Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

Kosmas I. Paraskevas, MD Dimitri P. Mikhailidis, MD, FFPM, FRCP, FRCPath Pier Luigi Antignani, MD, PhD, FIUA Hediyeh Baradaran, MD Reinoud P.H. Bokkers, MD, PhD, EBIR Richard P. Cambria, MD, FACS Alan Dardik, MD, PhD, FACS, DFSVS, FAHA Alun H. Davies, MA, DM, FRCS Hans-Henning Eckstein, MD, PhD, FEBVS Gianluca Faggioli, MD, PhD Jose Fernandes e Fernandes, MD, PhD, FACS, FRCS Eng., FESC, FEBVS Gustav Fraedrich, MD George Geroulakos, MD, PhD, FRCS Peter Gloviczki, MD Jonathan Golledge, MB, BChir, MA, MChir, FRCS, FRACS Ajay Gupta, MD, MS Mateja K. Jezovnik, MD, PhD Stavros K. Kakkos, MD, DM, MSc, PhD, RVT Niki Katsiki, MD, MSc, PhD Michael Knoflach, MD, PhD M. Eline Kooi, PhD Gaetano Lanza, MD, PhD Christos D. Liapis, MD, FEBVS, FACS, FRCS Ian M. Loftus, BSc, MBChB, MD, FRCS Armando Mansilha, MD, PhD, FIUA, FEBVS Antoine Millon, MD, PhD Andrew N. Nicolaides, MD, PhD Rodolfo Pini, MD, PhD Pavel Poredos, MD, PhD Jean-Baptiste Ricco, MD, PhD, FEBVS Thomas S. Riles, MD, FACS Peter Arthur Ringleb, MD Tatjana Rundek, MD, PhD Luca Saba, MD Felix Schlachetzki, MD Mauro Silvestrini, MD Francesco Spinelli, MD Francesco Stilo, MD, PhD Sherif Sultan, MD, FACS, FRCS, PhD Jasjit S. Suri, PhD, MBA, FIEEE, FAIMBE, FAIUM, FSVM, FAPVS Clark J. Zeebregts, MD, PhD Seemant Chaturvedi, MD

Objectives The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement is to reconcile the conflicting views on the topic.

Stent Opening Visualization During Mechanical Thrombectomy; Relationship with the Retrieved Clot and Procedural Success

Ilah Shin, MD, PhD Byung Moon Kim, MD, PhD Dong Joon Kim, MD, PhD

Purpose: The angiographic visualization of the stent during mechanical thrombectomy (MT) may provide information regarding the characteristics of the underlying occluding clot, device-clot interaction, and recanalization. The purpose of this study was to evaluate the open stent sign in relation to the retrieved clot and recanalization.

Novel Imaging Biomarker Prediction of Parenchymal Hemorrhage after Mechanical Thrombectomy in Patients with Large Ischemic Core

Yiqi Wang, MS 1 Peng Wang, BS 1 Sheng Zhang, MD Zongjie Shi, MS Jiangyong Min, MD Yu Geng, MD

Background Recently studies have shown that select acute ischemic stroke (AIS) patients with large ischemic core could be deemed as reasonable candidates to receive mechanical thrombectomy (MT) with low risk of developing parenchymal hemorrhage (PH) or symptomatic intracerebral hemorrhage (sICH); however, the selection criterion remains lacking. Our study aims to investigate the relationship between a novel imaging biomarker of largest core mass volume (LCMV) and development of PH in stroke patients with large ischemic core who have undergone MT.

Comparison of the Safety, Efficacy, and Procedural Characteristics Associated with Proximal and Distal Radial Access for Diagnostic Cerebral Angiography

Haydn Hoffman, MD Katherine M. Bunch, MD Tatiana Mikhailova, BA John R. Cote, BA Apeksha Ashok Kumar, BA Hesham E. Masoud, MD Grahame C. Gould, MD

Objectives Radial access is an increasingly popular approach for performing cerebral angiography. There are two sites for radial artery puncture: proximal transradial access (pTRA) in the wrist and distal transradial access (dTRA) in the snuffbox. These approaches have not been directly compared.

Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

Mostafa Jafari, MD Thanh N. Nguyen, MD Santiago Ortega-Gutierrez, MD, MSc Muhammad Shazam Hussain, MD Ameer E. Hassan, DO Asad Ikram, MD Javed Khader Eliyas, MD, FRCSC Gustavo J. Rodriguez, MD Afshin A. Divani, PhD, FAHA

Objectives/Background Medical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect.

White Matter Acute Infarct Volume After Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke is Associated with Long Term Outcomes

Robert W. Regenhardt, MD,PhD Mark R. Etherton, MD,PhD Alvin S. Das, MD Markus D. Schirmer, PhD Joshua A. Hirsch, MD Christopher J. Stapleton, MD Aman B. Patel, MD Thabele M. Leslie-Mazwi, MD Natalia S. Rost, MD,MPH

Objectives Despite the proven efficacy of endovascular thrombectomy (EVT) for large vessel occlusion stroke, over half treated remain functionally disabled or die. Infarct topography may have implications for prognostication, patient selection, and the development of tissue-specific neuroprotective agents. We sought to quantify white matter injury in anterior circulation acute infarcts post-EVT to understand its significance and identify its determinants.

Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors

Isabel Siow Keng Siang Lee John J.Y. Zhang Seyed Ehsan Saffari Adeline Ng Barnaby Young

Introduction COVID-19 is a multi-system infection which predominantly affects the respiratory system, but also causes systemic inflammation, endothelialitis and thrombosis. The consequences of this include renal dysfunction, hepatitis and stroke. In this systematic review, we aimed to evaluate the epidemiology, clinical course, and outcomes of patients who suffer from stroke as a complication of COVID-19.

Transcranial Doppler Ultrasound Evidence of Active Cerebral Embolization in COVID-19

Ayush Batra, MD # Jeffrey R. Clark, BA # Katie LaHaye, BS Nathan A. Shlobin, BA Steven C. Hoffman, BS Zachary S. Orban, BS Katharine Colton, MD Jane E. Dematte, MD Farzaneh A. Sorond, MD, PhD Igor J. Koralnik, MD Eric M. Liotta, MD, MS

Objective To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke.

Functional Outcome After Mechanical Thrombectomy with or without Previous Thrombolysis

Manuel Machado, MD Marta Alves, MSc Alberto Fior, MD Isabel Fragata, MD, PhD Ana Luísa Papoila, PhD João Reis, MD Ana Paiva Nunes, MD Show less

Introduction Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned.

Endovascular Therapy of Acute Ischemic Stroke in Patients with Large-Vessel Occlusion Associated with Active Malignancy

Tomohiko Ozaki Patrick Nicholson 1 Joanna D. Schaafsma 2 Ronit Agid 3 Timo Krings 4 Aleksandra Pikula 5 Vitor Mendes Pereira Show less Show footnotes

Purpose There is limited data on the effectiveness of endovascular therapy (EVT) in stroke patients with active malignancy. In this study, we investigated the outcome of EVT for acute ischemic stroke for patients with active malignancy compared to those without malignancy.

Treatment Approaches and Outcomes for Acute Anterior Circulation Stroke Patients with Tandem Lesions

Neal M. Nolan, MD 1 Robert W. Regenhardt, MD, PhD 1 Matthew J. Koch, MD Scott B. Raymond, MD Christopher J. Stapleton, MD James D. Rabinov, MD Scott B. Silverman, MD Thabele M. Leslie-Mazwi, MD Aman B. Patel, MD

Objectives Endovascular thrombectomy (EVT) has revolutionized stroke care for large vessel occlusions (LVOs). However, over half treated remain functionally disabled or die. Patients with tandem lesions, or severe stenosis/occlusion of the cervical internal carotid artery (ICA) with intracranial LVO, may have technical EVT challenges and worse outcomes. We sought to compare treatments and outcomes for patients with anterior circulation tandem lesions versus isolated LVOs.

Conventional Angiography in the Assessment of Recently Symptomatic Patients with Ipsilateral Carotid Stenosis

Daniel A. Tonetti, MD Shashvat M. Desai, MD Gautam Nayar, MD Brian T. Jankowitz, MD Ashutosh P. Jadhav, MD PhD Tudor G. Jovin, MD Show all authors

Background and Purpose Benefits of revascularization for moderate and severe (≥50%) carotid stenosis were established based on digital subtraction angiography (DSA). We aimed to assess the discrepancy between invasive and non-invasive angiography in a consecutive, prospective cohort of patients with recent stroke and non-invasive imaging suggesting ≥50% ipsilateral carotid stenosis.

Intravenous Thrombolysis before Thrombectomy may Increase the Incidence of Intracranial Hemorrhage inTreating Carotid T Occlusion

Mingyang Du, MD 1 Shun Li, MD 1 Xianjun Huang, MD Shuai Zhang, MD Yongjie Bai, MD Bin Yan, MD Hongquan Guo, MD Gelin Xu, MD, PhD Xinfeng Liu, MD, PhD

Background and Purpose Current evidence does not agree on the merits of direct and bridging thrombectomy. This study aimed to compare the safety and efficacy of direct thrombectomy (DT) and bridging thrombectomy (BT) in treating patients with acute ischaemic stroke due to carotid T occlusion.

National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly

Amol Mehta, MD 1 Johanna T Fifi, MD 2 Hazem Shoirah, MD 2 I.Paul Singh, MD, MPH 2 Tomoyoshi Shigematsu, MD, PhD 2 Christopher P Kellner, MD, PhD 2 Reade De Leacy, MD 2 J Mocco, MD 2 Shahram Majidi, MD Show less Show footnotes

Objective Octogenarians were excluded and/or underrepresented in the major endovascular thrombectomy (EVT) randomized controlled trials, but continue to make up a growing proportion of stroke patients. To evaluate real-world trends in utilization and outcome of EVT in patients ≥80 years in a large nationally representative database.

Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes

Sanjana Salwi, BA Katherine A. Kelly, BA Pious D. Patel, BA Eva A. Mistry, MBBS Akshitkumar M. Mistry, MD Rohan V. Chitale, MD

Background/Purpose Our study aimed to assess the impacts of neighborhood socioeconomic status on mechanical thrombectomy (MT) outcomes for acute ischemic stroke (AIS).