Neurovascular Intervention

Fifty-four percent of the improvement in functional outcome after successful recanalization is apparent in NIHSS at 24 hours, 75% in NIHSS at hospital discharge. Other unknown factors not apparent in NIHSS at the 2 time points investigated account for the remaining effect on long term outcome, suggesting, among others, clinical relevance of delayed neurological improvement and deterioration.

Despite stroke being one of the biggest killers in economically developed countries, there are currently few options for the consequences of stroke. One of the most severe consequences of stroke is neuronal death, which is caused by a lack of oxygen during the arterial blockade and the inflammation that follows the restoration of blood flow.

Stroke is one of the main causes of death in economically developed countries. The most common form of stroke is ischemic stroke, which happens when a blockage in one of the cerebral arteries restricts blood flow to the brain. There are currently few treatment options available for the consequences of stroke, one of the most severe of which is neuronal death, caused by the lack of oxygen during the arterial blockade and the inflammation that follows the restoration of blood flow. The damage caused by these events is responsible for much of the long-term ill health and incapacity experienced by stroke survivors.

Occurrence of DR is closely associated with tissue outcome and functional independence. DR may be an independent prognostic parameter, suggesting it as a potential outcome surrogate for medical rescue therapies.

Fiehler began with a nod to the undoubted relevance that time to recanalisation has, referencing previous studies that have demonstrated the direct influence reperfusion times have on computed tomography (CT) perfusion imaging outcomes. “We definitely have a time dependency and we all know that complete reperfusion is the desired outcome for thrombectomy,” he said. “And, Osama Zaidat’s group [Mercy Health, Toledo, USA] made it clear, really for the first time, that it is also about having complete reperfusion as early as possible.”

Reducing the time between the stroke symptom onset to intervention is the key to reduce irreversible brain damage. Telestroke with integration of AI, Mobile stroke units, Neuro ED, Direct patient transfer to angio suite are some of the important concepts that are being evaluated to optimize the stroke management workflow. Use of perfusion studies are helpful to assess the extent of salvageable brain tissue that might benefit from reperfusion therapy in patient presenting beyond 6 hours of symptom onset. Significant advancements in aspiration catheter and stent retriever designs have allowed a faster and safer reperfusion after mechanical thrombectomy.

Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows

Background Drug coated balloon (DCB) angioplasty can provide sustained anti-restenotic efficacy without the limitations of permanent vascular implantation and is presumably ideal for treating intracranial atherosclerotic disease. However, the safety of paclitaxel in the neurovasculature remains a concern.

Intracranial atherosclerotic stenosis (ICAS) is one of the most frequent causes of stroke worldwide and confers one of the greatest risks of recurrent stroke compared with other causes of stroke. Asymptomatic ICAS is increasingly recognised as a risk factor for silent brain infarctions and dementia, magnifying the global burden of ICAS. Although ICAS is a lumen-based diagnosis, newer diagnostic imaging techniques, such as high-resolution MRI, might help to identify high-risk population subgroups to test interventions that might reduce the risk of stroke recurrence. Secondary stroke prevention in patients with ICAS currently consists of intensive management of modifiable risk factors and dual antiplatelet therapy, which is subsequently reduced to aspirin alone.

After treatment with DCB angioplasty, complications were no different from those after standard balloon angioplasty or stenting. This study suggests that DCB angioplasty may be a safe and effective procedure for intracranial arterial stenosis.

In patients with severely calcified coronary artery lesions, preparation with a super high-pressure balloon versus a scoring balloon was associated with comparable stent expansion on intravascular imaging and a trend towards improved angiographic performance.

The recently published Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that statins exert a marginally beneficial effect on stroke prevention in patients with a history of cerebrovascular disease. Interestingly, the magnitude of the beneficial effect shown in this study is smaller than in similar studies, which included patients without a history of cerebrovascular disease. In SPARCL, an increased occurrence of hemorrhagic strokes in patients on statin treatment was observed, an effect that was also earlier described in the Heart Protection Study in a subgroup of patients with a history of cerebrovascular disease.

Statins increase the risk of HS in a medication dose- and type of index brain vascular injury-dependent manner; PCSK9Is do not increase HS risk. PCSK9Is may be a preferred lipid-lowering medication class in patients with elevated HS risk, including patients with prior HS.

Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events.

Intracranial atherosclerotic disease is the most common cause of stroke worldwide. The past decade of research in intracranial atherosclerotic disease has led to marginally improved medical therapy, yet recurrent stroke rates remain high. Despite the enormous global burden of disease, we lack effective clinical acumen to appropriately risk stratify patients and optimize the therapeutic approach. In this review, we examine our current understanding of intracranial atherosclerotic disease pathophysiology, imaging techniques, lifestyle, medical therapy, and endovascular strategies.

Patients with MeVO achieved similar 90-day mRS, SICH rate and successful recanalisation rate after EVT compared with patients with LVO. Several independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined, which should be highly considered in MeVO stroke management.

Intracranial atherosclerotic disease is the most common cause of stroke worldwide. The past decade of research in intracranial atherosclerotic disease has led to marginally improved medical therapy, yet recurrent stroke rates remain high. Despite the enormous global burden of disease, we lack effective clinical acumen to appropriately risk stratify patients and optimize the therapeutic approach. In this review, we examine our current understanding of intracranial atherosclerotic disease pathophysiology, imaging techniques, lifestyle, medical therapy, and endovascular strategies. We also present steps needed to incorporate imaging and serum biomarkers in intracranial atherosclerotic disease to facilitate individualized treatment plans and realize the potential of precision medicine in this global health disorder. Trials in the next decade should be targeted to help us gain a better understanding of key mechanisms and disease course with an ultimate goal of improving long‐term patient outcomes.

The blood type describes the variety of chemicals in the red blood cells. The most familiar blood types are A, B, AB, and O. However, there could be subtle variations due to mutation in genes that may make a person susceptible to certain diseases.

Strokes are among the leading causes of death worldwide. Ischemic stroke, due to plaque or other buildup blocking blood flow to the brain, is the most common type. Although ischemic stroke is treatable, current methods have severe shortcomings with high mortality rates. Clot retrieval devices, for example, can result in physically damaged vessels and death. This study aims to create blood clots that are representative of those found in vivo and demonstrate a new method of removing them.

Flow diverters with or without selective adjunctive coiling for the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery may be safe and effective with good occlusion effects not inferior to those of stent-assisted coiling and stenting alone even though the long-term effect still warrants confirmation.

Remote ischemic conditioning (RIC), a process that involves repeated occlusion/release cycles on bilateral upper limb arteries, is superior to usual care in optimizing neurologic function for patients who have had an acute moderate ischemic stroke, new research suggests.

Endovascular approaches for distal occlusions can be more challenging and are associated with a higher risk of periprocedural complications as a result of a longer path to the occlusion and a smaller vessel diameter.1 This study was undertaken to assess the safety and reperfusion success of aspiration thrombectomy in patients with these occlusions.

Newly compiled data evaluated by researchers in the Department of Neurology and the Smidt Heart Institute at Cedars-Sinai shows that COVID-19 vaccines do not raise stroke risk—but that severe COVID-19 infection does. Physician-scientists hope this growing body of evidence, highlighted today in an editorial in the journal Neurology, will ease the minds of individuals still hesitant to be vaccinated.

When executed consistently and interpreted correctly, RAPID automated CT perfusion studies can identify appropriate candidates for thrombectomy.