29 septiembre 2015

STROKE. Clinical Sciences. Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Alan Flores, MD, PhD; Marta Rubiera, MD, PhD; Marc Ribó, MD, PhD; Jorge Pagola, MD, PhD; David Rodriguez-Luna, MD, PhD; Marian Muchada, MD, PhD; Sandra Boned, MD; Laia Seró, MD; Estela Sanjuan, PhD; Pilar Meler, RN; Daniel Carcámo, MD; Estevo Santamarina, MD, PhD; Alejandro Tomassello, MD; Miguel Lemus, MD; Pilar Coscojuela, MD; Carlos A. Molina, MD, PhD

Background and Purpose: Collateral circulation (CC) has been associated with recanalization, infarct volume, and clinical outcome in patients undergoing acute reperfusion therapies. However, its relationship with the development to malignant middle cerebral artery infarction (mMCAi) has not been evaluated. Our aim was to determine the impact of CC using multiphase computed tomographic angiography (during the acute stroke phase in the prediction of mMCAi.

22 septiembre 2015

STROKE. Clinical Sciences. Endovascular Thrombectomy for Anterior Circulation Stroke Systematic Review and Meta-Analysis

Chester K. Yarbrough, MD, MPHS*; Charlene J. Ong, MD*; Alexander B. Beyer, MD, MPHS; Kim Lipsey, MLS; Colin P. Derdeyn, MD

Background and Purpose: Stroke affects ≈700 000 patients annually. Recent randomized controlled trials comparing endovascular thrombectomy (ET) with medical therapy, including intravenous thrombolysis (IVT) with tissue-type plasminogen activator, have shown effectiveness of ET for some stroke patients. The study objective is to evaluate the effect of ET on good outcome in stroke patients.

08 octubre 2015

STROKE. Clinical Sciences. Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Carina Wendorff, MD*; Heiko Wendorff, MD*; Jaroslav Pelisek, PhD; Pavlos Tsantilas, MD; Alexander Zimmermann, MD; Alma Zernecke, MD; Andreas Kuehnl, MD, MPH*; Hans-Henning Eckstein, MD, PhD*

Background and Purpose: The purpose of this study was to analyze the association between morphological characteristics of human carotid plaques and patient’s sex, age, and history of neurological symptoms.

06 octubre 2015

STROKE. Basic Sciences. Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke

Jean-Philippe Desilles, MD, MSc; Stephane Loyau, BSc; Varouna Syvannarath, MSc; Jaime Gonzalez-Valcarcel, MD; Marie Cantier, MD; Liliane Louedec, BSc; Bertrand Lapergue, MD, PhD; Pierre Amarenco, MD; Nadine Ajzenberg, MD, PhD; Martine Jandrot-Perrus, MD, PhD; Jean-Baptiste Michel, MD, PhD; Benoit Ho-Tin-Noe, PhD; Mikael Mazighi, MD, PhD

Background and Purpose: Downstream microvascular thrombosis (DMT) is known to be a contributing factor to incomplete reperfusion in acute ischemic stroke. The aim of this study was to determine the timing of DMT with intravital imaging and to test the hypothesis that intravenous alteplase infusion could reduce DMT in a transient middle cerebral artery occlusion (MCAO) rat stroke model.

29 septiembre 2015

STROKE. Brief Report. Reflux of Anterior Spinal Artery Predicts Recurrent Posterior Circulation Stroke in Bilateral Vertebral Artery Disease

Hitoshi Fukuda, MD; Kosuke Hayashi, MD; Akira Handa, MD; Yoshitaka Kurosaki, MD; Benjamin Lo, MD; Sen Yamagata, MD

Backgrounds and Purpose: Predictive value of reflux of anterior spinal artery for recurrent posterior circulation ischemia in bilateral vertebral arteries steno-occlusive disease was evaluated.

17 septiembre 2015

STROKE. Brief Report. Does the Stenting Versus Aggressive Medical Therapy Trial Support Stenting for Subgroups With Intracranial Stenosis?

Helmi L. Lutsep, MD; Michael J. Lynn, MS; George A. Cotsonis, MA; Colin P. Derdeyn, MD; Tanya N. Turan, MD; David Fiorella, MD, PhD; L. Scott Janis, PhD; Bethany F. Lane, RN; Jean Montgomery, RN; Marc I. Chimowitz, MB, ChB, for the SAMMPRIS Investigators

Background and Purpose: Although the Stenting Versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial showed that medical therapy alone was superior to stenting plus medical therapy for preventing recurrent strokes in patients with symptomatic intracranial stenosis, we determined whether SAMMPRIS supported the use of stenting in any subpopulations of patients with symptomatic intracranial arterial stenosis.

06 octubre 2015

STROKE. Brief Report. Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Celine S. Gathier, MD; Jan Willem Dankbaar, MD, PhD; Mathieu van der Jagt, MD, PhD; Bon H. Verweij, MD, PhD; Annemarie W. Oldenbeuving, MD, PhD; Gabriel J.E. Rinkel, MD, FRCPE; Walter M. van den Bergh, MD, PhD; Arjen J.C. Slooter, MD, PhD, for the HIMALAIA Study Group

Background and Purpose: The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid hemorrhage patients with delayed cerebral ischemia in a randomized clinical trial.

17 septiembre 2015

STROKE. Brief Report. Ultrasound and Clinical Predictors of Recurrent Ischemia in Symptomatic Internal Carotid Artery Occlusion

Juliane Schneider, MD; Beate Sick, PhD; Andreas R. Luft, MD; Susanne Wegener, MD

Background and Purpose: Occlusion of the internal carotid artery puts patients at risk of recurrent ischemic events because of hemodynamic compromise. Our goal was to characterize clinical and duplex parameters indicating patients at risk of recurrent ischemia.

08 octubre 2015

STROKE. Brief Report. Early Loss of Immediate Reperfusion While Stent Retriever in Place Predicts Successful Final Reperfusion in Acute Ischemic Stroke Patients

Masakazu Okawa, MD; Satoshi Tateshima, MD; David Liebeskind, MD; Neal Rao, MD; Reza Jahan, MD; Nestor Gonzalez, MD; Viktor Szeder, MD; Latisha Ali, MD; Doojin Kim, MD; Jeffrey Saver, MD; Gary Duckwiler, MD

Background and Purpose: Degree of stent retriever engagement with target thrombi may be reflected by (1) immediate reperfusion (IR) on first deployment, indicating displacement of clot toward the vessel wall, and (2) by early loss of IR (ELOIR), indicating penetration of retriever struts through the thrombus. The relation of these early findings to final reperfusion and clinical outcomes has not been well delineated.

08 octubre 2015

STROKE. Clinical Sciences. Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event

Michal Karlinski, MD, PhD; Adam Kobayashi, MD, PhD; Anna Czlonkowska, MD, PhD; Robert Mikulik, MD, PhD; Daniel Vaclavik, MD, PhD; Miroslav Brozman, MD, PhD; Zuzana Gdovinova, MD, PhD; Viktor Švigelj, MD; Laszlo Csiba, MD, PhD; Klara Fekete, MD; Janika Kõrv, MD, PhD; Vida Demarin, MD, PhD; Vanja Bašic-Kes, MD; Aleksandras Vilionskis, MD; Dalius Jatuzis, MD, PhD; Yakup Krespi, MD; Nikolay Shamalov, MD, PhD; Silva Andonova, MD, PhD; Niaz Ahmed, MD, PhD; Nils Wahlgren, MD, PhD, for the Safe Implementation of Treatments in Stroke–East Registry (SITS-EAST) Investigators

Background and Purpose: According to the European license, alteplase can be given no sooner than 3 months after previous stroke. However, it is not known whether past history of stroke influences the effect of treatment. Our aim was to evaluate safety and functional outcome after intravenous thrombolysis administered in everyday practice to patients with previous stroke ≤3 months compared with those with first-ever stroke.

29 septiembre 2015

STROKE. Clinical Sciences. Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

George Kwok Chu Wong, MD; Ryan Chi Hang Nung, FRCR; Jacqueline Ching Man Sitt, FRCR; Vincent Chung Tong Mok, MD; Adrian Wong, PhD; Faith Lok Yan Ho, MRCS; Wai Sang Poon, FRCR; Defeng Wang, PhD; Jill Abrigo, MD; Deyond Yun Woon Siu, FRCR

Background and Purpose: Aneurysmal subarachnoid hemorrhage is a serious disease with high case fatality and morbidity. Delayed cerebral infarction (DCI) is an important surrogate marker. How location and infarct load affected outcomes was unclear. We aimed to assess the effects of load and location of DCI on outcomes of aneurysmal subarachnoid hemorrhage at 3 months.

15 septiembre 2015

STROKE. Clinical Sciences. Optimizating Clot Retrieval in Acute Stroke

Diogo C. Haussen, MD; Leticia C. Rebello, MD; Raul G. Nogueira, MD

Background and Purpose: We aimed to investigate the safety and efficacy of the Push and Fluff technique (PFT) as compared with the standard unsheathing technique for closed-cell stent retrievers in acute ischemic stroke.

18 agosto 2015

STROKE. Clinical Sciences. Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting

Marion Boulanger, MD; Lucie Camelière, MD; Rui Felgueiras, MD; Ludovic Berger, PhD; Kittipan Rerkasem, PhD; Peter M. Rothwell, PhD; Emmanuel Touzé, PhD

Background and Purpose: Carotid angioplasty and stenting (CAS) is associated with higher risk of periprocedural stroke and death when compared with carotid endarterectomy (CEA). By contrast, the risk of myocardial infarction (MI) was higher after CEA than after CAS in randomized trials. However, numbers were small, and risk factors are unknown.

20 agosto 2015

STROKE. Clinical Sciences. Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures

Marc Ribo, MD; Alejandro Tomasello, MD; Miguel Lemus, MD; Marta Rubiera, MD; Carla Vert, MD; Alan Flores, MD; Pilar Coscojuela, MD; Jorge Pagola, MD; David Rodriguez-Luna, MD; Sandra Bonet, MD; Marian Muchada, MD; Alex Rovira, MD; Carlos A. Molina, MD

Background and Purpose: Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM).

08 septiembre 2015

STROKE. Clinical Sciences. Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Jenifer H. Voeks, PhD; George Howard, DrPH; Gary Roubin, MD, PhD; Richard Farb, MD; Donald Heck, MD; William Logan, MD; Mary Longbottom, BA; Alice Sheffet, PhD; James F. Meschia, MD; Thomas G. Brott, MD

Background and Purpose: There is higher combined risk of stroke or death (S+D) at older ages with carotid stenting. We assess whether this can be attributed to patient or arterial characteristics that are in the pathway between older age and higher risk.