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Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas.
Authors: Kageji T, Obata F, Oka H, Kanematsu Y, Tabata R, Tani K, Bando H, Nagahiro S Abstract There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Pref...
Source: Neurologia Medico-Chirurgica - June 25, 2016 Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research

Wake-up stroke in a young woman with rotational vertebral artery occlusion due to far-lateral cervical disc herniation.
Abstract Wake-up stroke is most likely to be caused by small-vessel disease, and is related to snoring. The authors present a rare case of far-lateral cervical disc herniation with neck rotation, resulting in wake-up stroke in a young woman. The patient, a 31-year-old woman, was admitted to the hospital because of dysarthria and confusion when she awoke in the morning. Brain MRI showed acute infarction in the posterior fossa. Cerebral angiography showed thrombus in the distal top of the basilar artery and the bilateral posterior cerebral arteries. During angiography, the thrombus size decreased with heparinization...
Source: Journal of Neurosurgery.Spine - May 1, 2015 Category: Neurosurgery Authors: Okawa M, Amamoto T, Abe H, Yoshimura S, Higashi T, Inoue T Tags: J Neurosurg Spine Source Type: research

Thrombolytic Treatment to Stroke Mimic Patients via Telestroke
The safety of intravenous thrombolysis (IVT) use among patients presenting with conditions mimicking acute ischemic stroke (AIS) is well established [1]. Rates of patients with stroke mimics (SM) treated with IVT at community hospitals who follow a “drip-and-ship” paradigm is higher than rates found for those presenting to stroke centers [2]. The implementation of telestroke (TS) where neurologists are connected to hospitals in areas without on-site neurological expertise has been proven to be effective in the safe implementation of IVT [3 ].
Source: Clinical Neurology and Neurosurgery - December 13, 2016 Category: Neurosurgery Authors: Ganesh Asaithambi, Amy L. Castle, Michael A. Sperl, Jayashree Ravichandran, Aditi Gupta, Bridget M. Ho, Sandra K. Hanson Source Type: research

E-055 Internal carotid artery reconstruction with flow diverting stents in the treatment of acute ischemic stroke: technical considerations and medical management
ConclusionsFDS appear to be a safe and effective tool for reconstruction of a symptomatic dissection in tortuous cervical ICAs. Their flexibility allows conformation to complex anatomies and they can be traversed multiple times by aspiration catheters/stentrievers. We found excellent patency at follow up. The unique challenges posed by utilization of high-profile stents in acute stroke require appropriate technical execution and medical management.Disclosures E. Orru: None. F. Bounni: None. M. Marosfoi: None. N. Patel: None. A. Wakhloo: 1; C; Philips medical. 2; C; Stryker, Phenox. 4; C; InNeuroCo, EpiEP, Neural Analytics, ThrombX.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Orru, E., Bounni, F., Marosfoi, M., Patel, N., Wakhloo, A. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

P-012 Longer Working Length of the Solitaire Retrieval Device Improves Revascularization
ConclusionsThe Solitaire 4 x 40 device showed a statistical trend for achieving better recanalization compared to the shorter devices. However due to our small sample size of patients undergoing treatment with the 4 x 40, further investigation is warranted to determine whether this result is maintained in larger sample size such as the STRATUS registry.DisclosuresW. Holloway: None. I. Akhtar: None. J. Halpin: None. C. Martin: None. N. Akhtar: None.
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: Holloway, W., Akhtar, I., Halpin, J., Martin, C., Akhtar, N. Tags: Oral poster abstracts Source Type: research

E-237 A 911 continuation of care protocol reduces door in, door out time for transfer patients with emergent large vessel occlusion
ConclusionUtilizing the 911 COC process for EMS transport of patients eligible for MT reduced DIDO time at the sending hospital, which may contribute to improved functional outcome.Disclosures R. Shaw: None. H. Rho: None. N. Sangha: None. J. Saver: 4; C; BrainQ, Clinical Trial Steering Committee. 6; C; Abbott, Clinical Trial Steering Committee, Medtronic, Clinical Trial Steering Committee, BrainsGate, Clinical Trial Steering Committee, Boehringer-Ingelheim (Prevention Only), Clinical Trial Steering Committee, Cerenovus, Clinical Trial Steering Committee, Phagenesis, Clinical Trial Steering Committee. C. Liang: None.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Shaw, R., Rho, H., Sangha, N., Saver, J., Liang, C. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

O23 Mechanical thrombectomy using a modified ADAPT (a direct aspiration first pass technique) in a patient with m1-occlusion and concomitant mca-aneurysm
We present a case in which a patient with a right-sided MCA M1 occlusion (NIHSS 30) and concomitant mediabifurcation aneurysm was fully recanalized (TICI 3) using a modified ADAPT technique, without prior passage of the thrombus as previously described by Turc et al.2. To us, the avoidance of blind aneurysm passage by microwire and microcatheter appears to be a major advantage of the method used. Instead, the aspiration catheter was advanced via a 0.035 Terumo guide wire for proximal stabilization. Thrombus was aspirated with proximally inflated BGC and repeated imaging series up to visualization of the aneurysm neck. Thus...
Source: Journal of NeuroInterventional Surgery - August 29, 2022 Category: Neurosurgery Authors: Demerath, T., Elbaz, A., Urbach, H., Taschner, C. Tags: 14th Congress of the European Society of Minimally Invasive Neurological Therapy 2022 Meeting Abstracts Source Type: research

Transradial versus transfemoral access for endovascular therapy of intracranial aneurysms: a systematic review and meta-analysis of cohort studies
This study showed comparable safety and efficacy outcomes between transradial and transfemoral access in patients with intracranial aneurysms treated endovascularly. Future large randomised trials are warranted to confirm these findings.
Source: Neurosurgical Review - November 14, 2022 Category: Neurosurgery Source Type: research

E-135 Dejerine-roussy syndrome in the setting of right sigmoid sinus thrombosis: a unique case report
DiscussionThis case illustrates the important clinical aspects and physical findings needed to diagnose DRS. The presence of focal allodynia and hyperalgesia with recent cerebrovascular incidents provides significant evidence for DRS. The purpose of this case is to provide awareness and to increase clinical suspicion of DRS during examination, especially in the setting of cerebral venous sinus occlusion as infarction alone may not present as atypical allodynia.Disclosures S. Nittala: None. C. Jara: None. D. Raza: None. J. Cazzaniga: None. D. Filippi: None.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Nittala, S., Jara, C., Raza, D., Cazzaniga, J., Filippi, D. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Anti glutamic acid decarboxylase antibody mediated encephalopathy while on etanercept in a patient with multiple autoimmune diseases
A 39 year old lady presented with an altered mental state and unsteadiness of gait. She had a history of juvenile idiopathic arthritis, autoimmune thyroiditis and alopecia, protein S deficiency with vena cava thrombosis, previous excision of ovarian mass and vasculitic rash. There was a previous history of ovarian mass and her immunomodulatory therapy for arthritis over the previous year was Etanercept. She used recreational cannabis but denied any other illicit drug usage. Her affect was variable and at times inappropriate with frequent laughter. She would spit regularly. There was anxiety and a prevailing sensation of do...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: MacDougall, N., Waddell, B., O'Riordan, J. I. Tags: Immunology (including allergy), Brain stem / cerebellum, Drugs: CNS (not psychiatric), Epilepsy and seizures, Infection (neurology), Stroke, Drugs misuse (including addiction), Connective tissue disease, Musculoskeletal syndromes Association of British Source Type: research

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture.
Abstract Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were eval...
Source: Journal of Neurosurgery - January 9, 2015 Category: Neurosurgery Authors: Hasegawa H, Inoue T, Tamura A, Saito I Tags: J Neurosurg Source Type: research

Pre-hospital and intra-hospital temporal intervals in patients requiring emergent trauma craniotomy. A 6-year observational study in a level 1 trauma center
According to level 2 evidence, earlier evacuation of acute subdural or epidural hematomas necessitating surgery is associated with better outcome. Hence, guidelines recommend performing these procedures “immediately”. Literature on extent and causes of pre- and intra-hospital intervals in trauma patients requiring emergent craniotomies is almost completely lacking. Studies delineating and refining the interval before thrombolytic agent administration in ischemic stroke have dramatically reduced the “door-to-needle time”.
Source: World Neurosurgery - March 13, 2018 Category: Neurosurgery Authors: Philippe De Vloo, Stefaan Nijs, Sandra Verelst, Johannes van Loon, Bart Depreitere Tags: Original article Source Type: research

Long-term Follow-up Results after Flow Diverter Therapy Using the Pipeline Embolization Device for Large or Giant Unruptured Internal Carotid Artery Aneurysms: Single-center Retrospective Analysis in the Japanese Population
Neurol Med Chir (Tokyo). 2021 Oct 27. doi: 10.2176/nmc.oa.2021-0203. Online ahead of print.ABSTRACTFlow diverter (FD) therapy using Pipeline embolization device (PED) has become an important alternative to treat internal carotid artery (ICA) aneurysms. Herein, we report the long-term outcome for 3 years after FD therapy using PED for ICA aneurysms in Japan. The patients who underwent angiographical and/or clinical follow-up for 3 years after the FD therapy using PED of large or giant unruptured ICA aneurysms from December 2012 at our university hospital are the subjects of this study. We retrospectively reviewed the in- an...
Source: Neurologia Medico-Chirurgica - October 28, 2021 Category: Neurosurgery Authors: Takashi Fujii Kohsuke Teranishi Kenji Yatomi Kazumoto Suzuki Yumiko Mitome-Mishima Akihide Kondo Hidenori Oishi Source Type: research

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