07 mayo 2015

STROKE. Clinical Sciences. Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes. Analysis From the National Cardiovascular Data Registry

Siddharth A. Wayangankar, MD, MPH; Kevin F. Kennedy, MS; Herbert D. Aronow, MD, MPH; John Rundback, MD; Alfonso Tafur, MD, MS; Douglas Drachman, MD; Bhavin Patel, MD; Chittur A. Sivaram, MD; Faisal Latif, MD

Background and Purpose: It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA).

01 junio 2015

SPRINGER. Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results

H. Lockau, T. Liebig, T. Henning, V. Neuschmelting, H. Stetefeld, C. Kabbasch, F. Dorn

Introduction: Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy.

01 junio 2015

SPRINGER. Patients with subarachnoid haemorrhage from vertebrobasilar dissection: treatment with stent-in-stent technique

Pervinder Bhogal, Patrick A Brouwer, Åsa Kuntze Söderqvist, Marcus Ohlsson, Tommy Andersson, Staffan Holmin, Michael Söderman

Introduction: Vertebrobasilar dissection is an uncommon cause of subarachnoid haemorrhage (SAH) that carries a high risk for early repeat haemorrhage. The need for rapid treatment of this disease entity is without question; however, the best method for treatment is still undetermined. Here, we present our results using the stent-in-stent technique, without coiling, for these patients and propose that it is a viable treatment strategy.

01 junio 2015

SPRINGER. Progressive thrombosis of small saccular aneurysms filled with contrast immediately after coil embolization: analysis of related factors and long-term follow-up

Young Dae Cho, Jin Pyeong Jeon, Jong Kook Rhim, Jeong Jin Park, Roh-Eul Yoo, Hyun-Seung Kang, Jeong Eun Kim, Won-Sang Cho, Moon Hee Han

Introduction: Although it is well-known that incomplete occlusion of aneurysms after coil embolization predisposes to later recanalization, not all aneurysms will be fully occluded by coiling. In follow-up, we evaluated outcomes of small aneurysms (<10 mm) that showed filling of the sac with contrast immediately after coil embolization and assessed factors implicated in subsequent progressive thrombosis.

01 julio 2015

SPRINGER. Preoperative embolization of intracranial meningiomas using n-butyl cyanoacrylate

Masanori Aihara, Isao Naito, Tatsuya Shimizu, Hiroya Fujimaki, Ken Asakura, Naoko Miyamoto, Yuhei Yoshimoto

Introduction: Preoperative embolization for intracranial meningioma has been controversial for several decades. This study retrospectively reviewed our experience using n-butyl cyanoacrylate (n-BCA) to identify the factors for effective devascularization and procedure-related complications.

01 julio 2015

SPRINGER. Modified coil protection for proper coil frame configuration in wide-necked aneurysms

Young Dae Cho, Jong Kook Rhim, Jeong Jin Park, Jin Pyeong Jeon, Hyun-Seung Kang, Jeong Eun Kim, Won-Sang Cho, Moon Hee Han

Introduction: Although various protective techniques for treating wide-necked intracranial aneurysms currently exist and continue to evolve, their utility may be limited in some lesions with complex configurations, small-caliber channels, or inherently tortuous vascular patterns. Described herein is a modified coil protection technique as a novel adjunct for proper coil frame configuration.

01 agosto 2015

THE LANCET. Neurology. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke

Dr Bruce C V Campbell, PhD, Prof Geoffrey A Donnan, MD, Prof Kennedy R Lees, MD, Prof Werner Hacke, MD, Prof Pooja Khatri, MD, Prof Michael D Hill, MD, Prof Mayank Goyal, MD, Peter J Mitchell, MBBS, Prof Jeffrey L Saver, MD, Prof Hans-Christoph Diener, MD, Prof Stephen M Davis, MD

Background: Results of initial randomised trials of endovascular treatment for ischaemic stroke, published in 2013, were neutral but limited by the selection criteria used, early-generation devices with modest efficacy, non-consecutive enrolment, and treatment delays.

01 junio 2015

THE LANCET. Neurology. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial

Annette Compter, MD, H Bart van der Worp, MD, Wouter J Schonewille, MD, Jan Albert Vos, MD, Jelis Boiten, MD, Paul J Nederkoorn, MD, Maarten Uyttenboogaart, MD, Rob T Lo, MD, Prof Ale Algra, MD, Prof L Jaap Kappelle, MD for the VAST investigators†

Background: Patients with a recent vertebrobasilar transient ischaemic attack or ischaemic stroke and vertebral artery stenosis of at least 50% have a high risk of future vertebrobasilar stroke. Stenting of vertebral artery stenosis is promising, but of uncertain benefit. We investigated the safety and feasibility of stenting of symptomatic vertebral artery stenosis of at least 50%, and assessed the rate of vascular events in the vertebrobasilar supply territory to inform the design of a phase 3 trial.

01 abril 2015

THE LANCET. Neurology. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study

Xuya Huang, MRCP, Bharath Kumar Cheripelli, MRCP, Suzanne M Lloyd, MSc, Dheeraj Kalladka, MRCP, Fiona Catherine Moreton, MRCP, Aslam Siddiqui, FRCR, Ian Ford, PhD, Prof Keith W Muir, FRCP

Background: In most countries, alteplase given within 4·5 h of onset is the only approved medical treatment for acute ischaemic stroke. The newer thrombolytic drug tenecteplase has been investigated in one randomised trial up to 3 h after stroke and in another trial up to 6 h after stroke in patients selected by advanced neuroimaging. In the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST), we aimed to assess the efficacy and safety of tenecteplase versus alteplase within 4·5 h of stroke onset in a population not selected on the basis of advanced neuroimaging, and to use imaging biomarkers to inform the design of a definitive phase 3 clinical trial.

01 abril 2015

THE LANCET. Neurology. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis

Dr Luciano A Sposato, MD, Lauren E Cipriano, PhD, Gustavo Saposnik, MD, Estefanía Ruíz Vargas, PhD, Patricia M Riccio, MD, Prof Vladimir Hachinski, MD

Background: Among patients with atrial fibrillation, the risk of stroke is highest for those with a history of stroke; however, oral anticoagulants can lower the risk of recurrent stroke by two-thirds. No consensus has been reached about how atrial fibrillation should be investigated in patients with stroke, and its prevalence after a stroke remains uncertain. We did a systematic review and meta-analysis to estimate the proportion of patients newly diagnosed with atrial fibrillation after four sequential phases of cardiac monitoring after a stroke or transient ischaemic attack.

02 julio 2015

STROKE. Clinical Sciences. Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial

Alex Abou-Chebl, MD; Sharon D. Yeatts, PhD; Bernard Yan, MD; Kevin Cockroft, MD; Mayank Goyal, MD; Tudor Jovin, MD; Pooja Khatri, MD; Phillip Meyers, MD; Judith Spilker, BSN; Rebecca Sugg, MD; Katja E. Wartenberg, MD; Tom Tomsick, MD; Joe Broderick, MD; Michael D. Hill, MD

Background and Purpose: General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.

14 julio 2015

STROKE. Clinical Sciences. Temporal Changes in Periprocedural Events in the Carotid Revascularization Endarterectomy Versus Stenting Trial

George Howard, DrPH; L. Nelson Hopkins, MD; Wesley S. Moore, MD; Barry T. Katzen, MD; Elie Chakhtoura, MD; William F. Morrish, MD; Robert D. Ferguson, MD; Robert J. Hye, MD; Fayaz A. Shawl, MD; Mark R. Harrigan, MD; Jenifer H. Voeks, PhD; Virginia J. Howard, PhD; Brajesh K. Lal, MD; James F. Meschia, MD; Thomas G. Brott, MD

Background and Purpose: Post-hoc, we hypothesized that over the recruitment period of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), increasing experience and improved patient selection with carotid stenting, and to a lesser extent, carotid endarterectomy would contribute to lower periprocedural event rates.

16 junio 2015

STROKE. Clinical Sciences. Carotid Plaque Morphological Classification Compared With Biomechanical Cap Stress

Frank J.H. Gijsen, PhD; Harm A. Nieuwstadt, PhD; Jolanda J. Wentzel, PhD; Hence J.M. Verhagen, MD, PhD; Aad van der Lugt, MD, PhD; Antonius F.W. van der Steen, PhD

Background and Purpose: Two approaches to target plaque vulnerability—a histopathologic classification scheme and a biomechanical analysis—were compared and the implications for noninvasive risk stratification of carotid plaques using magnetic resonance imaging were assessed.

11 junio 2015

STROKE. Clinical Sciences. Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Carlina E. van Donkelaar, MSc*; Nicolaas A. Bakker, MD, PhD*; Nic J.G.M. Veeger, PhD; Maarten Uyttenboogaart, MD, PhD; Jan D.M. Metzemaekers, MD, PhD; Gert-Jan Luijckx, MD, PhD; Rob J.M. Groen, MD, PhD; J. Marc C. van Dijk, MD, PhD

Background and Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We therefore aimed to determine predictors for an early rebleeding after aSAH in relation with time after ictus.

30 junio 2015

STROKE. Brief Report. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis

Célia Machado, MD; João Pinho, MD; José Nuno Alves, MD; Ana Filipa Santos, MD; Maria do Céu Ferreira, MD; Maria João Abreu, MD; Liliana Oliveira, MD; João Mota, MD; João Ramalho Fontes, MD; Carla Ferreira, MD

Background and Purpose: Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT).