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Every 3 seconds, someone in the United States needs blood, and it is estimated that 1 in 20 Americans will receive a transfusion at some point in their lives. This demand for blood will increase further as the population ages, as>40% of all donated blood currently is used in people>65 years old. In addition, an increasing number of individuals take oral anticoagulants (OACs) and antiplatelet agents for cardiac reasons (e.g., atrial fibrillation or valvular disease), for stroke prevention, or for management of venous thromboembolism.
Source: World Neurosurgery - March 29, 2016 Category: Neurosurgery Authors: Peter Le Roux Tags: Book Review Source Type: research

Relative CBV ratio on perfusion-weighted MRI indicates the probability of early recanalization after IV t-PA administration for acute ischemic stroke
Conclusions The results of this study suggest that the rCBV ratio on PWI might serve as a useful indicator of ER after IV t-PA administration.
Source: Journal of NeuroInterventional Surgery - February 14, 2016 Category: Neurosurgery Authors: Sohn, S.-W., Park, H.-S., Cha, J.-K., Kim, D.-H., Kang, M.-J., Choi, J.-H., Nah, H.-W., Huh, J.-T. Tags: Ischemic stroke Source Type: research

Midbrain and bilateral paramedian thalamic stroke due to artery of Percheron occlusion
Conclusion Bilateral thalamic stroke due to artery of Percheron occlusion is a rare presentation of stroke, which can be overlooked in routine CT scan. If diagnosed, it requires further evaluation for stroke risk factors, especially cardiovascular disorders associated with increased embolic risk.
Source: Polish Journal of Neurology and Neurosurgery - January 26, 2016 Category: Neurosurgery Source Type: research

Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy (CEA) for Carotid Artery Stenosis
Conclusions Our data suggest that family history of stroke, cigarette smoking and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored post-operative patient management and patient education.
Source: World Neurosurgery - December 18, 2015 Category: Neurosurgery Source Type: research

Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial Results on the Performance of Carotid Artery Stent Placement and Carotid Endarterectomy in the United States
BACKGROUND: CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) results, published in 2010, showed no difference in the rates of composite outcome (stroke, myocardial infarction, or death) between carotid artery stent placement (CAS) and carotid endarterectomy (CEA). OBJECTIVE: To identify any changes in use and outcomes of CAS and CEA subsequent to the CREST results. METHODS: We estimated the frequency of CAS and CEA procedures in the years 2009 (pre-CREST period) and 2011 (post-CREST period), using data from the National Inpatient Sample (NIS). Demographic and clinical characteristics and in-hospital o...
Source: Neurosurgery - October 22, 2015 Category: Neurosurgery Tags: Research-Human-Clinical Studies Source Type: research

Oral anticoagulant prescribing in a hyperacute stroke unit
Conclusion Currently, renal impairment is the main determinant for thromboprophylaxis choice. Local guidelines have been created with physician education underway and re-audit planned in 3 months. The authors will present the full data.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 14, 2015 Category: Neurosurgery Authors: Samani, A., Kayani, M., Asokanathan, A. Tags: Stroke Thur 21, Parallel session 5: Therapeutics Source Type: research

P-015 flow stasis after the deployment of stent-retriever predicts successful final recanalization in acute stroke patients
ConclusionLoss of IFR effect during the embedding time after deployment of stent retriever was associated with successful recanalization. It may be an angiographic sign of adequate thrombus engagement with the stent retriever. This observation may be useful in order to optimize the embedding time during which a stent retriever cuts into the occlusive thrombus particularly when a new stent retriever is introduced to the clinical practice.DisclosuresS. Tateshima: 2; C; Covidien. M. Okawa: None. D. Liebeskind: None. R. Jahan: 2; C; Covidien. N. Gonzalez: None. V. Szeder: None. N. Rao: None. L. Ali: None. D. Kim: None. J. Save...
Source: Journal of NeuroInterventional Surgery - July 26, 2015 Category: Neurosurgery Authors: Tateshima, S., Okawa, M., Liebeskind, D., Jahan, R., Gonzalez, N., Szeder, V., Rao, N., Ali, L., Kim, D., Saver, J., Duckwiler, G. Tags: SNIS 12th Annual Meeting Oral Poster Abstracts Source Type: research

P-016 role of balloon guiding catheter in mechanical thrombectomy using stentretrivers subgroup analysis of swift prime
ConclusionBGC use in the SWIFT PRIME cohort of patients treated with rTPA and mechanical thrombectomy with Solitaire demonstrated significantly lower infarct size and higher reperfusion rates at 27 h. Overall procedure times were shorter for BGC group. These findings suggest that there is likely benefit from use of BGC when treating AIS with mechanical thrombectomy; however, randomized trials are required to confirm this finding.Abstract P-016 Table 1Distribution of variables among BGC and no BGC group Characteristic No BGC BGC Total p-value Number394887Age (years)61.8 ± 13.566.8 ± 11.764.6 ± 12....
Source: Journal of NeuroInterventional Surgery - July 26, 2015 Category: Neurosurgery Authors: Pereira, V., Siddiqui, A., Jovin, T., Yavagal, D., Levy, E., Bonafe, A., Cognard, C., Jansen, O., Nogueira, R., Jahan, R., Slater, L., Coutinho, J., Saver, J., Goyal, M. Tags: SNIS 12th Annual Meeting Oral Poster Abstracts Source Type: research

E-084 proximal versus distal occlusions in the posterior circulation: acute stroke etiology in endovascular therapy
ConclusionsWhile clinically devastating, posterior circulation stroke, may have favorable outcomes if endovascular strategies are targeted to arterial occlusion etiology.DisclosuresM. Nour: None. S. Tateshima: 2; C; Reverse Medical, Stryker Neurovascular, Silkroad Medical, Blockade Medical. G. Duckwiler: 2; C; Sequent Medical, Asahi Medical. R. Jahan: 2; C; Covidien, Medina. N. Gonzalez: None. V. Szeder: None. L. Ai: None. J. Saver: 6; C; Dr. Saver is an employee of the University of California. The University of California, Regents receive funding for Dr. Saver’s services as a scientific consultant. D. Liebeskind: 2...
Source: Journal of NeuroInterventional Surgery - July 26, 2015 Category: Neurosurgery Authors: Nour, M., Tateshima, S., Duckwiler, G., Jahan, R., Gonzalez, N., Szeder, V., Ai, L., Saver, J., Liebeskind, D. Tags: SNIS 12th Annual Meeting Electronic Poster Abstracts Source Type: research

Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?
The novel direct anticoagulant rivaroxaban has been approved in 2011 for the prophylaxis of thromboembolic events in patients with atrial fibrillation. Its mechanisms of action involve direct inhibition of factor Xa and a large multicentre trial has demonstrated at least non-inferiority compared with warfarin regarding the prevention of ischemic stroke [1]. This trial has also demonstrated that the risk of major bleeding was not increased with rivaroxaban and indeed, intracranial and fatal bleeding occurred less frequently in rivaroxaban-treated patients.
Source: Clinical Neurology and Neurosurgery - May 30, 2015 Category: Neurosurgery Authors: Christopher Beynon, Anna Potzy, Oliver W. Sakowitz, Andreas W. Unterberg Source Type: research

Watching, but not waiting: vascular neurology perspective on the disparate regulatory pathways for stroke
Vascular neurologists have keenly watched the Watchman device (Atritech, Plymouth, Minnesota, USA) regulatory approval process. We are, as always, searching for additional options in the prevention and treatment of stroke to better care for our patients, and new approaches to the management of atrial fibrillation play a large part in this effort. Recently, a Food and Drug Administration (FDA) panel voted 13:1 in favor of the Watchman device for the prevention of ischemic stroke in non-valvular atrial fibrillation.1 The panelists came to this decision after reviewing data from large randomized trials that compared anticoagu...
Source: Journal of NeuroInterventional Surgery - May 14, 2015 Category: Neurosurgery Authors: Sheth, S. A., Nogueira, R. G., Noorian, A. R., Liebeskind, D. S. Tags: Editorials Source Type: research

Spontaneous Cerebellar Hemorrhage in a Patient Taking Apixaban
Conclusions Recent FDA approval of several novel oral anticoagulants for use in patients with atrial fibrillation has resulted in a significant number of patients formerly treated with warfarin being switched to these newer agents. There remains a lack of clear guidelines for the management of hemorrhagic complications. This case report describes one management strategy and highlights the paucity of current evidence to support critical clinical decisions.
Source: Interdisciplinary Neurosurgery - December 24, 2014 Category: Neurosurgery Source Type: research

Complexity of heart rate variability predicts outcome in intensive care unit admitted patients with acute stroke
Conclusions In ICU-admitted patients with acute stroke, early assessment of the complexity of HRV by MSE can help in predicting outcomes in patients without AF.
Source: Journal of Neurology, Neurosurgery and Psychiatry - December 17, 2014 Category: Neurosurgery Authors: Tang, S.-C., Jen, H.-I., Lin, Y.-H., Hung, C.-S., Jou, W.-J., Huang, P.-W., Shieh, J.-S., Ho, Y.-L., Lai, D.-M., Wu, A.-Y., Jeng, J.-S., Chen, M.-F. Tags: Stroke Cerebrovascular disease Source Type: research

Predictors and clinical relevance of hemorrhagic transformation after endovascular therapy for anterior circulation large vessel occlusion strokes: a multicenter retrospective analysis of 1122 patients
Conclusions Greater understanding about the predictors and consequences of ICH post endovascular stroke therapy is essential to improve risk assessment, patient selection/clinical outcomes, and early prognostication. Our data suggest that patients with atrial fibrillation are particularly prone to severe ICH and question the ‘benign’ nature of HI suggested by earlier studies.
Source: Journal of NeuroInterventional Surgery - December 11, 2014 Category: Neurosurgery Authors: Nogueira, R. G., Gupta, R., Jovin, T. G., Levy, E. I., Liebeskind, D. S., Zaidat, O. O., Rai, A., Hirsch, J. A., Hsu, D. P., Rymer, M. M., Tayal, A. H., Lin, R., Natarajan, S. K., Nanda, A., Tian, M., Hao, Q., Kalia, J. S., Chen, M., Abou-Chebl, A., Nguye Tags: Ischemic stroke Source Type: research

Socioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study
Conclusions Stroke healthcare inequalities in England exist for some important indicators, although overall it has improved over time. The impact of SED may be stronger in black patients than in white patients. Further efforts are required to achieve stroke care equality.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 17, 2014 Category: Neurosurgery Authors: Chen, R., McKevitt, C., Crichton, S. L., Rudd, A. G., Wolfe, C. D. A. Tags: Other rehabilitative therapies, Stroke, Physiotherapy Cerebrovascular disease Source Type: research

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