Which imaging before reperfusion strategy?
Which imaging before reperfusion strategy? Rev Neurol (Paris). 2017 Oct 13;: Authors: Olivot JM Abstract The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4.5hours after the onset of acute BI diagnosed by the absence of hemorrhage on a non-contrast head CT scan has been the only approved revascularization treatment. Over the past 2years, 6 randomized trials have confirmed the benefit of a thrombectomy performed within 6-8 hours after the onset of an acute anterior BI downstream of an ICA/M1 occlusion. The recommended imaging modality for such patients remains a NCCT to exclude an hemorrhage and a CTA to confirm the proximal vessel occlusion. As a consequence, in the absence of collateral or penumbral imaging, studies and meta-analyses, have emphasized the importance of treatment delay on the outcome of patient after a revascularisation treatment (tPA/thrombectomy). These findings have supported the development of mobile stroke unit for tPA administration and the direct transfer of the pat...
Condition: Patients (>=65 Years Old) Suffering From Mild-moderate Stroke (Ischemic or Hemorrhagic, Stroke Severity Assessed by NIHSS
AbstractPurpose of ReviewThromboelastography (TEG) has been gaining attention for its potential use in a variety of disease of states to guide therapies and determine prognosis. This review will explore recent research specifically regarding the use of thromboelastography in the emergency, trauma, and critical care clinical environments.Recent FindingsThromboelastography has its drawbacks. TEG has wide operator and machine variability. Known coagulopathic states may exhibit normal viscoelastic results, indicating inconsistent results. Thromboelastography has shown to decrease transfusion of blood products in traumatic hemo...
To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke aetiology (i.e. ischemic or hemorrhagic).
ConclusionsThe number of PAVMs correlated significantly with risk of brain abscess, and a larger feeding artery significantly with more ischaemic strokes. These findings can lead to a better recognition and management of the PAVMs at risk of cerebral complications.Key Points•Chest CT helps clinicians to facilitate appropriate PAVM management strategies.•Pulmonary arteriovenous malformation CT findings are correlated with risk of cerebral complications.•Risk of brain abscess is significantly correlated with number of PAVMs.•Risk of ischaemic stroke is significantly correlated with large feeding artery PA...
Conclusion: In general, the natural history of VBDAs is poor. However, dolichoectatic and fusiform VBDAs appear to have distinct natural histories with substantially higher growth and rupture associated with fusiform aneurysms. These findings suggest that these aneurysms should be considered separate entities. Further studies on the natural history of vertebrobasilar dolichoectatic and fusiform aneurysms with more complete follow-up are needed to better understand the risk factors for progression of these aneurysms.Cerebrovasc Dis 2018;45:68 –77
Megan A. Hird, Kristin A. Vesely, Tahira Tasneem, Gustavo Saposnik, R. Loch Macdonald, Tom A. Schweizer
CONCLUSIONS: Permanent stent placement with the Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
In conclusion, in patients who have an ICH while receiving warfarin, resuming anticoagulation results in a favorable trade-off between bleeding susceptibility and thromboembolic risk. PMID: 29433151 [PubMed - as supplied by publisher]