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Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion
Neurol Med Chir (Tokyo). 2023 Jan 5. doi: 10.2176/jns-nmc.2022-0183. Online ahead of print.ABSTRACTMechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes o...
Source: Neurologia Medico-Chirurgica - January 4, 2023 Category: Neurosurgery Authors: Minoru Ideguchi Kyongsong Kim Masanori Suzuki Junya Kaneko Shin Sato Kazutaka Shirokane Akio Morita Source Type: research

Mechanical Thrombectomy for M1 Subocclusive Thrombus With Lateral Lenticulostriate Artery Occlusion: A Case Report and Literature Review
This article describes a treatment strategy for M1 subocclusive thrombus, focusing on the indications for mechanical thrombectomy. A 58-year-old male on admission for pneumonia had a sudden onset of dysarthria and motor deficits. He has a history of dilated cardiomyopathy and underwent left ventricular assist device implantation 3 years ago. At onset, his National Institutes of Health Stroke Scale (NIHSS) score was nine. Computed tomography angiography demonstrated a filling defect in the distal right M1 segment of the middle cerebral artery. Angiography confirmed the presence of a subocclusive thrombus within the distal r...
Source: Frontiers in Neurology - February 7, 2022 Category: Neurology Source Type: research

Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke
by Hung-Ming Wu, I-Hui Lee, Chao-Bao Luo, Chih-Ping Chung, Yung-Yang Lin BackgroundClinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. MethodsBrain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 pa...
Source: PLoS One - April 30, 2021 Category: Biomedical Science Authors: Hung-Ming Wu Source Type: research

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator
AbstractEarly neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6  mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those du...
Source: Journal of Thrombosis and Thrombolysis - December 16, 2019 Category: Hematology Source Type: research

Modified diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score including deep white matter lesions predicts symptomatic intracerebral hemorrhage following intravenous thrombolysis
AbstractThe Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used for the assessment of early ischemic changes (EICs) before thrombolysis. However, for symptomatic intracerebral hemorrhage (sICH) following intravenous recombinant tissue plasminogen activator (rt-PA), the prediction abilities of CT-ASPECTS, diffusion-weighted imaging (DWI)-ASPECTS, and DWI-ASPECTS including EICs in deep white matter (DWI-ASPECTS  + W) are unclear. We investigated associations between each score and sICH following intravenous rt-PA. Data from consecutive patients who received intravenous rt-PA for acute ischemic...
Source: Journal of Thrombosis and Thrombolysis - November 18, 2019 Category: Hematology Source Type: research

Risk factors for decompressive craniectomy after endovascular treatment in acute ischemic stroke
This study aimed to evaluate the risk factors for subsequent DC after EVT. This retrospective cohort study comprised 138 patients who received EVT between April 2015 and June 2019 at our center. The need for subsequent DC was defined as cerebral edema or/and hemorrhagic transformation caused by large ischemic infarction, with a ≥ 5-mm midline shift and clinical deterioration after EVT. The relationship between risk factors and DC after EVT was assessed via univariate and multivariable logistic regression. Thirty (21.7%) patients required DC. These patients tended to have atrial fibrillation (P = 0.037), sedation (P...
Source: Neurosurgical Review - September 3, 2019 Category: Neurosurgery Source Type: research

Acute Ischemic Stroke in a Child Successfully Treated with Thrombolytic Therapy and Mechanical Thrombectomy
We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was perfo...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Effective ADAPT Thrombectomy in a Patient with Acute Stroke due to Cardiac Papillary Elastofibroma: Histological Thrombus Confirmation
A 75-year-old man with hypertension and atrial fibrillation was admitted to our emergency room with right-sided hemiplegia and complete aphasia (National Institutes of Health Stroke Scale [NIHSS] score  = 18). A noncontrast computed tomography scan showed a slight hypodensity in the left insular region and a bright hyperdense sign in the M1 tract of the left middle cerebral artery (MCA). Angio-CT confirmed an occlusion of the M1 tract of the MCA. Magnetic resonance diffusion-weighted imaging/p erfusion-weighted imaging was obtained and revealed a mismatch in the left parietal cortical region.
Source: Journal of Stroke and Cerebrovascular Diseases - August 14, 2016 Category: Neurology Authors: Francesco Biraschi, Francesco Diana, Francesco Alesini, Giulio Guidetti, Simone Peschillo Tags: Case Studies Source Type: research

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