Neurovascular Intervention

With accurate lesion segmentation in mind, the USC-led expansion built upon the Anatomical Tracings of Lesion After Stroke (ATLAS), version 1.2. ATLAS 1.2 contained hundreds of stroke T1w MRIs and manually segmented lesion masks, and though the intentions were good the results were less so. Many algorithms developed using that dataset did not yield acceptable accuracy or were improperly invalidated, limiting the usefulness of the data in stroke research.

Despite ongoing developments, prevention and treatment of atherothrombotic cardiovascular disease remains a common challenge. Antithrombotic options for cardiocerebrovascular disease prevention involves a choice between dual antiplatelet therapy (DAPT) and dual pathway inhibition (DPI), which includes an antiplatelet agent and a reduced dose anticoagulant agent. In selected patients at high risk of event and low risk of bleeding, especially those undergoing recent and complex coronary revascularization using drug-eluting stents (DES) (“revascularization-driven effect”), DAPT is superior to single antiplatelet therapy with aspirin. DPI involves a wider potential range of treatment and is superior to single antiplatelet therapy with aspirin, particularly in patients with atherothrombotic involvement in different vascular beds both previously revascularized and not (“no revascularization-driven effect”). After nearly thirty years of randomized trials and observational registries, we have sufficient data to customize antithrombotic therapy in patients at high cardiovascular risk. Therefore, “atherothrombosis stakeholders” must identify the right patient for the right therapy to ensure high levels of efficacy and safety with the best of current therapeutic opportunities.

Carotid artery stenosis, also called carotid artery disease, is a condition that can lead to stroke. When you have carotid artery stenosis, a substance called plaque builds up and blocks the normal flow of blood in your artery. One treatment option for carotid artery stenosis is a surgical procedure call endarterectomy.

Our study results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

This study identified a novel subset of CD8+ regulatory-like T cells, or CD8+TRLs, as “first responders” to stroke. Attracted to the site of ischemic injury by a unique “homing” signal released by dying brain cells, CD8+TRLs reach the brain within 24 hours after stroke onset, where they release molecules that provide direct neuroprotective effects, as well as limit inflammation and secondary brain damage.

Outcomes of ET among older adults are better than among the older adults treated with ST. The lower NIHSS at the admission, shorter duration of ET, and better TICI could be the predictors of good ET outcome, while HTN could be a predictor of poor outcome. Better patient selection and more studies of ET in the elderly are needed.

The study, “AI Based Gaze Deviation Detection to Aid LVO Diagnosis in NCCT,” used AI algorithms to detect gaze deviation from a non-contrast computed tomography (NCCT scan). These scans predict if a patient is having an LVO, which is a type of ischemic stroke that occurs when a major artery in the brain is blocked. If a patient is having this type of stroke, they can receive EVT to treat it.

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Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.

Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still fail to achieve reperfusion of the affected vascular territory and an even larger portion of patients who have poor functional outcomes in spite of successful recanalization. There are no guidelines on how to treat these patients when such failures occur. In an effort to understand the underpinnings of how failed thrombectomy occurs, we extensively reviewed the current literature in clot properties, vascular access problems, stroke pathogenic mechanisms, embolic complications, failed procedures and pre-procedural imaging.

PharmStars, a digital health accelerator, graduated its latest cohort of startups, each of them developing a solution addressing some aspect of neurological disease. The accelerator is accepting applications for the next group of startups for the fall program. The theme is innovations in real-world evidence.

Adding a polygenic risk score (PRS) as an additional risk-enhancing factor in the current standard-of-care atherosclerotic cardiovascular disease Pooled Cohort Equation (PCE) risk assessment would provide cost savings to U.S. healthcare systems.

In 2020, the largest U.S. health care payer, the Centers for Medicare & Medicaid Services (CMS), established payment for artificial intelligence (AI) through two different systems in the Medicare Physician Fee Schedule (MPFS) and the Inpatient Prospective Payment System (IPPS). Within the MPFS, a new Current Procedural Terminology code was valued for an AI tool for diagnosis of diabetic retinopathy, IDx-RX. In the IPPS, Medicare established a New Technology Add-on Payment for Viz.ai software, an AI algorithm that facilitates diagnosis and treatment of large-vessel occlusion strokes.

The US Centers for Medicare & Medicaid Services (CMS) recently said it would pay for use of two AI systems: one that can diagnose a complication of diabetes that causes blindness, and another that alerts a specialist when a brain scan suggests a patient has suffered a stroke. The decisions are notable for more than just Medicare and Medicaid patients—they could help drive much wider use of AI in health care.

About 85 percent of strokes are ischemic. They occur when a blood vessel becomes blocked, hindering blood flow to the brain. Many ischemic strokes don’t cause headaches, but are associated with other telltale symptoms, such as drooping on one side of the face, weakness in an arm, or leg or difficulty speaking. Some types of ischemic strokes, however, can produce a splitting headache. These include arterial dissections—tears in the wall of an artery supplying the brain that leads to a blockage—and cerebral venous sinus thrombosis, which is a blockage in veins draining blood from the brain.

Tenecteplase (TNK), a common clot-busting drug used in people suffering from a heart attack, is a safe and effective treatment for those in the midst of acute ischemic stroke, reports a University of Alberta research team involved in the largest stroke clinical trial in Canadian history.

The rising cases of stroke and the recent pandemic upheaval have demonstrated the need for improved healthcare delivery. Dealing with the challenge involves both increasing awareness to prevent such incidences, and also improving infrastructure.

NeuroVasc Technologies recently announced that the first patient has been treated in its US investigational device exemption (IDE) clinical study, the ENVI randomised controlled trial (RCT). The ENVI RCT will evaluate the safety and efficacy of the company’s ENVI-SR stent retriever, which is intended for the treatment of acute ischaemic stroke to reduce disability by removing blood clots in patients with large vessel occlusion (LVO) stroke.

A strategy employing aspiration thrombectomy as the front-line approach achieves recanalization rates similar to those seen when stent retrievers are used as the first option in patients with acute ischemic strokes caused by large vessel occlusions, the French ASTER trial shows. But questions remain regarding cost, effects on clinical outcomes, and applicability to other populations.

The agency called for the hold because of three serious adverse events involving study participants experiencing clinically significant, transient hypotension, also known as low blood pressure, shortly after beginning an intravenous treatment. Because the three patients recovered shortly after the IV infusion was stopped, the company is investigating the IV bags as a possible cause, but is also considering reduced doses and IV infusion times to resolve the issue.

Algernon Pharmaceuticals is working to complete an intravenous formulation (IVF) that will be used in its Phase 1 DMT study investigating the compound’s efficacy as a treatment for stroke patients.

Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still fail to achieve reperfusion of the affected vascular territory and an even larger portion of patients who have poor functional outcomes in spite of successful recanalization. There are no guidelines on how to treat these patients when such failures occur.

A silent stroke has no symptoms. Strokes can happen when a blood clot obstructs the blood vessels in your brain. The blockage stops the blood and oxygen from getting to the parts of your brain, causing brain cells to die. Depending on where the clot is located, it will cause symptoms like weakness or problems with your vision. But a silent stroke is small enough and usually occurs in a part of your brain that doesn’t control any vital functions or major movement. This is why it’s called a silent stroke. Here is some important information on both silent strokes and traditional strokes that you should be aware of.