24 noviembre 2015

STROKE. Clinical Sciences. Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion

Raul G. Nogueira, MD*; Diogo C. Haussen, MD*; Seena Dehkharghani, MD; Leticia C. Rebello, MD; Andrey Lima, MD; Meredith Bowen, BA; Samir Belagaje, MD; Aaron Anderson, MD; Michael Frankel, MD

Background and Purpose: Acute ischemic stroke patients with large volumes of severe hypoperfusion (Tmax>10 s>100 mL) on magnetic resonance imaging have a higher likelihood of intracranial hemorrhage and poor outcomes after reperfusion. We aim to evaluate the impact of the extent of Tmax>10 s CTP lesions in patients undergoing successful treatment.

22 octubre 2015

STROKE. Brief Report. Time From Symptoms to Carotid Endarterectomy or Stenting and Perioperative Risk

James F. Meschia, MD; L. Nelson Hopkins, MD; Irfan Altafullah, MD; Lawrence R. Wechsler, MD; Grant Stotts, MD; Nicole R. Gonzales, MD; Jenifer H. Voeks, PhD; George Howard, Dr PH; Thomas G. Brott, MD

Background and Purpose: Prior meta-analysis showed that carotid endarterectomy benefits decline with increasing surgical delay following symptoms. For symptomatic patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), we assessed if differences in time between symptoms and carotid endarterectomy or carotid artery stenting are associated with differences in risk of periprocedural stroke or death.

15 octubre 2015

STROKE. Brief Report. Endovascular Treatment for Acute Ischemic Stroke in the Setting of Anticoagulation

Letícia C. Rebello, MD; Diogo C. Haussen, MD; Samir Belagaje, MD; Aaron Anderson, MD; Michael Frankel, MD; Raul G. Nogueira, MD

Background and Purpose: Oral anticoagulation (OAC) plays a major role in atrial fibrillation stroke prevention but represents a contraindication to intravenous tissue-type plasminogen activator. Intra-arterial therapy remains a potential reperfusion strategy in these patients; however, supporting data are scarce.

27 octubre 2015

STROKE. Clinical Sciences. Mechanical Thrombectomy in and Outside the REVASCAT Trial

Xabier Urra, MD, PhD*; Sònia Abilleira, MD, PhD*; Laura Dorado, MD, PhD; Marc Ribó, MD, PhD; Pere Cardona, MD; Mònica Millán, MD, PhD; Angel Chamorro, MD, PhD; Carlos Molina, MD, PhD; Erik Cobo, PhD; Antoni Dávalos, MD, PhD; Tudor G. Jovin, MD; Miquel Gallofré, MD, PhD, Catalan Stroke Code and Reperfusion Consortium

Background and Purpose: Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial.

15 octubre 2015

STROKE. Clinical Sciences. Summary of Evidence on Early Carotid Intervention for Recently Symptomatic Stenosis Based on Meta-Analysis of Current Risks

Paola De Rango, MD, PhD; Martin M. Brown, MD; Seemant Chaturvedi, MD; Virginia J. Howard, PhD; Tudor Jovin, MD; Michael V. Mazya, MD, PhD; Maurizio Paciaroni, MD, PhD; Alessandra Manzone, MS; Luca Farchioni, MD; Valeria Caso, MD, PhD

Background and Purpose: This study aimed to assess the evidence on the periprocedural (<30 days) risks of carotid intervention in relation to timing of procedure in patients with recently symptomatic carotid stenosis.

20 octubre 2015

STROKE. Clinical Sciences. Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke. Pooled Analysis of Interventional Management of Stroke III and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands Data

Joseph P. Broderick, MD; Olvert A. Berkhemer, MD; Yuko Y. Palesch, PhD; Diederik W.J. Dippel, MD, PhD; Lydia D. Foster, MS; Yvo B.W.E.M. Roos, MD, PhD; Aad van der Lugt, MD, PhD; Thomas A. Tomsick, MD; Charles B.L.M. Majoie, MD, PhD; Wim H. van Zwam, MD, PhD; Andrew M. Demchuk, MD; Robert J. van Oostenbrugge, MD, PhD; Pooja Khatri, MD; Hester F. Lingsma, PhD; Michael D. Hill, MD; Bob Roozenbeek, MD, PhD; Edward C. Jauch, MD; Tudor G. Jovin, MD; Bernard Yan, MD; Rüdiger von Kummer, Dr. Med; Carlos A. Molina, MD; Mayank Goyal, MD; Wouter J. Schonewille, MD, PhD; Mikael Mazighi, MD, PhD; Stefan T. Engelter, MD; Craig S. Anderson, MD, PhD; Judith Spilker, RN, BSN; Janice Carrozzella, RN, BA, RT (R); Karla J. Ryckborst, RN, BN; L. Scott Janis, PhD; Kit N. Simpson, PhD, for the IMS III and MR CLEAN Investigators

Background and Purpose: We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan.

27 octubre 2015

STROKE. Clinical Sciences. Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management

Ritvij Bowry, MD; Stephanie Parker, RN; Suja S. Rajan, PhD; Jose-Miguel Yamal, PhD; Tzu-Ching Wu, MD; Laura Richardson, BS; Elizabeth Noser, MD; David Persse, MD; Kamilah Jackson, RT; James C. Grotta, MD

Background and Purpose: Faster treatment with intravenous tissue-type plasminogen activator (tPA) is likely to improve outcomes. Optimizing prehospital triage by mobile stroke units (MSUs) may speed treatment times. The Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit (BEST-MSU) study was launched in May 2014 using the first MSU in the United States to compare stroke management using an MSU versus standard management (SM). Herein, we describe the results of the prespecified, nonrandomized run-in phase designed to obtain preliminary data on study logistics.

01 octubre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Paclitaxel-Coated Balloon in Infrapopliteal Arteries. 12-Month Results From the BIOLUX P-II Randomized Trial (BIOTRONIK´S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries

Thomas Zeller, MD∗; Ulrich Beschorner, MD†; Ernst Pilger, MD‡; Marc Bosiers, MD§; Koen Deloose, MD§; Patrick Peeters, MD‖; Dierk Scheinert, MD, PhD¶; Karl-Ludwig Schulte, MD, PhD#; Aljoscha Rastan, MD∗; Marianne Brodmann, MD, PhD‡

Objectives: The aim of BIOLUX P-II (BIOTRONIK´S–First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries) trial was to compare the safety and efficacy of a novel paclitaxel-coated drug-eluting balloon (DEB) versus an uncoated balloon (percutaneous transluminal angioplasty [PTA]) in de novo or native restenotic lesions of the infrapopliteal arteries in patients with claudication and critical limb ischemia.

01 noviembre 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Safety and Efficacy of Stent Retrievers for the Management of Acute Ischemic Stroke. Comprehensive Review and Meta-Analysis

Konstantinos Marmagkiolis, MD∗,†; Abdul Hakeem, MD‡; Mehmet Cilingiroglu, MD§,‖; Betul Gundogdu, MD¶; Cezar Iliescu, MD#; Despina Tsitlakidou∗∗; Angelos Katramados, MD††

Objectives: This study sought to evaluate the safety and efficacy of stent retriever for the management of acute ischemic stroke.

11 junio 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with Acute Middle Cerebral Artery Occlusions

T. Struffert, Y. Deuerling-Zheng, S. Kloska, T. Engelhorn, S. Lang, A. Mennecke, M. Manhart, C.M. Strother, S. Schwab and A. Doerfler

BACKGROUND AND PURPOSE: Perfusion and angiographic imaging using intravenous contrast application to evaluate stroke patients is now technically feasible by flat detector CT performed by the angiographic system. The aim of this pilot study was to show the feasibility and qualitative comparability of a novel flat detector CT dynamic perfusion and angiographic imaging protocol in comparison with a multimodal stroke MR imaging protocol.

13 agosto 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Clopidogrel Resistance in Neurovascular Stenting: Correlations between Light Transmission Aggregometry, VerifyNow, and the Multiplate

N. Flechtenmacher, F. Kämmerer, R. Dittmer, U. Budde, P. Michels, J. Röther and B. Eckert

BACKGROUND AND PURPOSE: Clopidogrel resistance is blamed for thromboembolic complications in neurovascular stent placement. Platelet-function assays are weakly standardized. The aim of this study was to correlate the results of 3 different platelet-inhibition measurements (from light transmission aggregometry, the VerifyNow P2Y12 test, and the Multiplate analyzer) and their relation to periprocedural thromboembolic complications in elective neurovascular stent placement.

18 junio 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center

F. Gao, W.T. Lo, X. Sun, D.P. Mo, N. Ma and Z.R. Miao

BACKGROUND AND PURPOSE: Acute basilar occlusions have a poor prognosis without recanalization. Many have underlying severe atherosclerotic intracranial stenosis coexisting with acute thrombosis, requiring treatment of both pathologies in the same session, though technical risks may be encountered. The purpose of this study was to evaluate the technical feasibility and safety of combined treatment by using stent retrievers for the thrombosis, together with angioplasty and stent placement for the underlying stenosis.

23 julio 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms

J.J. Schneiders, H.A. Marquering, P. van Ooij, R. van den Berg, A.J. Nederveen, D. Verbaan, W.P. Vandertop, M. Pourquie, G.J.E. Rinkel, E. vanBavel and C.B.L.M. Majoie

BACKGROUND AND PURPOSE: Hemodynamics are thought to play an important role in the rupture of intracranial aneurysms. We tested whether hemodynamics, determined from computational fluid dynamics models, have additional value in discriminating ruptured and unruptured aneurysms. Such discriminative power could provide better prediction models for rupture.

23 julio 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes

S.W. Hetts, T. Tsai, D.L. Cooke, M.R. Amans, F. Settecase, P. Moftakhar, C.F. Dowd, R.T. Higashida, M.T. Lawton and V.V. Halbach

BACKGROUND AND PURPOSE: A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas.

27 agosto 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review

D. Cannizzaro, W. Brinjikji, S. Rammos, M.H. Murad and G. Lanzino

BACKGROUND AND PURPOSE: Tentorial dural arteriovenous fistulas are characterized by a high hemorrhagic risk. We evaluated trends in outcomes and management of tentorial dural arteriovenous fistulas and performed a meta-analysis evaluating clinical and angiographic outcomes by treatment technique.