03 abril 2014

STROKE. Clinical Sciences. Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy

Nishant K. Mishra, MBBS, PhD, FESO; Gregory W. Albers, MD; Søren Christensen, PhD; Michael Marks, MD; Scott Hamilton, PhD; Matus Straka, PhD; John T.P. Liggins, MSc; Stephanie Kemp, BS; Michael Mlynash, MD, MS; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 Investigators

Background and Purpose: The Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) study has shown that clinical response to endovascular reperfusion differs between patients with and without perfusion–diffusion (perfusion-weighted imaging–diffusion-weighted imaging, PWI–DWI) mismatch: patients with mismatch have a favorable clinical response to reperfusion, whereas patients without mismatch do not. This study examined whether alternative mismatch criteria can also differentiate patients according to their response to reperfusion.

20 marzo 2014

STROKE. Clinical Sciences. Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms

Daan Backes, MD; Mervyn D.I. Vergouwen, MD, PhD; Birgitta K. Velthuis, MD, PhD; Irene C. van der Schaaf, MD, PhD; A. Stijntje E. Bor, MD; Ale Algra, MD, PhD; Gabriel J.E. Rinkel, MD, FRCPE

Background and Purpose: Prediction of the risk of rupture of unruptured intracranial aneurysms is mainly based on aneurysm size and location. Previous studies identified features of aneurysm shape and flow angles as additional risk factors for aneurysm rupture, but these studies were at risk for confounding by patient-specific risk factors such as hypertension and age. In this study, we avoided this risk by comparing characteristics of ruptured and unruptured aneurysms in patients with both aneurysmal subarachnoid hemorrhage and multiple intracranial aneurysms.

13 marzo 2014

STROKE. Basic Sciences. Extravascular Optical Coherence Tomography. Evaluation of Carotid Atherosclerosis and Pravastatin Therapy

Robert T. Wicks, MD*; Yong Huang, PhD*; Kang Zhang, PhD; Mingtao Zhao, PhD; Betty M. Tyler, BA; Ian Suk, CMI; Lee Hwang, MD; Jacob Ruzevick, BS; George Jallo, MD; Henry Brem, MD; Gustavo Pradilla, MD; Jin U. Kang, PhD

Background and Purpose: Extravascular optical coherence tomography (OCT), as a noninvasive imaging methodology with micrometer resolution, was evaluated in a murine model of carotid atherosclerosis by way of assessing the efficacy of pravastatin therapy.

04 marzo 2014

STROKE. Clinical Sciences. Outcomes of a Contemporary Cohort of 536 Consecutive Patients With Acute Ischemic Stroke Treated With Endovascular Therapy

Sònia Abilleira, MD, PhD; Pere Cardona, MD; Marc Ribó, MD, PhD; Mònica Millán, MD, PhD; Víctor Obach, MD, PhD; Jaume Roquer, MD, PhD; David Cánovas, MD; Joan Martí-Fàbregas, MD, PhD; Francisco Rubio, MD, PhD; José Álvarez-Sabín, MD, PhD; Antoni Dávalos, MD, PhD; Ángel Chamorro, MD, PhD; Maria Angeles de Miquel, MD, PhD; Alejandro Tomasello, MD, PhD; Carlos Castaño, MD, PhD; Juan M. Macho, MD, PhD; Aida Ribera, BSc, PhD; Miquel Gallofré, MD, PhD; on behalf of the Catalan Stroke Code and Reperfusion Consortium

Background and Purpose: We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome.

25 febrero 2014

STROKE. Clinical Sciences. Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

Michael P. Marks, MD; Maarten G. Lansberg, MD; Michael Mlynash, MD; Jean-Marc Olivot, MD; Matus Straka, PhD; Stephanie Kemp, BS; Ryan McTaggart, MD; Manabu Inoue, MD; Greg Zaharchuk, MD, PhD; Roland Bammer, PhD; Gregory W. Albers, MD; for Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Investigators

Background and Purpose: Our aim was to determine the relationships between angiographic collaterals and diffusion/perfusion findings, subsequent infarct growth, and clinical outcome in patients undergoing endovascular therapy for ischemic stroke.

20 febrero 2014

STROKE. Clinical Sciences. Early Diffusion-Weighted Imaging Reversal After Endovascular Reperfusion Is Typically Transient in Patients Imaged 3 to 6 Hours After Onset

Manabu Inoue, MD, PhD; Michael Mlynash, MD, MS; Soren Christensen, PhD; Hayley M. Wheeler, BS; Matus Straka, PhD; Aaryani Tipirneni, MS; Stephanie M. Kemp, BS; Greg Zaharchuk, MD, PhD; Jean-Marc Olivot, MD, PhD; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; Gregory W. Albers, MD; for the DEFUSE 2 Investigators

Background and Purpose: The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient.

30 enero 2014

STROKE. Clinical Sciences. Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China. The Chinese Intracranial Atherosclerosis (CICAS) Study

Yongjun Wang, MD; Xingquan Zhao, MD; Liping Liu, MD; Yannie O.Y. Soo, MD; Yuehua Pu, MD; Yuesong Pan, MD; Yilong Wang, MD; Xinying Zou, MD; Thomas W.H. Leung, MD; Yefeng Cai, MD; Qingke Bai, MD; Yiping Wu, MD; Chunxue Wang, MD; Xiaoping Pan, MD; Benyan Luo, MD; Ka Sing Lawrence Wong, MD; for the CICAS Study Group

Background and Purpose: We aimed to establish the prevalence, characteristics, and outcomes of intracranial atherosclerosis (ICAS) in China by a large, prospective, multicenter study.

13 febrero 2014

STROKE. Clinical Sciences. Serial Alberta Stroke Program Early CT Score From Baseline to 24 Hours in Solitaire Flow Restoration With the Intention for Thrombectomy Study. A Novel Surrogate End Point for Revascularization in Acute Stroke

David S. Liebeskind, MD; Reza Jahan, MD; Raul G. Nogueira, MD; Tudor G. Jovin, MD; Helmi L. Lutsep, MD; Jeffrey L. Saver, MD for the SWIFT Investigators

Background and Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of acute ischemic stroke outcomes. We analyzed change on serial ASPECTS at baseline and 24-hour imaging in the Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT) study to determine prognostic value and to identify subgroups with extensive injury after intervention.

28 enero 2014

STROKE. Clinical Sciences. Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial

David S. Liebeskind, MD; Thomas A. Tomsick, MD; Lydia D. Foster, MS; Sharon D. Yeatts, PhD; Janice Carrozzella, MSN, NP, RT(R); Andrew M. Demchuk, MD; Tudor G. Jovin, MD; Pooja Khatri, MD; Ruediger von Kummer, MD; Rebecca M. Sugg, MD; Osama O. Zaidat, MD; Syed I. Hussain, MD; Mayank Goyal, MD; Bijoy K. Menon, MD; Firas Al Ali, MD; Bernard Yan, MD; Yuko Y. Palesch, PhD; Joseph P. Broderick, MD for the IMS III Investigators

Background and Purpose: Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion, and clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III trial.

25 marzo 2014

STROKE. Clinical Sciences. North American SOLITAIRE Stent-Retriever Acute Stroke Registry. Choice of Anesthesia and Outcomes

Alex Abou-Chebl, MD; Ossama O. Zaidat, MD, MS; Alicia C. Castonguay, PhD; Rishi Gupta, MD; Chung-Huan J. Sun, MD; Coleman O. Martin, MD; William E. Holloway, MD; Nils Mueller-Kronast, MD; Joey D. English, MD; Italo Linfante, MD; Guilherme Dabus, MD; Timothy W. Malisch, MD; Franklin A. Marden, MD; Hormozd Bozorgchami, MD; Andrew Xavier, MD; Ansaar T. Rai, MD; Micahel T. Froehler, MD, PhD; Aamir Badruddin, MD; Thanh N. Nguyen, MD, FRCPC; Muhammad Taqi, MD; Michael G. Abraham, MD; Vallabh Janardhan, MD; Hashem Shaltoni, MD; Roberta Novakovic, MD; Albert J. Yoo, MD; Peng R. Chen, MD; Gavin W. Britz, MD; Ritesh Kaushal, MD; Ashish Nanda, MD; Mohammad A. Issa, MD; Raul G. Nogueira, MD

Background and Purpose: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy.

03 abril 2014

STROKE. Clinical Sciences. Challenges of Decision Making Regarding Futility in a Randomized Trial. The Interventional Management of Stroke III Experience

Sharon D. Yeatts, PhD; Renee H. Martin, PhD; Christopher S. Coffey, PhD; Patrick D. Lyden, MD; Lydia D. Foster, MS; Robert F. Woolson, PhD; Joseph P. Broderick, MD; Marco R. Di Tullio, MD; Charles A. Jungreis, MD; Yuko Y. Palesch, PhD; for the IMS III Investigators

Background and Purpose: Interventional Management of Stroke (IMS) III is a randomized, parallel arm trial comparing the approach of intravenous tissue-type plasminogen activator followed by endovascular treatment with intravenous tissue-type plasminogen activator alone in patients with acute ischemic stroke presenting <3 hours of symptom onset. The trial intended to enroll 900 subjects to ensure adequate statistical power to detect an absolute 10% difference in the percentage of subjects with good outcome, defined as modified Rankin Scale score of 0 to 2 at 3 months. In April 2012, after 656 subjects were randomized, further enrollment was terminated by the National Institute of Neurological Disorders and Stroke based on the prespecified criterion for futility using conditional power <20%.

07 marzo 2014

AMERICAN JOURNAL OF NEURORADIOLOGY. Natural Course of Dissecting Vertebrobasilar Artery Aneurysms without Stroke

N. Kobayashi, Y. Murayama, I. Yuki, T. Ishibashi, M. Ebara, H. Arakawa, K. Irie, H. Takao, I. Kajiwara, K. Nishimura, K. Karagiozov and M. Urashima

Background and Purpose: The natural history and therapeutic management of dissecting vertebrobasilar aneurysms without ischemic or hemorrhagic stroke (nonstroke dissecting vertebrobasilar aneurysms) are not well-established. We conservatively followed patients with nonstroke dissecting vertebrobasilar aneurysms and evaluated the factors related to clinical and morphologic deterioration.

24 octubre 2013

AMERICAN JOURNAL OF NEURORADIOLOGY. Neurointerventions in Children: Radiation Exposure and Its Import

D.B. Orbach, C. Stamoulis, K.J. Strauss, J. Manchester, E.R. Smith, R.M. Scott and N. Lin

Background and Purpose: Neurointerventions in children have dramatically improved the clinical outlook for patients with previously intractable cerebrovascular conditions, such as vein of Galen malformations and complex arteriovenous fistulas. However, these complex and sometimes lengthy procedures are performed under fluoroscopic guidance and thus unavoidably expose vulnerable pediatric patients to the effects of ionizing radiation. Recent epidemiologic evidence from a national registry of children who underwent CT scans suggests a higher-than-expected incidence of secondary tumors. We sought to calculate the predicted risk of secondary tumors in a large cohort of pediatric neurointerventional patients.

30 enero 2014

AMERICAN JOURNAL OF NEURORADIOLOGY. The Impact of Arterial Collateralization on Outcome after Intra-Arterial Therapy for Acute Ischemic Stroke

S. Seeta Ramaiah, L. Churilov, P. Mitchell, R. Dowling and B. Yan

Background and Purpose: Although intra-arterial therapy for acute ischemic stroke is associated with superior recanalization rates, improved clinical outcomes are inconsistently observed following successful recanalization. There is emerging concern that unfavorable arterial collateralization, though unproven, predetermines poor outcome. We hypothesized that poor leptomeningeal collateralization, assessed by preprocedural CTA, is associated with poor outcome in patients with acute ischemic stroke undergoing intra-arterial therapy.

14 noviembre 2013

AMERICAN JOURNAL OF NEURORADIOLOGY. Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes

A.M. Mortimer, M.D. Bradley, P. Mews, A.J. Molyneux and S.A. Renowden

Background and Purpose: There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center.