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14 septiembre 2021

Carotid Intraplaque Hemorrhage: An Underappreciated Cause of Unexplained Recurrent Stroke

Mohamad Alkhouli, David Holmes, James P. Klaas, Guiseppe Lanzino, and John C. Benson

Intraplaque hemorrhage (IPH) represents a potent atherogenic stimulus in atherosclerotic coronary lesions regardless of their severity (1,2). This may explain the finding of mild nonobstructive lesions on angiography in the context of myocardial infarction. Recently, IPH has also been increasingly recognized as a vulnerable feature of carotid artery atherosclerotic lesions, and a potential cause of stroke. A recent study showed that IPH is associated with 2-fold increased stroke risk at 5-year follow-up (3). Herein, we illustrate a case of recurrent unexplained strokes caused by a nonobstructive carotid plaque with IPH.

01 junio 2022

Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA

Anna Kopczak, Andreas Schindler, Dominik Sepp, Anna Bayer-Karpinska, Rainer Malik, Mia L. Koch, Julia Zeller, Christoph Strecker, Daniel Janowitz, Frank A. Wollenweber, Johann-Martin Hempel, Tobias Boeckh-Behrens, Clemens C. Cyran, Andreas Helck, Andreas Harloff, Ulf Ziemann, Sven Poli, Holger Poppert, Tobias Saam, and Martin Dichgans

Background Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.

25 diciembre 2021

Renal Dysfunction is the Strongest Prognostic Factor After Carotid Artery Stenting According to Real-World Data

Shigeta Miyake, MD, PhD 1 Ryosuke Suzuki, MD 1 Taisuke Akimoto, MD, PhD Yu Iida, MD Wataru Shimohigoshi, MD Yasunobu Nakai, MD, PhD Hiroshi Manaka, MD, PhD

Purpose Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data.

07 octubre 2021

Utilization and Outcomes of Acute Revascularization Treatments in Ischemic Stroke Patients with SARS-CoV-2 Infection

Adnan I. Qureshi, MD William I. Baskett, MS Wei Huang, MA Muhammad F. Ishfaq, MD S. Hasan Naqvi, MD Brandi R. French, MD Farhan Siddiq, MD Camilo R. Gomez, MD Chi-Ren Shyu, PhD

Abstract Objectives Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy).

02 enero 2021

Traumatic Distal Anterior Cerebral Artery Aneurysms – Pathomechanism and Revascularisation Strategies

Julia Velz, MD Giuseppe Esposito, MD, PhD Luca Regli, MD

Abstract Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA – radial artery – A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.

05 enero 2021

Clinical Trial of the New Stent Retriever Tron FX for both Proximal and Distal Intracranial Large Vessel Occlusions

Hirotoshi Imamura, Nobuyuki Sakai, Hiroshi Yamagami,Tetsu Satow, Yasushi Matsumoto, Keisuke Imai, Shinzo Ota, Nobutaka Horie, Rei Kondo,Yukiko Enomoto, Shinichi Yoshimura, Masaru Hirohata, Masunari Shibata, Yuji Matsumaru, Nobuyuki Ohara, Chiaki Sakai,

Abstract Background In all of randomized controlled trials of mechanical thrombectomy, the target vessels were proximal. Herein we report a clinical trial of the Tron FX stent retriever, including the smallest size of 2/15 mm for distal intracranial large vessel occlusion (LVO).

09 diciembre 2020

Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

Adam de Havenon, MD John P. Ney, MD, MPH Brian Callaghan, MD. MS Alen Delic, MS Samuel Hohmann, PhD Ernie Shippey, MS Gregory J. Esper, MD, MBA Eric Stulberg, MD, MPH David Tirschwell, MD Jennifer Frontera, MD Shadi Yaghi, MD Mohammad Anadani, MD Jennifer J. Majersik, MD, MS

Abstract Background Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes.

28 enero 2021

Bridging May Increase the Risk of Symptomatic Intracranial Hemorrhage in Thrombectomy Patients With Low Alberta Stroke Program Early Computed Tomography Score

Johannes Kaesmacher, Thomas R. Meinel, Stefania Nannoni, Marta Olivé-Gadea, Eike I. Piechowiak, Christian Maegerlein, Martina Goeldlin, Laurent Pierot, David J. Seiffge, Vitor Mendes Pereira, Mirjam R. Heldner, Lorenz Grunder, Vincent Costalat, Marcel Arnold, Tomas Dobrocky, Jan Gralla, Pasquale Mordasini and Urs Fischer

Abstract Background and Purpose: Whether intravenous thrombolysis (IVT) increases the risk for symptomatic intracranial hemorrhage (sICH) in patients treated with mechanical thrombectomy (MT) is a matter of debate. Purpose of this study was to evaluate the extent of early ischemia as a possible factor influencing the risk for sICH after IVT+MT versus direct MT.

20 enero 2021

Procedural Complications During Early Versus Late Endovascular Treatment in Acute Stroke

Errikos Maslias, Stefania Nannoni, Federico Ricciardi, Bruno Bartolini, Davide Strambo, Francesco Puccinelli, Steven David Hajdu, Ashraf Eskandari, Guillaume Saliou and Patrik Michel

Abstract Background and Purpose: Endovascular treatment (EVT) in acute ischemic stroke is effective in the late time window in selected patients. However, the frequency and clinical impact of procedural complications in the early versus late time window has received little attention.

04 febrero 2021

Integrated Stroke System Model Expands Availability of Endovascular Therapy While Maintaining Quality Outcomes

Victor Lopez-Rivera, Sergio Salazar-Marioni, Rania Abdelkhaleq, Sean I. Savitz, Alexandra L. Czap, Yazan J. Alderazi, Peng R. Chen, James C. Grotta, Spiros L. Blackburn, Wesley Jones, Gary Spiegel, Mark J. Dannenbaum, Tzu-Ching Wu, Joseph Cochran, Dong H. Kim, Arthur L. Day, Grace Farquhar, Louise D. McCullough and Sunil A. Sheth

Background and Purpose: The optimal endovascular stroke therapy (EVT) care delivery structure is unknown. Here, we present our experience in creating an integrated stroke system (ISS) to expand EVT availability throughout our region while maintaining hospital and physician quality standards.

04 febrero 2021

Acute Ischemic Stroke and COVID-19

Adnan I. Qureshi, William I. Baskett, Wei Huang, Daniel Shyu, Danny Myers, Murugesan Raju, Iryna Lobanova, M. Fareed K. Suri, S. Hasan Naqvi, Brandi R. French, Farhan Siddiq, Camilo R. Gomez and Chi-Ren Shyu

Background and Purpose: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke.

22 febrero 2021

Endovascular Treatment for Acute Ischemic Stroke in Children

Adriaan C.G.M. van Es, Maayke A.W. Hunfeld, Ido van den Wijngaard, Ulrike Kraemer, Marc Engelen, Boudewijn A.A.M. van Hasselt, Puck S.S. Fransen, Diederik W.J. Dippel, Charles B.L.M. Majoie, Aad van der Lugt, Bart J. Emmer and for the MR CLEAN Registry Investigators

Abstract Background and Purpose: Multiple trials have shown the efficacy and safety of endovascular therapy (EVT) of acute ischemic stroke in adults. Trials in children are lacking and only case reports and case series exist. However, the long-term outcome of children with acute ischemic stroke can be devastating with significant mortality and morbidity. In this study, we describe the safety and efficacy of EVT in children with anterior circulation acute ischemic stroke who were included in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands).

10 febrero 2021

Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

Precious Jolugbo and Robert A.S. Ariëns

Abstract Thrombi retrieved from patients with acute ischemic stroke are highly heterogeneous. Recent data suggest that thrombus composition may impact on mechanical thrombectomy, the number of recanalization manoeuvres, resistance to retrieval, and on thrombolytic potential. Our aim was to summarize evidence describing the impact of thrombus composition on efficacy of mechanical thrombectomy and thrombolysis in patients with acute ischemic stroke. The scoping review methodology guided by the Joanna Briggs Institute, an adaption of the Arksey and O’Malley, was followed. Comprehensive searches were conducted in MEDLINE, EMBASE, SCOPUS, and Web of Science. Articles were classified into 4 key themes: (1) composition of stroke thrombi, (2) thrombus composition and mechanical thrombectomy, (3) thrombus composition and thrombolytic therapy, and (4) novel imaging and endovascular approaches. Our search identified 698 articles published from 1987 to June 2020. Additional articles were extracted from reference lists of the selected articles. Overall, 95 topic-specific articles identified for inclusion published in 40 different journals were included. Reports showed that thrombus composition in stroke was highly heterogeneous, containing fibrin, platelets, red blood cells, VWF (von Willebrand Factor), and neutrophil extracellular traps. Thrombi could roughly be divided into fibrin- and red blood cell–rich clots. Fibrin-rich clots were associated with increased recanalization manoeuvres, longer procedure time, and less favorable clinical outcomes compared with red blood cell–rich clots. Advances in detection or treatment of thrombi that take into account clot heterogeneity may be able to improve future endovascular and thrombolytic treatment of stroke.

25 enero 2021

Female Stroke, Sex Differences in Acute Treatment and Early Outcomes of Acute Ischemic Stroke

Anna K. Bonkhoff, André Karch, Ralph Weber, Jürgen Wellmann and Klaus Berger

Abstract Background and Purpose: Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry.

25 enero 2021

Absence of Consistent Sex Differences in Outcomes From Symptomatic Carotid Endarterectomy and Stenting Randomized Trials

Virginia J. Howard, Ale Algra, George Howard, Leo H. Bonati, Gert J. de Borst, Richard Bulbulia, David Calvet, Hans-Henning Eckstein, Gustav Fraedrich, Jacoba P. Greving, Alison Halliday, Jeroen Hendrikse, Olav Jansen, Martin M. Brown, Jean-Louis Mas, Peter A. Ringleb, Thomas G. Brott and on behalf of the Carotid Stenosis Trialists’ Collaboration

Background and Purpose: CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) reported a higher periprocedural risk for any stroke, death, or myocardial infarction for women randomized to carotid artery stenting (CAS) compared with women randomized to carotid endarterectomy (CEA). No difference in risk by treatment was detected for women relative to men in the 4-year primary outcome. We aimed to conduct a pooled analysis among symptomatic patients in large randomized trials to provide more precise estimates of sex differences in the CAS-to-CEA risk for any stroke or death during the 120-day periprocedural period and ipsilateral stroke thereafter.

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