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AJNR Am J Neuroradiol 2019 Feb 14. Epub 2019 Feb 14.

From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.).

Background And Purpose: There are very few published data on the patency of carotid stents implanted during thrombectomies for tandem lesions in the anterior circulation. We aimed to communicate our experience of stenting in the acute setting with systematic follow-up of stent patency and discuss predictors and clinical repercussions of delayed stent thrombosis.

Materials And Methods: We performed a retrospective study of stroke thrombectomies in a single center between January 2009 and April 2018. Read More

J Int Med Res 2019 Feb 14:300060519828930. Epub 2019 Feb 14.

1 Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Large artery atherosclerosis and cardioembolism are the two major subtypes of ischemic stroke. We herein describe a 75-year-old man with acute complete cerebral infarction in the typical territories of the bilateral anterior cerebral artery (ACA) and left middle cerebral artery. Brain magnetic resonance angiography showed that the right A1 segment of the ACA was affected by severe arteriosclerosis and that the right ACA other than the A1 segment was compensated by the left ACA through the anterior communicating artery. Read More

World Neurosurg 2019 Feb 8. Epub 2019 Feb 8.

Neuroradiology Unit, University of Padua School of Medicine, Padua, Italy.

Background: Intracranial hemorrhage (ICH) is the most feared complication of endovascular treatment (EVT) for acute ischemic stroke due to anterior circulation large vessel occlusion (LVO). The purpose of this study was to identify cerebral hemodynamic predictors of ICH and poor outcome in patients with successful recanalization.

Materials And Methods: Serial transcranial color-coded sonography (TCCS) examinations assessed vessel status and cerebral hemodynamics of 226 [mean-age 69. Read More

Int J Stroke 2019 Feb 11:1747493019830585. Epub 2019 Feb 11.

1 Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Hong Kong.

Background: Ischemic stroke due to large vessel occlusion can be effectively treated with thrombectomy but access to this treatment is limited in many parts of the world. Local incidence of large vessel occlusion is critical in determining the development of thrombectomy service, but reliable data from Asian countries are lacking.

Aims: We performed a population-based study to estimate the burden of large vessel occlusion and the service gap for thrombectomy in Hong Kong. Read More

J Neurol 2019 Feb 9. Epub 2019 Feb 9.

Department of Neurology, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Background And Aims: Previously, microvascular cerebral blood flow (CBF) response to a mild head-of-bed (HOB) elevation has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). We have hypothesized that early CBF response is related to the functional outcome.

Methods: Patients with a non-lacunar AIS in the anterior circulation were monitored by DCS to measure relative CBF (ΔrCBF) on the frontal lobes bilaterally during a 0°-30° HOB elevation at early (≤ 12) or late (> 12) hours from symptom onset. Read More

J Neurosurg 2019 Feb 8:1-6. Epub 2019 Feb 8.

2Department of Clinical Medicine, Macquarie University; and.

OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. Read More

JAMA Neurol 2019 Feb 7. Epub 2019 Feb 7.

Departments of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California.

Importance: Although thrombectomy benefit was maintained in transfer patients with ischemic stroke in early-window trials, overall functional independence rates were lower in thrombectomy and medical management-only groups.

Objective: To evaluate whether the imaging-based selection criteria used in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) trial would lead to comparable outcome rates and treatment benefits in transfer vs direct-admission patients.

Design, Setting, And Participants: Subgroup analysis of DEFUSE 3, a prospective, randomized, multicenter, blinded-end point trial. Read More

Stroke 2019 Feb 6:STROKEAHA118023407. Epub 2019 Feb 6.

Department of Radiology, Stanford University, CA (M.P.M., J.J.H.).

Background and Purpose- The effect of leptomeningeal collaterals for acute ischemic stroke patients with large vessel occlusion in the late window (>6 hours from last known normal) remains unknown. We sought to determine if collateral status on baseline computed tomography angiography impacted neurological outcome, ischemic core growth, and moderated the effect of endovascular thrombectomy in the late window. Methods- This is a prespecified analysis of DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke). Read More

J Vasc Interv Radiol 2019 Feb;30(2):134-140

Department of Neurosurgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu 4-9-1 292-8535, Japan.

Purpose: To determine whether thrombolysis with a lower dose of intravenous recombinant tissue plasminogen activator before mechanical thrombectomy is beneficial for functional outcomes compared with mechanical thrombectomy alone.

Materials And Methods: Data for 100 Japanese patients who underwent mechanical thrombectomy between July 2014 and November 2017 were retrospectively reviewed. These patients were divided into groups according to whether they received intravenous thrombolysis before mechanical thrombectomy, and outcomes were compared. Read More

J Neurosurg Pediatr 2019 Feb 1:1-5. Epub 2019 Feb 1.

Departments of1Neurosurgery and.

OBJECTIVEPHACE syndrome (PHACES) has been linked to cervical and cerebral vascular anomalies, including persistent embryonic anastomoses and progressive steno-occlusive disease. However, no prior studies have documented the long-term response of PHACES patients with moyamoya disease to surgical revascularization with pial or myosynangiosis. The authors present their experience with 8 consecutive patients with PHACES and moyamoya disease. Read More

Neurosurg Focus 2019 Feb;46(2):E16

1National Skull Base Foundation, Thousand Oaks.

OBJECTIVESeveral retrospective studies have supported the use of conscious sedation (CS) over general anesthesia (GA) as the preferred methods of sedation for stroke thrombectomy, but a recent randomized controlled trial showed no difference in outcomes after CS or GA. The purpose of the Ideal Sedation for Stroke Thrombectomy (ISST) study was to evaluate the difference in time and outcomes in the reperfusion of anterior circulation in ischemic stroke using GA and monitored anesthesia care (MAC).METHODSThe ISST study was a prospective, open-label registry. Read More

World Neurosurg 2019 Feb 1. Epub 2019 Feb 1.

Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002, China. Electronic address:

Objective: To explore the differences among grades of recanalization on outcomes of endovascular treatment for acute anterior large vessel occlusion with small infarct core beyond 6 hours time window.

Methods: Patients beyond 6 hours time window with ASPECTS>7 were retrospectively enrolled from the endovascular treatment for acute anterior circulation ischemic stroke (ACTUAL) registry. They were divided into three groups according to the degree of recanalization: modified treatment in cerebral infarction (mTICI) 0-2a, 2b, and 3. Read More

Eur J Neurol 2019 Feb 3. Epub 2019 Feb 3.

Department of Neurology, University of Lübeck, Lübeck, Germany.

Dysphagia is a common neurological, often underdiagnosed symptom of an acute stroke, particularly, in patients suffering from a stroke in the posterior circulation, particularly brainstem infarction or a malign anterior circulation stroke, with altered consciousness. Up to 80% of acute stroke patients showed a dysfunction in swallowing, whereas the determined rate of dysphasia is depending on the stroke's severity, the type and timing of the dysphasia screening techniques. A quarter of the dysphasia patients developed a chronic swallowing dysfunction which severely affects the quality of life in addition to the malnutrition and dehydration risk . Read More

Front Neurol 2018 18;9:1198. Epub 2019 Jan 18.

Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.

Association between net vertebral artery flow volume (NVAFV) and stroke types remains unclear. We hypothesize NVAFV is low in patients with posterior circulation infarction (PCI) and an ideal cut-off value for discriminating PCI from anterior circulation infarction (ACI) and controls may be present. As study candidates, we retrospectively enrolled hospitalized patients with first-time non-AF stroke within 2-years period. Read More

J Neurointerv Surg 2019 Feb 2. Epub 2019 Feb 2.

Departments of Endovascular Neurosurgery and Stroke, St Vincent Mercy Medical Center, Toledo, Ohio, USA.

Introduction: The Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter.

Methods: The TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. Read More

Clin Neuroradiol 2019 Feb 1. Epub 2019 Feb 1.

Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Purpose: Leptomeningeal collaterals play a pivotal role in acute ischemic stroke. While most collateral scores rely on subjective visual analysis, an objective quantification is possible using dynamic computed tomography (CT) angiography (dynCTA). The aim was to determine the value of collateral filling delay (CFD) as assessed by dynCTA for predicting subacute stroke complications. Read More

Aging Dis 2019 Feb 1;10(1):62-70. Epub 2019 Feb 1.

20Department of Ultrasonography, Brain Hospital of Hunan Province, China.

The aim of this multicenter study was to demonstrate the distribution pattern of atherosclerotic stenosis and its trend with aging between extracranial and intracranial arteries and its distribution between the anterior and posterior circulations in Chinese patients hospitalized with ischemic stroke. In addition, the risk factors for the distribution pattern were illustrated. From June 2015 to May 2016, 9,346 patients with ischemic stroke from 20 hospitals were enrolled. Read More

Brain Circ 2018 Oct-Dec;4(4):153-159. Epub 2018 Dec 31.

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

The treatment of acute ischemic stroke patients with a proximal large vessel occlusion (LVO) in the anterior circulation has seen tremendous advances initially with the demonstration of the substantial benefit of thrombectomy within 6-h of stroke onset and then with the demonstration of thrombectomy in carefully selected patients up to 24-h from onset. In both the early and late time windows, imaging played an important role in patient selection, especially in the later time window trials where very strict imaging inclusion criteria were employed to identify patients with a small/moderate sized ischemic core on computed tomography perfusion scanning and diffusion-weighted magnetic resonance imaging. In clinical practice, it is important to identify LVO patients quickly so several scoring scales have been developed to help route appropriate patients to a thrombectomy capable center. Read More

J Neurointerv Surg 2019 Jan 22. Epub 2019 Jan 22.

Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.

Background: A transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory. Read More

JAMA Neurol 2019 Jan 22. Epub 2019 Jan 22.

University of Lorraine, and University Hospital of Nancy, Nancy, France.

Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results.

Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. Read More

Rofo 2019 Jan 21. Epub 2019 Jan 21.

Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.

Purpose:  The collateral status can be defined not only by its morphological extent but also by the velocity of collateral filling characterized by the relative filling time delay (rFTD). The aim of our study was to compare different methods of noninvasive visualization of rFTD derived from 4D-CT angiography (4D-CTA) with digital substraction angiography (DSA) and to investigate the correlation between functional and morphological collateral status on timing-invariant CTA.

Materials And Methods:  50 consecutive patients with acute occlusion in the M1 segment who underwent DSA for subsequent mechanical recanalization after multimodal CT were retrospectively analyzed. Read More

World Neurosurg 2019 Jan 19. Epub 2019 Jan 19.

Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China. Electronic address:

Background: In this study, we present our experiences on the feasibility of rescue permanent Solitaire stent placement for failed mechanical thrombectomy (MT) and our protocol to avoid ineffective stent placement.

Methods: We retrospectively evaluated the data for consecutive patients admitted into the Second Affiliated Hospital of Wenzhou Medical University and 2 collaboration hospitals from August 2014 to May 2018 for emergency large artery occlusion. The baseline clinical characteristics and radiologic assessment, interventional data, clinical outcome, and angiographic follow-up data were assessed. Read More

J Atheroscler Thromb 2019 Jan 19. Epub 2019 Jan 19.

Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University.

Aim: Carotid-cerebral pulse wave velocity (ccPWV) reflects the segment (C-M segment) stiffness between the common carotid artery and ipsilateral middle cerebral artery. C-M segment atherosclerosis (CMSA) is regarded the most frequent cause of anterior circulation ischemic stroke. We aimed to evaluate the association of ccPWV with early stage CMSA in this study. Read More

J Stroke Cerebrovasc Dis 2019 Jan 16. Epub 2019 Jan 16.

Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China. Electronic address:

Objective: Our objective was to review 15 consecutive patients with anterior circulation aneurysms managed through a contralateral approach. Individualized surgical simulation using three-dimensional (3D) imaging was adopted to enable safe performance of clipping surgery.

Methods: Five patients had multiple intracranial aneurysms, and 10 patients had a single aneurysm on the contralateral side of the craniotomy. Read More

Neurol Sci 2019 Jan 19. Epub 2019 Jan 19.

Stroke Unit - Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.

Objectives: To produce a scoring system for predicting the development of edema in ischemic stroke patients without edema on admission.

Methods: This retrospective study included 572 ischemic stroke patients (73.3 ± 13. Read More

J Stroke Cerebrovasc Dis 2019 Jan 14. Epub 2019 Jan 14.

Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.

Fatalities following intravenous recombinant tissue-type plasminogen activator therapy have been reported. Major fatal complications following intravenous recombinant tissue-type plasminogen activator therapy include intracranial hemorrhage, aortic dissection, and extracranial bleeding. However, the possibility that intravenous recombinant tissue-type plasminogen activator therapy itself paradoxically induces synchronized multiple cerebral novel infarctions has never been considered. Read More

J Stroke Cerebrovasc Dis 2019 Jan 14. Epub 2019 Jan 14.

International Clinical Research Centre, Stroke Research Program, St. Anne´s University Hospital, Brno, Czech Republic; Departments of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Background: In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and comparison with CTP trials. Read More

BMC Neurol 2019 Jan 15;19(1):11. Epub 2019 Jan 15.

Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

Background: Futile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT.

Methods: Using a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b-3). Read More

PLoS One 2019 15;14(1):e0210709. Epub 2019 Jan 15.

Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.

This study aimed to elucidate spatial characteristics for magnetic resonance imaging (MRI) of cardiogenic cerebral embolism, to determine imaging biomarkers predicting patient outcome and cerebral herniation in cardioembolic stroke. This retrospective study assessed 90 patients with cardiogenic cerebral embolism. All images from MRI were normalized using a voxel-based symptom lesion mapping technique. Read More

J Neurosurg 2019 Jan 11:1-8. Epub 2019 Jan 11.

Departments of1Neurosurgery and.

OBJECTIVEWith the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes. Read More

J Neurosurg 2019 Jan 11:1-9. Epub 2019 Jan 11.

1Department of Neurologic Surgery.

OBJECTIVEThe role of CT perfusion (CTP) in the management of patients with acute ischemic stroke (AIS) remains a matter of debate. The primary aim of this study was to evaluate the correlation between the areas of infarction and penumbra on CTP scans and functional outcome in patients with AIS.METHODSThis was a retrospective review of 100 consecutively treated patients with acute anterior circulation ischemic stroke who underwent CT angiography (CTA) and CTP at admission between February 2011 and October 2014. Read More

Stroke Vasc Neurol 2018 Dec 3;3(4):215-221. Epub 2018 Sep 3.

Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.

Background And Purpose: Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the predictive value of various models based on National Institutes of Health Stroke Scale (NIHSS) subitems, ranging from simple to more complex models, for predicting large artery occlusion (LAO) in anterior circulation stroke. Read More

Indian J Anaesth 2018 Dec;62(12):951-957

Department of Anaesthesiology and Neurological Surgery, Washington University, St. Louis, MO, USA.

Background And Aims: Though, many practitioners prefer conscious sedation (CS), it is unclear which factors most influence neurological outcome following mechanical thrombectomy under CS. The aim of this retrospective study is to identify these factors.

Methods: After institutional review board approval, data were collected for the patients >18 years of age who underwent endovascular treatment of AIS under CS at our comprehensive stroke centre between January 2009 and June 2015. Read More

Neuropediatrics 2019 Jan 10. Epub 2019 Jan 10.

Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Background:  Brain aneurysms are rare in the pediatric population. The diagnosis of a brain aneurysm in a child may be difficult because of its infrequency and often subtle or nonspecific clinical presentation. Endovascular therapy and microsurgical treatment are increasingly used approaches in treating children, possibly contributing to favorable outcomes if patients are treated in a timely manner. Read More

J Cereb Blood Flow Metab 2019 Jan 10:271678X18823601. Epub 2019 Jan 10.

3 Department of Clinical Radiology, University Hospital Münster, Münster, Germany.

Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. Read More

Case Rep Neurol 2018 Sep-Dec;10(3):342-345. Epub 2018 Dec 4.

REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.

The azygos anterior cerebral artery (AACA) is a large single anterior cerebral artery that supplies both medial territories of the anterior cerebral hemispheres. Occlusion of the AACA can result, therefore, in bifrontal infarction. We report a patient who suffered from a tetraparesis following a bilateral anterior cerebral artery territory infarction due to an occluded AACA and provide a brief review of the literature. Read More

Front Neurol 2018 13;9:1046. Epub 2018 Dec 13.

University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland.

Endovascular treatment of tandem occlusions is an emerging option. We describe our multicenter experience with endovascular management of atherosclerotic tandem occlusions in the anterior circulation, particularly the technical aspects and complications in comparison to isolated intracranial occlusions. Consecutive patients with tandem occlusions due to atherosclerotic causes who underwent mechanical thrombectomy at two major stroke centers between January 2010 and September 2015 were reviewed. Read More

J Vasc Interv Radiol 2019 Feb 2;30(2):141-147.e1. Epub 2019 Jan 2.

Department of Neurology, Jinling Clinical College of Nanjing Medical University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China. Electronic address:

Purpose: To assess the safety of low-dose intra-arterial (IA) tirofiban bolus after unsuccessful mechanical thrombectomy in patients with ischemic stroke due to large artery occlusion in anterior cerebral circulation.

Materials And Methods: Patients with ischemic stroke who were treated with mechanical thrombectomy were enrolled in a multicenter registry. Low-dose tirofiban was injected into the residual arterial thrombus in patients after unsuccessful mechanical thrombectomy. Read More

Med Sci Monit 2019 Jan 2;25:52-60. Epub 2019 Jan 2.

Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland).

BACKGROUND Effective early management of cerebral infarction patients with transient ischemic attack (TIA) is undermined by an inability to predict who is at highest risk of stroke. MATERIAL AND METHODS A total of 577 TIA patients with symptoms lasting no more than 1 hour were prospectively investigated and divided into a TIA group and a transient symptoms associated with infarction (TSI) group based on diffusion-weighted magnetic resonance imaging findings after hospital admission. The baseline characteristics, symptoms of TIA, features of disease onset, and findings from clinical examinations were compared between the 2 groups. Read More

J Neuroimaging 2019 Jan 2. Epub 2019 Jan 2.

Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, München, Germany.

Background And Purpose: Mechanical thrombectomy has been shown to be effective for acute stroke treatment, but lesions of cerebral vessels can develop thereafter. Such lesions of recanalized vessels and altered cerebral hemodynamics after mechanical thrombectomy are poorly investigated. In particular for neurosonography, data are sparse. Read More

J Stroke Cerebrovasc Dis 2018 Dec 29. Epub 2018 Dec 29.

Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.

Background: The results of recent trials of mechanical thrombectomy for acute ischemic stroke have increased the demand for identification of patients with large vessel occlusion (LVO) at the primary stroke center, where a prompt detection may expedite transfer to a comprehensive stroke center for endovascular treatment. However, in developing countries, a noncontrast computed tomography (NCCT) may be the only neuroimaging modality available at the primary stroke center scenario, what calls for a screening strategy accurate enough to avoid unnecessary transfers of noneligible patients for endovascular therapy. Algorithms based on National Institute of Health Stroke Scale (NIHSS) and NCCT findings can be used to screen for LVO in patients with anterior circulation stroke (ACS). Read More

J Stroke Cerebrovasc Dis 2019 Mar 28;28(3):531-541. Epub 2018 Dec 28.

Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China. Electronic address:

Background: Although endovascular treatment (EVT) is very effective for acute ischemia stroke (AIS) patients with proximal large vessels occlusion (LVO), whether bridging rPA before EVT in stroke patients of LVO is of any benefit and is currently one of the most urgent unanswered questions. We aim to comprehensively determine the efficacy and safety of direct EVT (DEVT) in AIS patients with LVO versus bridging therapy (BT).

Methods: Clinical researches published in the Embase, PubMed, and Cochrane Library electronic databases up to May 2017 were identified for analysis. Read More

AJNR Am J Neuroradiol 2019 Jan 27;40(1):51-58. Epub 2018 Dec 27.

Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania

Background And Purpose: Anterior circulation large-vessel occlusion stroke, one of the most devastating stroke subtypes, is associated with substantial economic burden. We aimed to identify predictors of increased acute care hospitalization costs associated with anterior circulation large-vessel occlusion stroke.

Materials And Methods: Comprehensive cost-tracking software was used to calculate acute care hospitalization costs for patients with anterior circulation large-vessel occlusion stroke admitted July 2012 to October 2014. Read More

Stroke 2019 Feb;50(2):516-519

From the Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254 (F.Z., S.B., B.G.), University Hospital of Nancy, France.

Background and Purpose- Carotid artery stenting in tandem large vessel occlusion strokes is usually avoided because of the intracranial hemorrhagic risks induced by antiplatelet therapy during thrombectomy interventions. This study aimed to evaluate the incidence of hemorrhagic transformation following thrombectomy in large vessel occlusion strokes patients with atherosclerotic cervical carotid occlusion, associated factors, and clinical relevance. Methods- The TITAN (Thrombectomy in Tandem Lesions) collaboration pooled individual data of prospectively collected multicentric thrombectomy databases for consecutive anterior circulation tandem large vessel occlusion strokes patients who underwent thrombectomy. Read More

Stroke 2019 Feb;50(2):428-433

From the Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.).

Background and Purpose- Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the extracranial lesion requires acute stenting remains unclear. Our aim was to investigate differences in clinical and procedural outcomes related to stenting extracranial lesions in a registry of patients undergoing thrombectomy for acute stroke. Methods- Data were analyzed from the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)-a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device. Read More

Stroke 2018 Dec 11:STROKEAHA118020840. Epub 2018 Dec 11.

From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.).

Background and Purpose- Although aggressive medical therapy was superior to stenting in the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), the stroke rate in the medical arm was still high. The aim of this study was to determine the association between hemodynamic markers (borderzone infarct pattern and impaired collateral flow on baseline imaging) and rates of recurrent stroke in patients treated medically in SAMMPRIS. Methods- This was a post hoc analysis of patients whose qualifying event for SAMMPRIS was an infarct in the territory of a stenotic middle cerebral artery or intracranial carotid artery. Read More

World Neurosurg 2018 Dec 19. Epub 2018 Dec 19.

Department of Radiology, University of California, Los Angeles, California, USA.

Background: Extensive evidence supports mechanical thrombectomy using stentrievers (SR) for acute large vessel occlusion (aLVO). Aspiration is also used as a first pass or adjunct technique during clot removal. Here we report technical results from mechanical thrombectomy cases using SR alone, aspiration alone (AD), or a combination of SR and aspiration (SA) as a first pass for aLVO. Read More

Med Sci Monit 2018 Dec 22;24:9342-9353. Epub 2018 Dec 22.

Department of Applied Mathematics, VŠB-Technical University of Ostrava, Ostrava, Czech Republic.

BACKGROUND We investigated the properties and effects of 5 mechanical thrombectomy procedures in patients with acute ischemic stroke. The relationships between the type of procedure, the time required, the success of recanalization, and the clinical outcome were analyzed. MATERIAL AND METHODS This prospective comparative analysis included 500 patients with acute ischemic stroke and large-vessel occlusion. Read More

AJNR Am J Neuroradiol 2019 Feb 20;40(2):283-286. Epub 2018 Dec 20.

From the Departments of Neuroradiology (F.S., J.P., C.H., M.B., M.A.M.)

Background And Purpose: We aimed to analyze the clinical outcome after mechanical thrombectomy in patients with premorbid mRS 3 and 4 because there are currently no data on this patient group.

Materials And Methods: Between January 2009 and November 2017, all patients with premorbid mRS 3 or 4 undergoing mechanical thrombectomy due to anterior circulation stroke were selected. Good outcome was defined as a clinical recovery to the status before stroke onset (ie, equal premorbid mRS and mRS at 90 days). Read More

Stroke 2018 Dec;49(12):2969-2974

From the Department of Diagnostic Imaging (R.A.M., E.L.D., G.L.B., R.A.H., M.V.J.), Rhode Island Hospital, Providence.

Background and Purpose- Interfacility transfers for thrombectomy in stroke patients with emergent large vessel occlusion (ELVO) are associated with longer treatment times and worse outcomes. In this series, we examined the association between Primary Stroke Center (PSC) door-in to door-out (DIDO) times and outcomes for confirmed ELVO stroke transfers and factors that may modify the interaction. Methods- We retrospectively identified 160 patients transferred to a single Comprehensive Stroke Center (CSC) with anterior circulation ELVO between July 1, 2015 and May 30, 2017. Read More