Mechanical recanalization in acute stroke : Torture or choice.

[Mechanical recanalization in acute stroke : Torture or choice.] Radiologe. 2013 Feb 24; Authors: Berlis A Abstract CLINICAL/METHODICAL ISSUE: Stroke is the third most common cause of death in the developed world and the leading cause of disability worldwide. The present demographic development will lead to increased numbers of stroke patients in the future. STANDARD RADIOLOGICAL METHODS: Patient selection takes place by using various computer tomographic (CT) or magnetic resonance (MR) imaging modalities. For endovascular stroke treatment a modern biplane angiography suite is recommended. METHODICAL INNOVATIONS: Intra-arterial chemical thrombolysis was shown to be effective in achieving recanalization and improving clinical outcome. Mechanical devices were introduced in the late 1990s and the highly effective stent retriever was recently included. PERFORMANCE: Mechanical devices allows a recanalization rate of up to 90 % of affected brain vessels. ACHIEVEMENTS: The advantage of a stent retriever compared to other mechanical devices seems to be an improvement in good clinical outcome. PRACTICAL RECOMMENDATIONS: Currently, the stent retriever seems to be the definitive first choice in the use of mechanical devices for intra-arterial recanalization treatment in acute ischemic stroke. PMID: 23435625 [PubMed - as supplied by publisher]
Source: Der Radiologe - Category: Radiology Authors: Tags: Radiologe Source Type: research

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AbstractPurpose of ReviewUrgent reperfusion treatment with intravenous thrombolysis or mechanical thrombectomy reduces disability after ischaemic stroke. Imaging plays an important role in identifying patients who benefit, particularly in extended time windows. However, the role of post-treatment neuroimaging is less well established. We review recent advances in neuroimaging after reperfusion treatment and provide a practical guide to the options and management implications.Recent FindingsPost-treatment imaging is critical to identify patients with reperfusion-related haemorrhage and oedema requiring intervention. It also...
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research
Conclusion: This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imagi...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Geng-Hong Xia1†, Chao You1,2†, Xu-Xuan Gao1, Xiu-Li Zeng1, Jia-Jia Zhu1, Kai-Yu Xu3, Chu-Hong Tan1, Ruo-Ting Xu1, Qi-Heng Wu1, Hong-Wei Zhou3, Yan He4*‡ and Jia Yin1*‡ 1Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China 2Department of Neurology, The First People's Hospital of Zunyi, Zunyi, China 3State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China 4Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical Univ...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusions: CG-FAST scale could be an effective and simple scale for accurate identification of LVOS among AIS patients. Introduction Large vessel occlusion stroke (LVOS) often leads to severe disability and mortality. Although endovascular therapy (EVT) has been proved to be effective for LVOS patients (1–9), especially in anterior circulation, its benefit is highly time-dependent (10, 11). As hospitals with around-the-clock endovascular capability are scarce in many parts of the world and patients admitted directly to a CSC would have better outcomes than those receiving drip and ship treatment (12, 13), thi...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This article presents an overview on recent advances in optical non-invasive diagnostics of the peripheral hemodynamics of the upper and lower limbs in rheumatological and endocrinological profile patients. Among these are laser Doppler flowmetry (LDF), tissue reflectance oximetry (TRO), pulse oximetry (PO) and fluorescent spectroscopy (FS). The laser Doppler flowmetry method allows for investigating the blood flow in the microcirculatory bed in vivo. The method is based on probing the tissue with laser radiation and analyzing back reflected from the tissue radiation partially scattered from moving red blood cells (Bonner...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
AbstractPurposeBCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke.MethodsDenver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT...
Source: Emergency Radiology - Category: Emergency Medicine Source Type: research
CONCLUSIONSAcute occlusion of the ICA on the contralateral side from an STA-MCA bypass is a rare, but potentially serious, complication of revascularization surgery for MMD. It highlights the importance of the hemodynamic interrelationships that exist between the two hemispheres, a concept that has been previously underappreciated. Induced hypertension during the acute period may provide adequate cerebral blood flow via developing collateral vessels, and good outcomes may be achieved with aggressive supportive management and expedited contralateral revascularization. PMID: 30554188 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Tags: J Neurosurg Source Type: research
ConclusionsThe factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.ResumenObjetivoEstudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían infl...
Source: Medicina Intensiva - Category: Intensive Care Source Type: research
ABSTRACT Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without...
Source: Arquivos de Neuro-Psiquiatria - Category: Neurology Source Type: research
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