, mechanical clot retrieval, clot aspiration, and stenting may complement intravenous pharmacotherapy. IA thrombolytics can be administered within 6 hours of symptom onset in anterior circulation strokes and within 24 hours in posterior circulation strokes. This review describes the indications, patient selection, and technique for IA administration of thrombolytics. Techniques in Vascular & Interventional Radiology Volume 15, Issue 1 , Pages 41-46, March 2012. Copyright © 2012 Elsevier Inc. All rights reserved.
The pathogenesis behind vascular malformations resulting from vascular dilatation or shunting remains unclear despite many years of genetics and proteonomics studies. Lesions such as arteriovenous malformations (AVMs), cavernous malformations, telangiectasias, and aneurysms likely result from abnormal embryonal genetic development and/or post-natal alteration in protein expression. In each of these lesions there is likely a multi-factorial cascade that results in abnormal vascular development and/or proliferation. Neurosurgery: August 2012 - Volume 71 - Issue 2 - p N18–N19 doi: 10.1227/01.neu.0000417533.23118.e1. Copyright © by the Congress of Neurological Surgeons
BACKGROUND: Previous hemorrhage, deep venous drainage, and deep location are established risk factors for arteriovenous malformation (AVM) hemorrhage. Although pregnancy is an assumed risk factor, there is a relative paucity of data to support this neurosurgical tenet. Neurosurgery: August 2012 - Volume 71 - Issue 2 - p 349–356 doi: 10.1227/NEU.0b013e318256c34b. Copyright © by the Congress of Neurological Surgeons
BACKGROUND AND PURPOSE: In clinical practice, durability of occlusion following coil embolization is superior in densely packed, compared with loosely packed, aneurysms. In a rabbit model, we probed, by using proteomics tools, the biologic mechanisms associated with densely packed and completely occluded aneurysms, compared with loosely packed and incompletely occluded aneurysms, to explore the biologic mechanisms of intra-aneurysmal healing following embolization. AJNR Am J Neuroradiol 33:1177– 81 Jun-Jul 2012 www.ajnr.org. Copyright © 2012 by American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Cerebral venous thrombosis is a rare entity that can be difficult to manage. Most patients with cerebral sinus thrombosis recover after treatment with heparin, but a subgroup of severe cerebral venous sinus thrombosis has a poor prognosis. Those patients may benefit from intrasinus thrombolysis. The purpose of this research was to carry out a retrospective analysis of patients with severe cerebral venous sinus thrombosis, and to study the safety and efficacy of intrasinus thrombolysis in patients with cerebral venous sinus thrombosis unresponsive to conventional heparin therapy. AJNR Am J Neuroradiol 33:1187–90 Jun-Jul 2012 www.ajnr.org. Copyright © 2012 by American Journal of Neuroradiology
Intracranial atherosclerotic disease (ICAD) is a major cause of stroke and yet there are no proven effective treatments for it. Medical therapy has been associated with a high rate of recurrence, particularly in those with the most severe stenoses who have a 22.5% risk of stroke or death in the first year after a stroke. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
Background and Purpose—Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study). Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
Background and Purpose—To evaluate the periprocedural outcome after carotid artery stenting with embolic brain protection (EBP+) versus without embolic brain protection (EBP−). Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
Background and Purpose—The purpose of this study is to present 12-month follow-up results for a series of patients undergoing percutaneous transluminal angioplasty and stenting with the Gateway-Wingspan stenting system (Boston Scientific) for the treatment of symptomatic intracranial atherostenosis. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
Background and Purpose—Depression after stroke is common. Like stroke, transient ischemic attack (TIA) is a manifestation of long-term atherosclerotic damage to the brain. However, the risk of depression developing after a TIA is uncertain. We studied whether TIA increases the risk of incident late-life depression. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
Background and Purpose—The longer-term natural history of depression after stroke is poorly understood. We estimate frequency, predictors, and associations of depression up to 5 years after stroke in a population-based study. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
Background and Purpose—Intra-arterial thrombolysis can be used for treatment of basilar artery occlusion. Predictors of outcome before initiation of treatment are of special interest. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
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