Neurovascular Intervention

Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

When utilised as a first-line technique for medium vessel occlusion (MeVO) stroke, aspiration and stent-retriever thrombectomy have demonstrated “no significant difference” in imaging-related or clinical outcomes. That is according to a multicentre, propensity score-matched analysis including more than 400 patients, the results of which have been published in the journal Stroke: Vascular and Interventional Neurology.

Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

In a recent narrative review published in BMJ Medicine, researchers summarized the current evidence on advancements in mechanical thrombectomy (MT), a ground-breaking treatment for acute ischaemic stroke involving removal of a thrombus by recanalization of an intracranial occlusion of a large vessel via an aspiration catheter, stent retriever, or both.

The Intracranial Aneurysm Market is experiencing significant growth driven by a key trend focused on advancements in minimally invasive treatments and innovative technologies for the management of cerebral aneurysms. A notable trend shaping this market is the development of novel endovascular therapies, including flow diverters, stent-assisted coiling, and intrasaccular devices. This trend underscores a shift towards less invasive and more effective treatment options, improving patient outcomes and reducing the risk associated with traditional surgical interventions.

James M. Horowitz, M.D., from the NYU Grossman School of Medicine in New York City, and colleagues assessed the safety and effectiveness of MT for high-risk PE. The analysis included 63 real-world, high-risk patients identified through the multicenter FlowTriever All-comer Registry for Patient Safety and Hemodynamics study.

In our real-world clinical experience, leading microwire use was infrequently necessary with the T7 delivery catheter. Successful AC delivery and complication rates were similar with and without microwire use in single-pass T7 thrombectomies. Initial pass with T7 may be performed without use of leading microwire, reserving microwire use for refractory cases or known difficult-to-navigate vasculature.

Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation. In silico computational analyses and investigations in preclinical animal models have provided valuable insights into the underlying biological basis for flow diverter therapy.

The use of flow diverters is a rapidly growing endovascular approach for the treatment of intracranial aneurysms. All FDA-approved flow diverters are composed of nitinol or cobalt-chromium, which will remain in the patient for the duration of their life. Bioresorbable flow diverters have been proposed by several independent investigators as the next generation of flow diverting devices. These devices aim to serve their transient function of occluding and healing the aneurysm prior to being safely resorbed by the body, eliminating complications associated with the permanent presence of conventional flow diverters.

The present study has focused on the impacts of the parent vessel mean diameter on the hemodynamic aspects of the cerebral aneurysm with endovascular coiling. Computational approach is used to model the transient blood flow inside the parent vessel and sac area while it is presumed that the blood is not Newtonian fluid. The contours of pressure, WSS and OSI of three nominated ICA aneurysms are compared to disclose the importance of the parent vessel mean diameter on the probability of aneurysm bleeding. Based on the OSI results at early diastolic, increasing parent vessel mean diameter about 40% would decrease the mean OSI on the sac area about 43%.

The new Solitaire X 3 mm is an effective and safe device for performing EVT in MDVOs, as its use is associated with good recanalization rates and an acceptable safety profile. A more thorough and in-depth analysis of its use with more parameters and in a larger patient group could provide us with important insight into this device. Also, in the future, data from currently recruiting RCTs will enable further study on the efficacy of this device, as well as on the optimization of its usage regarding combined EVT approaches to thrombectomy.

Route 92 claims to have “reimagined” neurovascular intervention through the development of a suite of reperfusion systems leveraging unique designs, including the Tenzing delivery catheter. These products are designed to work harmoniously as a system to improve the efficiency of endovascular thrombectomy procedures, enabling clinicians to quickly restore blood flow to a patient’s brain following acute ischaemic stroke.

Microvention’s Sofia aspiration catheter is designed for tracking to the occlusion site and the aspiration of thrombus. Its “exceptionally” soft distal segment allows for excellent navigability and trackability through tortuous anatomy, enabling Sofia to reliably reach the occlusion site, according to the company. In addition, the device’s hybrid braid coil design provides enhanced control while its coil reinforcement enables “lumen integrity, flexibility and excellent shape retention”.

The guideline is an initiative of the Intercollegiate Stroke Working Party. The fifth edition of the guideline was published in 2016. The 2023 edition is a partial update of the 2016 edition and was developed in collaboration with the Scottish Intercollegiate Guidelines Network (SIGN) and the National Clinical Programme for Stroke, Ireland. The 2023 edition is endorsed for use in clinical practice by the Royal College of Physicians of London, SIGN and the RCPI. Out of 538 recommendations in this 2023 guideline, almost 300 have been updated, added or endorsed since the 2016 edition.

People who have a higher biological age than their actual chronological age have a significantly increased risk of stroke and dementia, especially vascular dementia. These are the results of a study from Karolinska Institutet in Sweden published in the Journal of Neurology, Neurosurgery and Psychiatry. The study is titled, "Clinical biomarker-based biological aging and future risk of neurological disorders in the UK Biobank."

Intracranial atherosclerotic disease is a common cause of ischemic stroke, particularly among minorities. Although treatment tailored for this disease involves aggressive risk factor management coupled with short-term dual antiplatelet therapy, ICAD is still associated with the highest rates of recurrent stroke of any stroke subtype. It is imperative that treating neurologists stay vigilant of this stroke mechanism and the nuances of its evaluation and management.

Imperative Care is addressing gaps across the entire patient journey — from detection through recovery — to elevate care for patients suffering from stroke and other devastating vascular diseases.

For the future many materials can be used for different biomedical applications. Nevertheless, in order to satisfy the conditions of biocompatibility, their surface needs to be modified. The final prospect of the material will determine the properties of the surface and the strategy chosen for its modification. The modification routes have been shown to be strongly dependent on the biologic fluid nature and composition. Depending on the type of the biomolecule(s) and its (their) physicochemical properties, one specific surface modification must be chosen and in our knowledge, no universal surface elaboration has been applied up to this point.

Protein adsorption at solid surfaces plays a key role in many natural processes and has therefore promoted a widespread interest in many research areas. Despite considerable progress in this field there are still widely differing and even contradictive opinions on how to explain the frequently observed phenomena such as structural rearrangements, cooperative adsorption, overshooting adsorption kinetics, or protein aggregation. In this review recent achievements and new perspectives on protein adsorption processes are comprehensively discussed. The main focus is put on commonly postulated mechanistic aspects and their translation into mathematical concepts and model descriptions.

There’s an urgent need to re-organize healthcare systems to prioritize stroke treatment, secure adequate funding, and build a well-trained workforce to make this treatment universally accessible,” Dr. Al-Mufti stated. “We call upon policymakers worldwide, especially in low and middle-income countries to direct their attention to this, because a cure for stroke exists.

Between 2018 and 2022, the smart brain-wave cap was tested in 12 Dutch ambulances, with data being collected from almost 400 patients. The study results now published in Neurology show that the brain-wave cap can recognise patients with a large ischaemic stroke with a high level of accuracy. “This study shows that the brain-wave cap performs well in an ambulance setting,” Coutinho added. “For example, with the measurements of the cap, we can distinguish between a large or small ischaemic stroke.”

Recanalization status by FPR and P-to-R time was significantly and independently associated with functional outcome after mechanical thrombectomy. FPR was associated with functional outcome in a time-dependent manner. Even for patients who achieved FPR, their functional outcome might not be favorable if the P-to-R time was > 30 min. To secure the benefit from FPR, recanalization should be as rapid as possible even in cases with FPR.

Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging. Devices and tools are rapidly evolving. We aimed to gain insight into preferences and global perspectives on the usage of endovascular tools in treating MeVOs.

Aneurysms with WE present multiple histopathological changes that may contribute to wall disruption and represent the pathophysiological basis of radiological WE. Moreover, WE is an independent diagnostic predictor of aneurysm symptoms and rupture.