05 marzo 2014

THE LANCET NEUROLOGY. Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study

Dr A Stijntje E Bor MD a, Prof Gabriel J E Rinkel MD a, Jeroen van Norden BSc a, Marieke J H Wermer MD b

Background: Individuals with two or more first-degree relatives who have had aneurysmal subarachnoid haemorrhage (aSAH) have an increased risk of aneurysms and aSAH. We investigated the yield of long-term serial screening for intracranial aneurysms in these individuals.

13 febrero 2014

THE LANCET NEUROLOGY. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial

Lisa Manning MBChB a b *, Yoichiro Hirakawa MD c *, Hisatomi Arima PhD c, Xia Wang MMed c, Prof John Chalmers MD c d, Prof Jiguang Wang PhD e, Prof Richard Lindley MD c, Emma Heeley PhD c, Candice Delcourt MD c d, Prof Bruce Neal MD c, Prof Pablo Lavados MD f g, Prof Stephen M Davis MD h i, Prof Christophe Tzourio MD j k, Prof Yining Huang MD l, Prof Christian Stapf MD m n o, Prof Mark Woodward PhD c, Prof Peter M Rothwell FMedSci p, Prof Thompson G Robinson MD a b, Prof Craig S Anderson MD c d, for the INTERACT2 investigators†

Background: High blood pressure is a prognostic factor for acute stroke, but blood pressure variability might also independently predict outcome. We assessed the prognostic value of blood pressure variability in participants of INTERACT2, an open-label randomised controlled trial

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.

14 enero 2014

STROKE. Clinical Sciences. Patient Phenotypes Associated With Outcomes After Aneurysmal Subarachnoid Hemorrhage

George M. Ibrahim, MD; Benjamin R. Morgan, MESc; R. Loch Macdonald, MD, PhD

Background and Purpose: Predictors of outcome after aneurysmal subarachnoid hemorrhage have been determined previously through hypothesis-driven methods that often exclude putative covariates and require a priori knowledge of potential confounders. Here, we apply a data-driven approach, principal component analysis, to identify baseline patient phenotypes that may predict neurological outcomes.

14 enero 2014

STROKE. Clinical Sciences. Impaired Cerebral Autoregulation Is Associated With Vasospasm and Delayed Cerebral Ischemia in Subarachnoid Hemorrhage

Fadar Otite, MD, MSc*; Susanne Mink, MD*; Can Ozan Tan, PhD; Ajit Puri, MD; Amir A. Zamani, MD; Aujan Mehregan; Sherry Chou, MD, MSc; Susannah Orzell, BS; Sushmita Purkayastha, PhD; Rose Du, MD, PhD; Farzaneh A. Sorond, MD, PhD

Background and Purpose: Cerebral autoregulation may be impaired in the early days after subarachnoid hemorrhage (SAH). The purpose of this study was to examine the relationship between cerebral autoregulation and angiographic vasospasm (aVSP) and radiographic delayed cerebral ischemia (DCI) in patients with SAH.

28 julio 2011

STROKE. Clinical Sciences. Progression Rate and Ipsilateral Neurological Events in Asymptomatic Carotid Stenosis

Liam S. Hirt, MBBS, MRCP

Background and Purpose: Progression of asymptomatic carotid stenoses with >50% luminal narrowing is associated with an increased risk of stroke. The significance of the progression rate in these patients is unknown. The main aim of this study was to evaluate the rate of change of carotid luminal narrowing over 1 year, as a risk factor for ipsilateral ischemic events, in patients with a >50% asymptomatic carotid stenosis. Secondary aims were to establish the incidence of changes in carotid luminal narrowing and establish additional risk factors for ipsilateral neurological events.

23 enero 2014

STROKE. Clinical Sciences. Association Between Arterial Calcifications and Nonlacunar and Lacunar Ischemic Strokes

Anouk C. van Dijk, MD; Susanne Fonville, MD; Taihra Zadi, BSc; Antonius M.G. van Hattem, BSc; Ghesrouw Saiedie, BSc; Peter J. Koudstaal, MD, PhD; Aad van der Lugt, MD, PhD

Background and Purpose: Nonlacunar cerebral infarcts are presumed to be caused by thromboembolism from the heart or extracranial arteries, whereas lacunar infarcts are thought to be caused by small vessel disease. We investigated to what extent arterial calcifications differ between nonlacunar and lacunar ischemic strokes.

06 febrero 2014

STROKE. Clinical Sciences. Impact of Pretreatment Noncontrast CT Alberta Stroke Program Early CT Score on Clinical Outcome After Intra-Arterial Stroke Therapy

Albert J. Yoo, MD; Osama O. Zaidat, MD, MS; Zeshan A. Chaudhry, MD; Olvert A. Berkhemer, MD; R. Gilberto González, MD, PhD; Mayank Goyal, MD; Andrew M. Demchuk, MD; Bijoy K. Menon, MD; Elan Mualem, BA; Dawn Ueda, MD; Hope Buell, MS; Siu Po Sit, PhD; Arani Bose, MD on behalf of the Penumbra Pivotal and Penumbra Imaging Collaborative Study (PICS) Investigators

Background and Purpose: The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT.

28 enero 2014

STROKE. Clinical Sciences. Symptomatic Intracranial Hemorrhage After Stroke Thrombolysis

Daniel Strbian, MD, PhD, MSc (Stroke Med); Patrik Michel, MD; David J. Seiffge, MD; Jeffrey L. Saver, MD, FAHA; Heikki Numminen, MD, PhD; Atte Meretoja, MD, PhD, MSc (Stroke Med); Kei Murao, MD; Bruno Weder, MD; Nina Forss, MD, PhD; Anna-Kaisa Parkkila, MD, PhD; Ashraf Eskandari, RN; Charlotte Cordonnier, MD, PhD; Stephen M. Davis, MD, PhD; Stefan T. Engelter, MD, PhD; Turgut Tatlisumak, MD, PhD

Background and Purpose: Several prognostic scores have been developed to predict the risk of symptomatic intracranial hemorrhage (sICH) after ischemic stroke thrombolysis. We compared the performance of these scores in a multicenter cohort.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Carotid Angioplasty With Stenting Versus Endarterectomy. 10-Year Randomized Trial in a Community Hospital

William H. Brooks, MD∗; Michael R. Jones, MD∗; Paula Gisler, PhD∗; Rick R. McClure, MD†; Timothy C. Coleman, MD∗; Linda Breathitt, RN∗; Cheryl Spear, RN∗

Objectives: This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Carotid Endarterectomy Versus Carotid Artery Stenting. Case Closed…Now What!?

Robert D. Safian, MD

The answer to the question “What is the optimal management of patients with carotid artery disease?” remains hotly debated and contentious. In the 1990s, the elements of this debate were focused on the relative merits of carotid endarterectomy (CEA) versus medical therapy (basically, aspirin), which most physicians considered settled by 4 randomized clinical trials in patients with symptomatic (1,) and asymptomatic (3,) carotid stenosis. Taken together, these trials formed the base of evidence that supported the recommendations for CEA in symptomatic carotid stenosis >50% and in asymptomatic carotid stenosis >70%. In the last 15 years, the findings of these studies have been challenged on the basis of 2 important therapeutic innovations: one in pharmacological approaches to coronary, peripheral, and cerebrovascular atherosclerosis, and the other in the development of minimally invasive techniques for carotid revascularization relying on carotid artery stenting (CAS) and embolic protection devices (EPDs). From a clinical trials perspective alone, more than $100 million have been devoted to studies of the technique of carotid revascularization, whereas there are no large-scale clinical trials of optimal medical therapy for stroke prevention in patients with severe carotid stenosis.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Comparative Effectiveness of Commonly Used Devices for Carotid Artery Stenting. An NCDR Analysis (National Cardiovascular Data Registry)

Jay Giri, MD, MPH∗; Kevin F. Kennedy, MS†; Ido Weinberg, MD‡; Beau M. Hawkins, MD‡; Marcella Calfon Press, MD, PhD§; Douglas Drachman, MD‡; Daniel J. McCormick, DO∗; Herbert D. Aronow, MD, MPH‖; Christopher J. White, MD¶; Kenneth Rosenfield, MD‡; Robert W. Yeh, MD, MSc‡

Objectives: This study sought to characterize usage and outcomes of carotid stenting platforms.

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Contemporary Carotid Stenting. Comparative Effectiveness Research From the NCDR (National Cardiovascular Data Registry)

Paul T. Vaitkus, MD, MBA

Comparative effectiveness research (CER) is a theme that will play an increasingly important role in the discourse of medical care. The Institute of Medicine defines CER as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care” (1). Most commonly, CER is used in the context of the politically-charged environment surrounding the Affordable Care Act, in which the explicitly stated purpose of CER is to rein in the growth of healthcare costs, largely by demanding evidence that newer, more expensive modalities be demonstrated to be more clinically effective and cost-effective than less expensive modalities as a condition for reimbursement 2. Whereas these are the principal domains for policy-makers and payers, clinical providers are also concerned with a somewhat more parochial issue: Given that we confront a clinical issue with a particular approach (e.g., a procedure such as carotid artery stenting [CAS]), which of several available alternative tools is the best for conducting the procedure?

01 febrero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Carotid Artery Stenting for Recurrent Carotid Artery Restenosis After Previous Ipsilateral Carotid Artery Endarterectomy or Stenting. A Report From the National Cardiovascular Data Registry

Brian G. Hynes, MD∗; Kevin F. Kennedy, MS†; Nicholas J. Ruggiero, MD‡; Thomas J. Kiernan, MD∗; Ronan J. Margey, MD∗; Kenneth Rosenfield, MD∗; Joseph M. Garasic, MD∗

Objectives: The purpose of this study was to evaluate and compare outcomes of patients undergoing carotid artery stenting (CAS) for ipsilateral restenosis, after either previous CAS or carotid artery endarterectomy (CEA) (CAS-R group), with those of patients who had CAS performed for de novo carotid atherosclerotic stenosis (CAS-DN group).

01 marzo 2014

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Unprotected carotid artery stenting in modern practice

Jay Giri MD, MPH1,†,*, Robert W. Yeh MD, MSC2,†, Kevin F. Kennedy MS3, Beau M. Hawkins MD2, Ido Weinberg MD2, Mitchell D. Weinberg MD2, Sahil A. Parikh MD4, Joseph Garasic MD2, Michael R. Jaff DO2, Christopher J. White MD5 andKenneth Rosenfield MD2

Background and Purpose: Embolic protection devices (EPD) may provide a mechanism to reduce peri-procedural strokes. They are advocated by consensus guidelines and mandated for Medicare reimbursement. However, outcomes data remain mixed. We aimed to characterize the population of patients undergoing unprotected carotid artery stenting (CAS) and assess the utility of distal filter EPD (F-EPD) in elective CAS.