1,392 results match your criteria Mechanical Thrombolysis in Acute Stroke


Thromboembolism and bleeding in patients with cancer and mechanical heart valves.

J Thromb Thrombolysis 2018 Dec 17. Epub 2018 Dec 17.

Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet s/n, 08916, Badalona, Spain.

Mechanical heart valves (MHV) require life-long anticoagulation with vitamin K antagonists (VKA), but anticoagulation management is complex in patients with cancer due to a high risk of thrombosis and bleeding. This is a retrospective, single-center study to assess anticoagulation management and thrombotic (stroke/valve thrombosis) and bleeding events in patients with active cancer and MHV. The incidence of thrombotic complications was compared to a control group (matched 1:1) of patients with MHV but without cancer. Read More

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http://dx.doi.org/10.1007/s11239-018-1790-3DOI Listing
December 2018

Functional Outcome and Safety of Intracranial Thrombectomy After Emergent Extracranial Stenting in Acute Ischemic Stroke Due to Tandem Occlusions.

Front Neurol 2018 20;9:940. Epub 2018 Nov 20.

Klinik für Neuroradiologie, Klinikum Stuttgart, Stuttgart, Germany.

Various endovascular approaches to treat acute ischemic stroke caused by extra- intracranial tandem occlusions (TO) exist: percutaneous transluminal angioplasty with or without emergent extracranial carotid stenting (ECS) due to high-grade stenosis preceded or followed by intracranial mechanical and/or aspiration thrombectomy (MT). Which treatment strategy to use is still a matter of debate. From our ongoing prospective stroke registry we retrospectively analyzed 1,071 patients with anterior circulation stroke getting endovascular treatment within 6 h of symptom onset. Read More

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http://dx.doi.org/10.3389/fneur.2018.00940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256428PMC
November 2018

Predictive and individualized management of stroke-success story in Czech Republic.

EPMA J 2018 Dec 25;9(4):393-401. Epub 2018 Oct 25.

1Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 66 Plzen, Czech Republic.

The model of centralized stroke care in the Czech Republic was created in 2010-2012 by Ministry of Health (MH) in cooperation with professional organization-Cerebrovascular Section of the Czech Neurological Society (CSCNS). It defines priorities of stroke care, stroke centers, triage of suspected stroke patients, stroke care quality indicators, their monitoring, and reporting. Thirteen complex cerebrovascular centers (CCC) provide sophisticated stroke care, including intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), as well as other endovascular (stenting, coiling) and neurosurgical procedures. Read More

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http://link.springer.com/10.1007/s13167-018-0150-x
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http://dx.doi.org/10.1007/s13167-018-0150-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261911PMC
December 2018
1 Read

Successful mechanical thrombectomy in stroke with thrombolysis-associated intracerebral hemorrhage-a case report.

J Stroke Cerebrovasc Dis 2018 Oct 24. Epub 2018 Oct 24.

Department of Neurology, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. Electronic address:

Background: Intravenous thrombolysis and mechanical thrombectomy are the standard of care for patients with acute ischemic stroke with large vessel occlusion. Intracerebral hemorrhage is a main complication of intravenous thrombolysis, however, no data are available on the efficacy and safety of mechanical thrombectomy in patients with thrombolysis-associated intracerebral hemorrhage. This constellation is expected to become more frequent as increasing numbers of patients are treated under the drip-and-ship paradigm. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.045DOI Listing
October 2018

Management of Stroke in the Neurocritical Care Unit.

Continuum (Minneap Minn) 2018 Dec;24(6):1658-1682

Purpose Of Review: This article provides updated information regarding the diagnosis and treatment (specifically critical care management) of acute ischemic stroke. This article also discusses the increased use of thrombolysis and thrombectomy in clinical practice.

Recent Findings: Stroke is the leading cause of disability in the United States. Read More

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http://dx.doi.org/10.1212/CON.0000000000000670DOI Listing
December 2018
1 Read

Effects of intermediate catheter evolution on technical outcome of mechanical thrombectomy - a comparison of the performance of two distal access catheters in mechanical thrombectomy of acute ischemic stroke.

World Neurosurg 2018 Nov 27. Epub 2018 Nov 27.

Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.

Purpose: Fast and secure access to intracranial vessel occlusion is essential for mechanical thrombectomy (MT) in treatment of acute ischemic stroke (AIS). We compared two intermediate distal access catheters (DAC®, Stryker Neurovascular (C1) and SOFIA®, Microvention (C2)) for procedural speed and safety of MT as well as clinical outcome at discharge and after 90 days.

Materials And Methods: This is a retrospective study of all 398 consecutive patients receiving MT with C1 or C2 for the treatment of AIS between 09/2010 and 06/2016, using a propensity score matched cohort. Read More

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http://dx.doi.org/10.1016/j.wneu.2018.11.185DOI Listing
November 2018
1 Read

A Direct Aspiration First Pass Technique in Japanese Real-World Clinical Setting.

Oper Neurosurg (Hagerstown) 2018 Nov 28. Epub 2018 Nov 28.

Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan.

Background: It is debatable whether mechanical thrombectomy has benefits in a real-world setting outside the more rigid and selective clinical trial environment.

Objective: To evaluate clinical outcomes, efficacy, and safety of mechanical thrombectomy in single-center retrospective cohort case series.

Methods: We reviewed prospectively collected data from our large-vessel occlusion stroke database to identify patients undergoing mechanical thrombectomy using Penumbra catheters (Penumbra, Almeida, California) as first-line devices. Read More

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http://dx.doi.org/10.1093/ons/opy349DOI Listing
November 2018
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Effects of mechanical thrombectomy for acute stroke patients with etiology of large artery atherosclerosis.

J Neurol Sci 2018 Oct 19;396:178-183. Epub 2018 Oct 19.

Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address:

Aims: Atherosclerosis is more prevalent in Asian population. This distinct etiology of stroke might disadvantage Asian patients when applying. mechanical thrombectomy (MT). Read More

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http://dx.doi.org/10.1016/j.jns.2018.10.017DOI Listing
October 2018
1 Read

Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment.

J Neurointerv Surg 2018 Nov 24. Epub 2018 Nov 24.

Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands.

Background: Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014270DOI Listing
November 2018
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Reasons for failed endovascular recanalization attempts in stroke patients.

J Neurointerv Surg 2018 Nov 24. Epub 2018 Nov 24.

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Purpose: Mechanical thrombectomy (MT) is a highly effective therapy in patients with acute ischemic stroke due to large vessel occlusion (LVO). However, complete recanalization of the occluded vessel cannot be achieved in all patients, leading to poor clinical outcome. We analyzed the reasons for failed recanalization to help direct future improvements in therapy. Read More

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http://jnis.bmj.com/lookup/doi/10.1136/neurintsurg-2018-0140
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http://dx.doi.org/10.1136/neurintsurg-2018-014060DOI Listing
November 2018
3 Reads

Primary Thrombectomy Versus Combined Mechanical Thrombectomy and Intravenous Thrombolysis in Large Vessel Occlusion Acute Ischemic Stroke.

J Stroke Cerebrovasc Dis 2018 Nov 22. Epub 2018 Nov 22.

Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Stroke Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.

Mechanical thrombectomy (MT) in combination with intravenous thrombolysis (IVT) is the standard of care for patients with acute ischemic stroke with anterior circulation large vessel occlusion. The particular benefit of IVT in these patients is unknown. We performed a retrospective analysis of patients submitted to MT at our center between January 2015 and June 2017. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.002DOI Listing
November 2018
2 Reads

Direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: focus on real life studies.

J Thromb Thrombolysis 2018 Nov 23. Epub 2018 Nov 23.

Internal Medicine, Stroke Unit and Center of Thromboembolic Diseases, Santa Maria Nuova Hospital, Florence, Italy.

Strong evidence for the use of direct oral anticoagulants (DOACs) in the early phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) is lacking, because this kind of patients were excluded from phase III randomized clinical trials (RCT) and ad hoc RCTs are ongoing. In the latest years a lot of real life studies on this topic have been published. The aim of our review was to focus on these. Read More

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http://link.springer.com/10.1007/s11239-018-1775-2
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http://dx.doi.org/10.1007/s11239-018-1775-2DOI Listing
November 2018
3 Reads

Is intravenous thrombolysis still necessary in patients who undergo mechanical thrombectomy?

Curr Opin Neurol 2019 Feb;32(1):3-12

Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens.

Purpose Of Review: To summarize available evidence on the potential utility of pretreatment with intravenous thrombolysis (IVT) using recombinant tissue-plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO) who are treated with mechanical thrombectomy.

Recent Findings: Despite theoretical concerns of a higher bleeding risk with IVT pretreatment, there are no data showing increased risk of symptomatic intracerebral hemorrhage (sICH) in patients with LVO receiving bridging therapy (IVT and mechanical thrombectomy) compared with direct mechanical thrombectomy (dMT). Additionally, evidence from observational studies suggest lower rates of infarctions in previously unaffected territories and higher rates of successful reperfusion, with lower number of device passes, in patients receiving bridging therapy. Read More

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http://dx.doi.org/10.1097/WCO.0000000000000633DOI Listing
February 2019
7 Reads

Final Results of the RHAPSODY trial: A multi-center, Phase 2 trial using a continual reassessment method to determine the safety and tolerability of 3K3A-APC, a Recombinant Variant of Human Activated Protein C, in combination with tissue plasminogen activator, mechanical thrombectomy or both in moderate to severe acute ischemic stroke.

Ann Neurol 2018 Nov 18. Epub 2018 Nov 18.

Zilkha Neurogenic Institute and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California Los Angeles.

Objective: Agonism of the protease activated receptor (PAR) 1 by activated protein C (APC) provides neuroprotection and vasculoprotection in experimental neuro-injury models. The pleiotropic PAR1 agonist, 3K3A-APC, reduces neurologic injury and promotes vascular integrity; 3K3A-APC proved safe in human volunteers. We performed a randomized, controlled, blinded, trial to determine the maximally tolerated dose (MTD) of 3K3A-APC in ischemic stroke patients. Read More

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http://doi.wiley.com/10.1002/ana.25383
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http://dx.doi.org/10.1002/ana.25383DOI Listing
November 2018
3 Reads

Real-World Thrombectomy Using the Sofia Catheter.

World Neurosurg 2018 Nov 14. Epub 2018 Nov 14.

Department of Interventional Neuroradiology, University Lille, CHU Lille, Lille, France. Electronic address:

Objective: To study the safety and performance of real-world thrombectomy using the SOFIA Catheter in our comprehensive stroke center.

Methods: We conducted a cohort study from a prospective clinical registry of consecutive stroke patients treated by mechanical thrombectomy between March 2016 and September 2017. Baseline clinical and imaging characteristics, recanalization rates, complications, and clinical outcomes were analyzed. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750183257
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http://dx.doi.org/10.1016/j.wneu.2018.11.023DOI Listing
November 2018
6 Reads

A Regional Network Organization for Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation; Timing, Safety, and Effectiveness.

J Stroke Cerebrovasc Dis 2018 Nov 12. Epub 2018 Nov 12.

Department of Neurology, CHRU, Gui de Chauliac Hospital, Montpellier, France. Electronic address:

Background: Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10523057183057
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.051DOI Listing
November 2018
5 Reads

Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome.

Neurol Sci 2018 Nov 14. Epub 2018 Nov 14.

Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy.

Background And Aims: Monitoring the quality of acute ischemic stroke (AIS) management is increasingly important since patient outcome could be improved with better access to evidence-based treatments. In this scenario, the aim of our study was to identify thrombolysis rate, reasons for undertreatment, and factors associated with better outcome.

Methods: From January to December 2016, individuals diagnosed with AIS at the Policlinic San Martino Hospital in Genoa, Italy, were prospectively included. Read More

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http://link.springer.com/10.1007/s10072-018-3644-3
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http://dx.doi.org/10.1007/s10072-018-3644-3DOI Listing
November 2018
6 Reads

Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke.

Clin Radiol 2018 Nov 9. Epub 2018 Nov 9.

Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Sokolská 581, CZ-500 05, Hradec Králové, Czech Republic. Electronic address:

Aim: To assess the safety and efficacy of mechanical thrombectomy (MT) with stent-retrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC.

Materials And Methods: The present retrospective study comprised 285 consecutive patients (115 males; mean age 74±13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score ≥2b), post-treatment imaging findings. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00099260183057
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http://dx.doi.org/10.1016/j.crad.2018.10.009DOI Listing
November 2018
4 Reads

Stent Retriever Thrombectomy with Mindframe Capture LP in Isolated M2 Occlusions.

Clin Neuroradiol 2018 Nov 9. Epub 2018 Nov 9.

University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.

Background And Purpose: Mechanical thrombectomy is an effective recanalization technique in acute ischemic stroke patients with large vessel occlusions; however, it is unclear to what extent stent retriever thrombectomy may be applicable to occlusions of smaller peripheral cerebral vessels. The outcome of patients with isolated M2 occlusions treated with the Mindframe Capture low profile (LP) stent retriever was reviewed.

Material And Methods: A retrospective review of prospectively collected data on all consecutive patients treated for isolated M2 occlusions between June 2013 and December 2017 using the Mindframe Capture LP was performed. Read More

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http://link.springer.com/10.1007/s00062-018-0739-4
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http://dx.doi.org/10.1007/s00062-018-0739-4DOI Listing
November 2018
5 Reads

Review of the Mobile Stroke Unit Experience Worldwide.

Interv Neurol 2018 Oct 31;7(6):347-358. Epub 2018 May 31.

Mercy Health-St. Vincent Medical Center, Toledo, Ohio, USA.

Background: The treatment of stroke is dependent on a narrow therapeutic time window that requires interventions to be emergently pursued. Despite recent "FAST" initiatives that have underscored "time is brain," many patients still fail to present within the narrow time window to receive maximum treatment benefit from advanced stroke therapies, including recombinant tissue plasminogen activator (tPA) and mechanical thrombectomy. The convergence of emergency medical services, telemedicine, and mobile technology, including transportable computed tomography scanners, has presented a unique opportunity to advance patient stroke care in the prehospital field by shortening time to hyperacute stroke treatment with a mobile stroke unit (MSU). Read More

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https://www.karger.com/Article/FullText/487334
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http://dx.doi.org/10.1159/000487334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216701PMC
October 2018
9 Reads

Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use.

Authors:
Mohamed S Teleb

Interv Neurol 2018 Oct 16;7(6):327-333. Epub 2018 May 16.

Neurointerventional Surgery, Stroke, and Neurocritical Care, Banner Health, Mesa, Arizona, USA.

Background: Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. Read More

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https://www.karger.com/Article/FullText/488601
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http://dx.doi.org/10.1159/000488601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216708PMC
October 2018
3 Reads

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis.

Cerebrovasc Dis 2018 Nov 1;46(5-6):193-199. Epub 2018 Nov 1.

Department of Radiology, Neurointervention Service, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.

Background/aim: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis.

Methods: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic stroke patients undergoing mechanical thrombectomy from January 2008 to June 2017. Read More

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http://dx.doi.org/10.1159/000493801DOI Listing
November 2018
2 Reads

Simplified selection criteria for patients with longer or unknown time to treatment predict good outcome after mechanical thrombectomy.

J Neurointerv Surg 2018 Oct 27. Epub 2018 Oct 27.

Department of Neurology, University of Heidelberg, Heidelberg, Germany.

Objective: To identify simplified selection criteria for mechanical thrombectomy (MT) in longer and unknown time windows.

Methods: Patients with large vessel occlusion (LVO) in the anterior circulation who underwent MT between January 2014 and November 2017 were identified from the local registry. Patients were selected for analysis if they met the current guideline recommendation for MT treatment except for time window (HERMES-like) and were divided according to time they were last seen well (LSW): LSW <6 hours or LSW >6 hours before MT. Read More

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http://jnis.bmj.com/lookup/doi/10.1136/neurintsurg-2018-0143
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http://dx.doi.org/10.1136/neurintsurg-2018-014347DOI Listing
October 2018
4 Reads

Percutaneous vascular interventions versus intravenous thrombolytic treatment for acute ischaemic stroke.

Cochrane Database Syst Rev 2018 Oct 26;10:CD009292. Epub 2018 Oct 26.

University Hospital of North Norway, Tromsø, Norway, NO-9018.

Background: Most ischaemic strokes are caused by blockage of a cerebral artery by a thrombus. Intravenous administration of recombinant tissue plasminogen activator given within 4.5 hours is now standard treatment for this condition. Read More

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http://doi.wiley.com/10.1002/14651858.CD009292.pub2
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http://dx.doi.org/10.1002/14651858.CD009292.pub2DOI Listing
October 2018
6 Reads

Abnormal Blood Flow on Transcranial Duplex Sonography Predicts Poor Outcome After Stroke Thrombectomy.

Stroke 2018 Nov;49(11):2780-2782

From the Department of Neurology (M.K., K.N., C.E., B.P., S.H., D.T., J.K., S.F., I.C., F.F., T.G.), Medical University of Graz, Austria.

Background and Purpose- Hemodynamic changes following mechanical thrombectomy for large vessel occlusion stroke could be associated with complications and might affect prognosis. We investigated postinterventional middle cerebral artery blood flow on transcranial duplex sonography (TCD) and its prognostic value for anterior large vessel occlusion stroke patients. Methods- We identified all ischemic stroke patients who had undergone mechanical thrombectomy for anterior circulation large vessel occlusion from 2010 onwards. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023213
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http://dx.doi.org/10.1161/STROKEAHA.118.023213DOI Listing
November 2018
5 Reads

Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients.

Stroke 2018 Nov;49(11):2643-2651

Neurology (S.B., L.P., M.A., S.J., A.G., U.F.), Bern University Hospital, Switzerland.

Background and Purpose- Sustained successful reperfusion is an important prognostic factor for good clinical outcome in acute ischemic stroke. We aimed to identify the prevalence, clinical impact, and predictors of early reocclusion after initially successful thrombectomies within a prospective cohort. Methods- A total of 711 stroke patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b/3) followed with magnetic resonance or computed tomographic angiography at 24 to 48 hours were included. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021685
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http://dx.doi.org/10.1161/STROKEAHA.118.021685DOI Listing
November 2018
3 Reads

Day 1 Extracranial Internal Carotid Artery Patency Is Associated With Good Outcome After Mechanical Thrombectomy for Tandem Occlusion.

Stroke 2018 Oct;49(10):2520-2522

Department of Neurology, INSERM U1171-Degenerative and Vascular Cognitive Disorders, CHU Lille, University of Lille, France (M.F., C.C., H.H.).

Background and Purpose- Optimal management of the extracranial occlusive component remains controversial in patients with acute ischemic stroke by tandem occlusion treated with mechanical thrombectomy. We investigated the association between extracranial internal carotid artery (ICA) patency at day 1 and the clinical outcome after mechanical thrombectomy. Methods- Consecutive patients with acute ischemic stroke with tandem occlusion were identified from a hospital-based prospective registry from 2011 to 2017. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022495
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http://dx.doi.org/10.1161/STROKEAHA.118.022495DOI Listing
October 2018
3 Reads

Mechanical Thrombectomy Outcomes With or Without Intravenous Thrombolysis.

Stroke 2018 Oct;49(10):2383-2390

From the Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (F.G., J.B., X.B., G.M.).

Background and Purpose- Intravenous thrombolysis (IVT) within 4.5 hours of symptom onset is currently recommended before mechanical thrombectomy (MT). We compared functional outcome, neurological recovery, reperfusion, and adverse events according to the use or not of IVT before MT. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021500
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http://dx.doi.org/10.1161/STROKEAHA.118.021500DOI Listing
October 2018
7 Reads

Recanalization Rate per Retrieval Attempt in Mechanical Thrombectomy for Acute Ischemic Stroke.

Stroke 2018 Oct;49(10):2523-2525

From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (F.F., H.L., G.B., J.N., M.B., T.D., J.F., C.B.), University Medical Center Hamburg-Eppendorf, Germany.

Background and Purpose- In acute ischemic stroke, mechanical thrombectomy allows flow restoration in the majority of cases. In case of an unsuccessful retrieval, little is known about how many retrieval attempts should be performed before stopping the procedure. This study assessed the recanalization rate and clinical outcome per retrieval maneuver. Read More

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https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022737
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http://dx.doi.org/10.1161/STROKEAHA.118.022737DOI Listing
October 2018
5 Reads

Systematic evaluation of stroke thrombectomy in clinical practice: The German Stroke Registry Endovascular Treatment.

Int J Stroke 2018 Oct 22:1747493018806199. Epub 2018 Oct 22.

1 Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Endovascular treatment has become standard of care for the treatment of acute ischemic stroke with large vessel occlusion. However, patients treated in clinical practice differ from the selected populations randomized in clinical trials.

Aims: The German Stroke Registry Endovascular Treatment (GSR-ET) aims at a systematic evaluation of outcome, safety, and process parameters of endovascular stroke treatment in standard of care in Germany. Read More

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http://dx.doi.org/10.1177/1747493018806199DOI Listing
October 2018
3 Reads

Disability Adjusted Life Years due to Ischaemic Stroke Preventable by Real-Time Stroke Detection-A Cost-Utility Analysis of Hypothetical Stroke Detection Devices.

Authors:
Ludwig Schlemm

Front Neurol 2018 1;9:814. Epub 2018 Oct 1.

Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Ischaemic stroke remains a significant contributor to permanent disability world-wide. Therapeutic interventions for acute ischaemic stroke (AIS) are available, but need to be administered early after symptom onset in order to be effective. Currently, one of the main factors responsible for poor clinical outcome is an unnecessary long time between symptom onset and arrival at a hospital (pre-hospital delay). Read More

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http://dx.doi.org/10.3389/fneur.2018.00814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174318PMC
October 2018

Health Care Organization for the Management of Stroke: The French Perspective.

Neuroimaging Clin N Am 2018 Nov;28(4):691-698

Interventional Neuroradiology and Neuroradiology, Department of Medical Imaging, Sutter Health, Sacramento, CA 95815, USA; Radiology Department, University of California Davis Medical School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA.

Stroke, a major burden to society, can now be treated in increasingly larger numbers of patients. Intravenous thrombolysis and mechanical thrombectomy are both now standard of care with class I, level of evidence A. Various local, regional, and national challenges are present, preventing equality in access to care for many patients. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10525149183006
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http://dx.doi.org/10.1016/j.nic.2018.06.010DOI Listing
November 2018
5 Reads

Advanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment.

Neuroimaging Clin N Am 2018 Nov 15;28(4):585-597. Epub 2018 Sep 15.

Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford Healthcare, 300 Pasteur Drive, Stanford, CA 94305, USA.

Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10525149183005
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http://dx.doi.org/10.1016/j.nic.2018.06.004DOI Listing
November 2018
6 Reads

First-Line A Direct Aspiration First-Pass Technique vs. First-Line Stent Retriever for Acute Ischemic Stroke Therapy: A Meta-Analysis.

Front Neurol 2018 25;9:801. Epub 2018 Sep 25.

Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.

Recent trials have proved the efficacy of mechanical thrombectomy over medical treatment for patients with acute ischemic stroke, with the balance of equivalent rates of adverse events. Stent retrievers were applied predominantly in most trials; however, the role of other thrombectomy devices has not been well validated. A direct aspiration first-pass technique (ADAPT) is proposed to be a faster thrombectomy technique than the stent retriever technique. Read More

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https://www.frontiersin.org/article/10.3389/fneur.2018.00801
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http://dx.doi.org/10.3389/fneur.2018.00801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167481PMC
September 2018
1 Read

Intravenous Thrombolysis Prior to Mechanical Thrombectomy in Acute Ischemic Stroke: Silver Bullet or Useless Bystander?

J Stroke 2018 Sep 30;20(3):385-393. Epub 2018 Sep 30.

Department of Neurology, Foch Hospital, Suresnes, France.

Background And Purpose: Recent single-center series and meta-analyses suggest that mechanical thrombectomy (MT) without prior intravenous thrombolysis (IVT) might be equally effective to bridging therapy. We analyzed, within the Endovascular Treatment in Ischemic Stroke (ETIS) prospective observational registry, the angiographic and clinical outcomes after IVT+MT versus MT alone.

Methods: From December 2012 to December 2016, a total of 1,507 consecutive patients with a proximal arterial occlusion of the anterior circulation were treated by MT. Read More

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http://j-stroke.org/journal/view.php?doi=10.5853/jos.2018.01
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http://dx.doi.org/10.5853/jos.2018.01543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186914PMC
September 2018
6 Reads

Higher Blood Pressure during Endovascular Thrombectomy in Anterior Circulation Stroke Is Associated with Better Outcomes.

J Stroke 2018 Sep 30;20(3):373-384. Epub 2018 Sep 30.

Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.

Background And Purpose: Reports investigating the relationship between in-procedure blood pressure (BP) and outcomes in patients undergoing endovascular thrombectomy (EVT) due to anterior circulation stroke are sparse and contradictory.

Methods: Consecutive EVT-treated adults (modern stent retrievers, BP managed in line with the recommendations, general anesthesia, invasive BP measurements) were evaluated for associations of the rate of in-procedure systolic BP (SBP) and mean arterial pressure (MAP) excursions to >120%/<80% of the reference values (serial measurements at anesthesia induction) and of the reference BP/weighted in-procedure mean BP with post-procedure imaging outcomes (ischemic lesion volume [ILV], hemorrhages) and 3-month functional outcome (modified Rankin Scale [mRS], score 0 to 2 vs. 3 to 6). Read More

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http://j-stroke.org/journal/view.php?doi=10.5853/jos.2018.01
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http://dx.doi.org/10.5853/jos.2018.01305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186925PMC
September 2018
3 Reads

Consensus Guides on Stroke Thrombolysis for Anticoagulated Patients from Japan: Application to Other Populations.

J Stroke 2018 Sep 30;20(3):321-331. Epub 2018 Sep 30.

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Development of direct oral anticoagulants and their antidotes has led to the need to reconsider the eligibility of acute stroke patients who have been taking oral anticoagulants for intravenous thrombolysis. Officially authorized Japanese guidelines on this issue were revised twice at the time of approval for clinical use of direct oral anticoagulants and idarucizumab, a specific reversal agent for dabigatran. A unique recommendation in the latest Japanese clinical guides was that thrombolysis can be recommended if the time of the last dose of direct oral anticoagulants exceeds 4 hours and if commonly available anticoagulation markers are normal or subnormal, i. Read More

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http://j-stroke.org/journal/view.php?doi=10.5853/jos.2018.01
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http://dx.doi.org/10.5853/jos.2018.01788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186921PMC
September 2018
5 Reads

Direct oral anticoagulants: a review of common medication errors.

J Thromb Thrombolysis 2018 Oct 8. Epub 2018 Oct 8.

College of Pharmacy, Florida Agricultural & Mechanical University, 2050 Art Museum Drive Building 4800 Suite 200, Jacksonville, FL, 32207, USA.

Stroke and venous thromboembolism continues to be a major cause of morbidity and mortality worldwide. The use of anticoagulation therapy has proven effective in the prevention of stroke and management of thromboembolism; however, initiating treatment may bear clinical burden given the capacity of these agents to cause bleeding. Originally, warfarin has been primarily used, but with the approval of direct oral anticoagulants, therapeutic recommendations have shifted to direct oral anticoagulants for first line therapy for venous thromboembolism for patients without cancer. Read More

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http://link.springer.com/10.1007/s11239-018-1752-9
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http://dx.doi.org/10.1007/s11239-018-1752-9DOI Listing
October 2018
1 Read

Mothership versus drip and ship for thrombectomy in patients who had an acute stroke: a systematic review and meta-analysis.

J Neurointerv Surg 2019 Jan 8;11(1):14-19. Epub 2018 Oct 8.

Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.

Background: The effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke due to large vessel occlusion is time-dependent. While only stroke centers with endovascular capabilities perform MT, many patients who had a stroke initially present to the closest primary stroke centers capable of administering earlier intravenous thrombolysis, and then require to be transferred to a comprehensive stroke center for MT.

Purpose: To compare the outcomes of this care pathway (drip and ship (DS)) with that whereby patients are directly transferred to a comprehensive stroke center (mothership (MS)). Read More

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http://jnis.bmj.com/lookup/doi/10.1136/neurintsurg-2018-0142
Publisher Site
http://dx.doi.org/10.1136/neurintsurg-2018-014249DOI Listing
January 2019
4 Reads

Direct endovascular thrombectomy and bridging strategies for acute ischemic stroke: a network meta-analysis.

J Neurointerv Surg 2018 Oct 5. Epub 2018 Oct 5.

Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

Objectives: The present Bayesian network meta-analysis aimed to compare the various strategies for acute ischemic stroke: direct endovascular thrombectomy within the thrombolysis window in patients with no contraindications to thrombolysis (DEVT); (2) direct endovascular thrombectomy secondary to contraindications to thrombolysis (DEVTc); (3) endovascular thrombectomy in addition to thrombolysis (IVEVT); and (4) thrombolysis without thrombectomy (IVT).

Methods: Six electronic databases were searched from their dates of inception to May 2017 to identify randomized controlled trials (RCTs) comparing IVT versus IVEVT, and prospective registry studies comparing IVEVT versus DEVT or IVEVT versus DEVTc. Network meta-analyses were performed using ORs and 95% CIs as the summary statistic. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014260DOI Listing
October 2018
6 Reads

Effect of mechanical thrombectomy alone or in combination with intravenous thrombolysis for acute ischemic stroke.

J Neurol 2018 Dec 1;265(12):2875-2880. Epub 2018 Oct 1.

Department of Systems Medicine, Comprehensive Stroke Center, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.

Objective And Design: Whether combining intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is superior to mechanical thrombectomy alone for large vessel occlusion acute ischemic stroke is still uncertain. Our aim was to compare the safety and the efficacy of these two therapeutic strategies.

Materials: Patients with acute ischemic stroke secondary to anterior circulation large vessel occlusion. Read More

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http://dx.doi.org/10.1007/s00415-018-9073-7DOI Listing
December 2018
1 Read

Uneventful Pregnancy and Delivery after Thrombolysis Plus Thrombectomy for Acute Ischemic Stroke: Case Study and Literature Review.

J Stroke Cerebrovasc Dis 2019 Jan 27;28(1):70-75. Epub 2018 Sep 27.

Department of Neurology, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan.

Background: Intravenous thrombolysis with recombinant tissue plasminogen activator and endovascular mechanical thrombectomy are known to be the most effective treatments in the acute phase of ischemic stroke. However, the safety of intravenous systemic thrombolysis with recombinant tissue plasminogen and endovascular mechanical thrombectomy during pregnancy is not well-confirmed. We describe a case of an uneventful pregnancy and delivery after thrombolysis plus endovascular mechanical thrombectomy for acute ischemic stroke. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10523057183050
Publisher Site
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.002DOI Listing
January 2019
8 Reads

First-in-man experience of the Versi Retriever in acute ischemic stroke.

J Neurointerv Surg 2018 Sep 27. Epub 2018 Sep 27.

Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, USA.

Objective: To describe our initial experience with the Versi Retriever for mechanical thrombectomy in patients with acute ischemic stroke.

Methods: This study is a single-center, single-arm, first-in-man registry under institutional review board control to evaluate the efficacy and safety of the new stent retriever, the Versi Retriever. Patients with acute ischemic stroke were consecutively enrolled between September and November 2017. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014040DOI Listing
September 2018
16 Reads

Single-center experience with the Tigertriever device for the recanalization of large vessel occlusions in acute ischemic stroke.

J Neurointerv Surg 2018 Sep 27. Epub 2018 Sep 27.

Department of Anesthesiology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey.

Background: Tigertriever (Rapid Medical, Yoqneam, Israel) is a new design of stent retriever.

Purpose: To evaluate the feasibility, safety, and efficacy of the Tigertriever in patients with acute ischemic stroke who have undergone mechanical thrombectomy.

Materials And Methods: Two different techniques-namely, standard unsheathing (SUT) and repetitive inflation-deflation (RID) techniques, were used. Read More

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http://jnis.bmj.com/lookup/doi/10.1136/neurintsurg-2018-0141
Publisher Site
http://dx.doi.org/10.1136/neurintsurg-2018-014196DOI Listing
September 2018
13 Reads

Transradial Mechanical Thrombectomy for Proximal Middle Cerebral Artery Occlusion in a First Trimester Pregnancy: Case Report and Literature Review.

World Neurosurg 2018 Dec 25;120:415-419. Epub 2018 Sep 25.

Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address:

Background: Acute ischemic stroke in pregnancy is a cause of maternal and fetal morbidity. Optimal treatment strategies for stroke in this population are undefined. Thrombolysis is recommended by guidelines should the benefit outweigh uterine bleeding risk. Read More

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http://dx.doi.org/10.1016/j.wneu.2018.09.095DOI Listing
December 2018
1 Read

Anaesthetic management during intracranial mechanical thrombectomy: systematic review and meta-analysis of current data.

J Neurol Neurosurg Psychiatry 2019 Jan 26;90(1):68-74. Epub 2018 Sep 26.

INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte Anne, Université Paris-Descartes, Paris, France

Objective: Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis.

Methods: The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation. Read More

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http://dx.doi.org/10.1136/jnnp-2018-318549DOI Listing
January 2019

Association of Cardioembolism and Intracranial Arterial Stenosis with Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke.

World Neurosurg 2019 Jan 19;121:e154-e158. Epub 2018 Sep 19.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. Electronic address:

Objective: To estimate the association of different etiologies of cardioembolism (CE), intracranial arterial stenosis (ICAS), or the combination of these conditions with outcomes of mechanical thrombectomy in acute ischemic stroke.

Methods: Data from the intervention group of the Endovascular therapy for Acute ischemic Stroke Trial (EAST) were analyzed. In 140 patients, the presence of CE, ICAS, neither CE nor ICAS, or both conditions was assessed. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750183210
Publisher Site
http://dx.doi.org/10.1016/j.wneu.2018.09.058DOI Listing
January 2019
8 Reads

Clinical treatment efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis for acute moderate/severe cerebral infarction.

Eur Rev Med Pharmacol Sci 2018 Sep;22(17):5740-5746

Department of Stroke Ward, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China.

Objective: This study aims to compare clinical efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis on moderate or severe acute brain infarction.

Patients And Methods: A total of 90 acute cerebral infarction patients due to artery stenosis or blockade from May 2016 to May 2017 were recruited and randomly assigned into thrombolysis group (N = 30), mechanical thrombectomy (N = 30), and combined treatment group (N = 30). Clinical information was collected. Read More

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http://dx.doi.org/10.26355/eurrev_201809_15842DOI Listing
September 2018
1 Read

#Fake news: a systematic review of mechanical thrombectomy results among neurointerventional stroke surgeons on Twitter.

J Neurointerv Surg 2018 Sep 15. Epub 2018 Sep 15.

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Objective: Twitter is a popular social media platform among physicians. Neurointerventionalists frequently document their lifesaving mechanical thrombectomy cases on Twitter with very favorable results. We fear that there may be some social media publication bias to tweeted mechanical thrombectomy cases with neurointerventionalists being more likely to tweet cases with favorable outcomes. Read More

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http://dx.doi.org/10.1136/neurintsurg-2018-014319DOI Listing
September 2018

[Acute phase of stroke: every minute counts].

Soins 2018 Sep;63(828):28-31

Neuroradiologie interventionnelle, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France; Unité de soins intensifs neurovasculaires, Hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.

Cerebral infarction (CI) is caused by intracranial artery occlusion. The main treatment approach is recanalisation, which is performed either medically, by intravenous thrombolysis within 4 hours and a half of the event, or by mechanical thrombectomy, which is possible up to 24 hours after CI. Read More

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http://dx.doi.org/10.1016/j.soin.2018.06.009DOI Listing
September 2018