Neurovascular Intervention

Not only do women have a higher lifetime risk of stroke, but more women die from strokes each year than men. And while risk factors such as smoking, diabetes and being obese don’t discriminate against age or sex, some lesser-known risks may be more likely to affect women. Find out your stroke risk, as well as ways to prevent or reduce your chance of stroke.

Stent retriever thrombectomy is a pre-eminent treatment modality for large vessel ischaemic stroke. Simulation of thrombectomy could help understand stent and clot mechanics in failed cases and provide a digital testbed for the development of new, safer devices. Here, we present a novel, in silico thrombectomy method using a hybrid finite-element analysis (FEA) and smoothed particle hydrodynamics (SPH). Inspired by its biological structure and components, the blood clot was modelled with the hybrid FEA–SPH method.

A blockage of a blood vessel in your brain or neck, known as an ischemic stroke, is the most common stroke causes and is responsible for about 80% of strokes. The occurrence of this blockage comes from 3 conditions: the formation of a clot within a blood vessel of the brain or neck, known as thrombosis; the movement of a clot from another part of your body such as the heart to your brain, known as embolism; or a severe narrowing of an artery in or leading to your brain, known as stenosis.

If high blood pressure, which can cause haemorrhagic stroke, is a problem that also affects young patients, ischemic stroke mainly affects elderly patients and depends on heart rhythm disorders, or on the presence of atherosclerotic plaques in the arteries carrying blood to the brain, or on vascular risk factors such as diabetes and hypertension itself. In any case, it is of fundamental importance that patients with these problems have access to an adequate prevention programme and keep their risk factors under control by means of periodic check-ups: from blood pressure, to glycaemia and cholesterol levels, to possible arrhythmia problems.

Aspiration thrombectomy is a widely accepted treatment option for large vessel occlusion (LVO). The MIVI aspiration system has a novel design to maximize the lumen size. We present the results of our initial experience with this innovative aspiration thrombectomy system.

The present study investigated the influence of low-dose red wine or ethanol consumption on the inflammatory response following transient focal cerebral ischemia. There are several new findings from this study. First, both red wine and ethanol decreased brain damage and improved neurological function following transient focal cerebral ischemia. Second, red wine suppressed ischemia-induced expression of ICAM-1, P-selectin and L-selectin and ethanol delineated ischemia-induced expression of ICAM-1, E-selectin and L-selectin. Third, both red wine and ethanol reduced ischemia-induced elaboration of IL-1α and CCL-3. Fourth, red wine significantly suppressed ischemia-induced infiltration of neutrophils. Fifth, both red wine and ethanol decreased ischemia-induced microglial activation. We speculate that chronic consumption of low-dose alcohol confers a neuroprotective effect against cerebral I/R injury by reducing several factors of the inflammatory response.

Ischemic stroke is one of the leading causes of permanent disability and death in adults worldwide. Apoptosis is a major element contributing to post-ischemic neuronal death. We previously found that low-dose alcohol consumption (LAC) protects against neuronal apoptosis in the peri-infarct cortex following transient focal cerebral ischemia.

Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

Tenecteplase is a tissue plasminogen activator (tPA) developed from modifications of natural human tPA complementary DNA. It binds to fibrin-rich clots and cleaves the Arg/Val bond in plasminogen to form plasmin, which then degrades the fibrin matrix of the thrombus, thereby exerting its thrombolytic action. For years, evidence has mounted that tenecteplase could offer similar benefit to alteplase, the only FDA-approved thrombolytic medication for AIS; however, large clinical studies confirming this benefit were still needed.

In this prespecified subgroup of a randomized trial, we found no evidence that occlusion location can inform intravenous alteplase decisions in endovascular treatment eligible patients directly presenting at endovascular treatment capable centers. Future studies are needed to confirm our findings.

In this study of patients evaluated on MSUs in 2 cities, a ML algorithm was able to accurately and rapidly detect LVO using prehospital CTA acquisitions.

In conclusion, a newly developed nomogram for predicting a poor prognosis at 3 months showed that an older age, diabetes, a higher NIHSS, a poor collateral circulation, a lower ASPECTS at baseline, a lower mTICI score, and in particular, a higher level of CDE were associated with a poor prognosis in AIS patients eligible for EVT. Remarkably, for the first time to our knowledge, CDE was also found to be an important mediator of a poor prognosis in AIS patients. Future multicenter prospective studies are needed to validate the findings in different ethnic groups.

PUFAs have cardiovascular benefits with a possible reduction in the incidence of all cause cardiac mortality in CAD. Since PUFAs have with minimal adverse effects, it may be considered in conjunction with optimal medical therapy for CAD. Patients who are refractory or intolerant to statins secondary to rhabdomyolysis or other associated side effects may benefit from PUFA consumption for cholesterol reduction. Since they decrease triglycerides and VLDL while increasing HDL, the overall cardiovascular risk profile for atherosclerosis is improved.
However, some studies have shown no beneficial effects of PUFAs for CAD, perhaps limited by the doses used. Therefore, further studies are necessary to unequivocally define the potential benefits for CAD. The final decision to administer PUFAs for cardiovascular protection in CAD should be based on overall individual patient characteristics and consideration of the potential merits.

Medium vessel occlusions (MeVOs, ie, M2, M3, A2, A3, P2, and P3 segment occlusions) are increasingly recognized as a target for endovascular treatment in acute ischemic stroke. It is important to note that not all MeVOs are equal. Primary MeVOs occur de novo with the underlying mechanisms being very similar to large vessel occlusion strokes. Secondary MeVOs arise from large vessel occlusions through clot migration or fragmentation, either spontaneously or following treatment with intravenous thrombolysis or endovascular treatment.

Using a customized light-conducting microcatheter and illumination module, the hydrogel was implanted in an in vitro silicone aneurysm model. Specifically, in situ fast and controllable injection and photopolymerization of the developed hydrogel is shown to be feasible in this work. Finally, the precursor and the polymerized hydrogel exhibit no toxicity for the endothelial cells. Photopolymerizable hydrogels are expected to be promising candidates for future intracranial aneurysm treatments.

The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.

Dual antiplatelet therapy initiated within 24 hours of symptom onset and continued for 3 weeks reduces stroke risk in select patients with high-risk TIA and minor stroke. For select patients with disabling AIS, thrombolysis within 4.5 hours and mechanical thrombectomy within 24 hours after symptom onset improves functional outcomes.

Two recent nationwide database analyses have yielded interesting insights for the management of patients with acute ischemic stroke. One showed that hospital transfer is associated with poorer outcomes, while the other demonstrated that stroke care since the launch of the “Target: Stroke” quality initiative by the American Heart Association has been associated with faster thrombolytic treatment and slightly lower one-year readmission rates.

If that's not enough to get feline fans purring, a 2009 study published in the Journal of Vascular and Interventional Neurology certainly will. In it, scientists found that cat ownership can be beneficial to our health in a number of ways. Most significantly, researchers observed a decreased risk for death due to heart attack and all cardiovascular diseases (including stroke) among persons with cats.

More bad news for diet soda lovers: Drinking two or more of any kind of artificially sweetened drinks a day is linked to an increased risk of clot-based strokes, heart attacks and early death in women over 50, according to a new study by the American Heart Association and American Stroke Association. The risks were highest for women with no history of heart disease or diabetes and women who were obese or African-American.

BrainQ today announced that the first patient has been enrolled at MedStar National Rehabilitation Hospital in its pivotal, randomized, double-blind, multicenter trial. The trial is evaluating its frequency-tuned electromagnetic field treatment in facilitating recovery in individuals with moderately-severe ischemic stroke.

With the larger variety of methods employed, recanalization therapy is increasingly used to treat acute ischemic stroke resulting in about one-third of patients undergoing early neurological deterioration, in which ischemia/reperfusion injuries are the main cause, leading to increases in the infarcted area, the no-reflow phenomenon, or hemorrhagic transformation. Efficient prevention or treatment of these injuries depends on extensive knowledge of the involved mechanisms.

Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.

No preclinical model is a perfect surrogate; however, models available can answer important questions during device development and have to date been successful in delivering efficacious and safe devices producing excellent clinical outcomes. This review reflects on the developments of preclinical modeling of mechanical thrombectomy with particular focus on clinical translation, as well as articulate existing gaps requiring additional research.