Neurovascular Intervention

Scientific research has found that the transition to daylight saving time, which takes place Sunday, could be linked to heart disease and strokes, according to a report from the American Heart Association. Daylight saving time is intended to extend the use of natural daylight as we transition to the summer months, but the annual ritual shows an increase in the incidents of heart disease and stroke during the changeover.

Mechanical thrombectomy (MT) has been established as a standard of care for patients with acute ischemic stroke for the past five years. However, the direct benefits of this treatment in patients with baseline disability remains unclear. This study aims to elucidate the cost impact of performing MT on patients with moderate-to-severe baseline disability to work towards an optimized system of care for acute ischemic stroke.

Mechanical thrombectomy (MT) is an effective treatment for acute cerebral large vessel occlusion (LVO). Complete recanalization of vessels in a single procedure is defined as the first-pass effect (FPE) and is associated with good prognosis. In this study, angiographic clot protruding sign termed the “claw sign,” was examined as candidate preoperative imaging factor for predicting the FPE.

Characterization of the clot occluding the arteries in acute ischemic stroke received ample attention, in terms of elucidating the relationship between the clot composition, its etiology and its amenability for pharmacological treatment and mechanical thrombectomy approaches. Traditional analytical techniques such as conventional 2D histopathology or electron microscopy sample only small parts of the clot. Visualization and analysis in 3D are necessary to depict and comprehend the overall organization of the clot. The aim of this study is to investigate the potential of microCT for characterizing the clot composition, structure, and organization.

This study shows that sex-specific underlying biological mechanisms associated with stroke onset could be due to differences in biological age acceleration between men and women.

“It is plausible that robotically performed neurointerventional procedures will eventually benefit patients and reduce occupational hazards for staff; however, there is no high-level efficacy and safety evidence to support this assertion,” Booth, Crinnion et al write in JNIS. “If robust efficacy and safety evidence emerges, and if proved to be cost-effective, one potential use would be for a fully functioning platform to perform teleoperated intervention—which, if applied to MT [mechanical thrombectomy] in stroke, would accelerate the treatment of eligible patients in locations that are at a considerable distance from the operator.

Tandem lesions with CFFT were successfully treated by advancing the BGC directly distal to the CFFT. The CFFT consequently moved to the ECA. This strategy may be effective for hyperacute tandem lesions with CFFT. We also showed that CFFT-induced cerebral infarction may develop as cancer-related cerebral infarction.

Thrombi retrieved from AF patients with prior AC contained more fibrins, more platelets and fewer RBCs compared with those of NAC patients. A trend of higher successful reperfusion rate was observed in AC patients but failed to reach statistical significance.

Although mechanical clot removal is known to improve stroke recovery in adults, children have not been included in previous research. This study compared post-stroke disability between children who received the procedure and those who did not to explore whether mechanical clot removal may be beneficial for children after severe stroke.

In a Phase 2a clinical trial in China, the clot busting medication tenecteplase was effective in restoring blood flow to the brain without symptomatic brain bleeding. Blood flow was safely restored to a small group of ischemic stroke patients with large vessel occlusion, at 4.5 to 24 hours from time of last-seen-well using tenecteplase, therefore, larger direct comparison, clinical trials to validate this approach are needed. Researchers say their findings indicate tenecteplase may someday extend the window for stroke treatment from 4.5 to 24 hours.

Taurine is a semi-essential, the most abundant free amino acid in the human body, with a six times higher concentration in platelets than any other amino acid. It is highly beneficial for the organism, has many therapeutic actions, and is currently approved for heart failure treatment in Japan. Taurine has been repeatedly reported to elicit an inhibitory action on platelet activation and aggregation, sustained by in vivo, ex vivo, and in vitro animal and human studies. Taurine showed effectiveness in several pathologies involving thrombotic diathesis, such as diabetes, traumatic brain injury, acute ischemic stroke, and others. As human prospective studies on thrombosis outcome are very difficult to carry out, there is an obvious need to validate existing findings, and bring new compelling data about the mechanisms underlying taurine and derivatives antiplatelet action and their antithrombotic potential.

There was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.

Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.

Women between the ages of 18 to 45 are at a greater risk of having an ischemic stroke than men, according to a new review looking at sex differences in stroke rate. Ischemic strokes occur when blood vessels are blocked, cutting off essential nutrients and oxygen to the brain. Within minutes, brain cells can begin to die off. The most common reason is because of a blood clot or fatty buildup known as plaque.

Half of patients with disabling ischemic stroke recovered within 18 months, and recovery was greatest within 6 months. Significant predictors of recovery included the severity of the index stroke and no history of ischemic stroke, peripheral artery disease, or diabetes.

A biochemical model of platelet activation and aggregation is developed to predict thrombus size and shape at the site of vascular injury. Computational fluid dynamics using the finite volume method is employed to compute the velocity and pressure fields which are influenced by the growing thrombi. The passive transport of platelets, agonists, the platelet activation kinetics, their adhesion to the growing thrombi and embolization of platelets are solved by a fully coupled set of convection–diffusion–reaction equations.

The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression.

According to a prespecified analysis of the BASKET-SMALL 2 trial, reperfusion with a drug-coated balloon in patients with CAD and small vessels may be noninferior to a drug-eluting stent, regardless of the indication for PCI.

In a recent trial, drug-eluting stents (DES) were observed to minimize the risks of in-stent restenosis (ISR) and ischemic stroke recurrence in patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS) compared to bare-metal stents (BMS). This study was conducted by Baixue Jia and the team, findings of which were published in the journal JAMA Neurology on 4th January 2022.

In patients with LTB, the NeVa MTD was safe and associated with high rates of vessel recanalisation and thrombus removal. The concomitant use of vacuum-assisted aspiration has potential to improve the effectiveness and safety of the technique.

The more healthful lifestyle factors you can rack up, the lower your risk of stroke. In fact, merely being physically active can cut your stroke risk by up to 30 percent. For every extra serving of fruits or vegetables you have per day, your risk drops by 6 percent.

Overall, DES resulted in a reduced risk of ISR after one year compared to BMS with similar procedural risk of stroke or death. Notably, most arteries stented in the study were associated with the posterior circulation, which only receives one-fifth of cerebral blood flow; therefore, it is unknown whether these results are generalizable to the anterior circulation.

This trial found that, compared with BMSs, DESs reduced the risks of ISR and ischemic stroke recurrence in patients with symptomatic high-grade ICAS. Further investigation into the safety and efficacy of DESs is warranted.

While tissue-type plasminogen activator (tPA) is currently the standard "clot-busting" drug used to treat patients with acute ischemic stroke, another new option for treatment is now under clinical study. Desmodus rotundus plasminogen activator (DSPA), an enzyme found in the saliva of vampire bats, may offer another therapeutic option instead of tPA, a current therapy for stroke. Animal research indicates that tPA may mediate neuronal death as well as increase systemic plasminogen consumption and fibrinogenolysis.

Stroke is a leading cause of death and disability worldwide with limited therapeutic options available for selected groups of patients. The susceptibility to stroke depends also on systemic parameters, and some stroke risk factors are modifiable, such as atrial fibrillation (AF) or hypertension. When considering new treatment strategies, it is important to remember that the consequences of stroke are not limited to the central nervous system (CNS) injury, but reach beyond the boundaries of the brain. We provide here a brief overview of the mechanisms of how the brain communicates with the body, focusing on the heart, immune system, and gut microbiota (GM).