Neurovascular Intervention

Ischemic stroke, resulting from insufficient blood supply to the brain, is among the leading causes of death and disability worldwide. A potentially severe complication of the disease itself or its treatment aiming to restore optimal blood flow is hemorrhagic transformation (HT) increasing morbidity and mortality. Detailed summaries can be found in the literature on the pathophysiological background of hemorrhagic transformation, the potential clinical risk factors increasing its chance, and the different biomarkers expected to help in its prediction and clinical outcome. Clinicopathological studies also contribute to the improvement in our knowledge of hemorrhagic transformation. We summarized the clinical risk factors of the hemorrhagic transformation of ischemic strokes in terms of risk reduction and collected the most promising biomarkers in the field.

There is Level 1 evidence around the management of symptomatic carotid artery stenosis, with superiority of intervention compared to medical therapy for stroke prevention,” Lim and colleagues state in their abstract. “While, long term, the efficacy of carotid intervention has been clearly documented, the natural history on symptomatic patients with ipsilateral carotid stenosis has not been well described in the contemporary era—when best medical therapy has evolved. With an ageing population and increase in frailty, information on medical management alone should be discussed with patients to assist in clinical decision-making.

The latest investment extends an earlier funding round, bringing the total raised to $82 million. Novo Holdings, the controlling shareholder of Novo Nordisk, joined returning investors.

The impact of IS on individuals and healthcare systems underscores the urgent need for groundbreaking early intervention strategies and refined prognostic tools. Currently, there is a notable absence of a reliable, user-friendly tools for assessing and accurately predicting IS outcomes. This deficiency represents a significant hurdle in our diagnostic and prognostic capabilities. To advance IS management, it is crucial to deepen our understanding of the complex mechanisms driving IS progression and recovery. These advancements are essential to enhance patient outcomes and alleviate the societal burden of IS.

A brain aneurysm, also known as an intracranial or cerebral aneurysm, occurs when a weak spot in the wall of a blood vessel in the brain bulges and fills with blood. It resembles a small, berry-shaped sac hanging from the artery. When a brain aneurysm ruptures or leaks, it can cause a life-threatening condition known as a hemorrhagic stroke, which requires immediate medical attention.

Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.

FDSM were safe with satisfactory effectiveness for intracranial ANs. More specific investigations are warranted to explore their performance in ANs beyond the ICA and optimal antiplatelet therapy.

For patients with symptomatic intracranial atherosclerotic stenosis (sICAS), balloon angioplasty plus aggressive medical management is associated with a lower risk for a composite outcome of any stroke or death, according to a study published online Sept. 5 in the Journal of the American Medical Association.

In patients with sICAS, balloon angioplasty plus aggressive medical management, compared with aggressive medical management alone, statistically significantly lowered the risk of a composite outcome of any stroke or death within 30 days or an ischemic stroke or revascularization of the qualifying artery after 30 days through 12 months. The findings suggest that balloon angioplasty plus aggressive medical management may be an effective treatment for sICAS, although the risk of stroke or death within 30 days of balloon angioplasty should be considered in clinical practice.

Our findings demonstrated that LP(a) was an independent risk factor for END post-thrombolysis and that LP(a) level≥ 300 mg/L could be associated with END post-thrombolysis in this study population.

The findings, reported Sept. 1 at the European Society of Cardiology meeting and published in the Journal of the American College of Cardiology, provide inconclusive data about whether atrial fibrillation screening lowers stroke rates. The COVID pandemic led to an early halt of the study before fully enrolling, so it did not have enough participants to establish definitive results about stroke.

Inari Medical is updating use instructions for the ClotTriever XL Catheter after discovering serious adverse events caused when the device becomes entrapped or blocks the lung arteries (pulmonary emboli). These events occurred in patients who had:

• The catheter inserted through the vein above the collarbone (venous access through the jugular vein)
• A clot (thrombus) that is tough, scarred (fibrotic), thick and dense (organized), and/or attached to the vessel (adherent)
  A clot formed in the blood vessel by tumor cells (tumor thrombus)
• An extremely large clot that can’t be removed in pieces (excessive clot volume with an inability to sequentially remove it in pieces).

Using peptides replicating the membrane-distal portion of CD31, which is prominently exposed on the inner side of healthy vessels, can simulate the surface of a healthy endothelium. This approach effectively prevents the deposition and activation of blood platelets and leukocytes, which are abnormally prolonged by the presence of a foreign body at sites of endovascular stent implantation, and promotes the acquisition of physiological phenotype by the ECs covering the surface.

Although the application of low-profile stents has greatly expanded the possibilities in treating intracranial aneurysms, improving the performance of stents with regard to biocompatibility is still necessary and can be achieved by implant surface modifications. In this in vitro study, albumin and heparin coatings reduced the thrombogenicity of the stents in comparison with the bare metal stent. Therefore, a surface that decreases platelet and coagulation activation can represent crucial progress in the treatment of intracranial aneurysms.

The Supernova stent retriever’s innovative design enhances the capture and removal of hard fibrin-rich (white) clots, which tend to present more in non-Caucasian populations. The Neutron aspiration catheter, with its enhanced kink resistance, ensures consistent aspiration power to effectively remove blood clots.

CD31-coated surfaces promoted the acquisition of a physiologic endothelial cell phenotype and rapid coverage at a significantly higher extent as compared to bare metallic surfaces in vitro. Nitinol and cobalt-chromium stents coated with CD31-mimetic peptides were rapidly integrated within the arterial wall in vivo without thrombo-inflammatory signs up to 30 days after implantation.

Oral health and the level of oral hygiene in patients hospitalized because of ischemic stroke, in comparison with that in a healthy population, is not satisfactory. Active interdisciplinary collaboration between various medical specialists in the therapy of patients with general illnesses, including stroke, is strongly recommended.

Lp(a) does its damage by connecting with cholesterol and causing fatty material builds up in the artery walls. It is not the same as LDL cholesterol, but rather an LDL-like particle that contains apo(a) linked to a single apoB molecule. Bittner cited work in the Journal of the American College of Cardiology that found while Lp(a) particles were less abundant than LDL particles, when present Lp(a) is far more dangerous: about 6 times more atherogenic than LDL.

The endothelial glycocalyx (GCX), located on the luminal surface of vascular endothelial cells, is composed of glycoproteins, proteoglycans, and glycosaminoglycans. It plays a pivotal role in maintaining blood–brain barrier (BBB) integrity and vascular health within the central nervous system (CNS), influencing critical processes such as blood flow regulation, inflammation modulation, and vascular permeability. While the GCX is ubiquitously expressed on the surface of every cell in the body, the GCX at the BBB is highly specialized, with a distinct composition of glycans, physical structure, and surface charge when compared to GCX elsewhere in the body.

The SOFAST study assessed the Sofia flow plus aspiration catheter in the treatment of acute ischaemic stroke caused by large vessel occlusion. It involved 108 patients, and aimed to confirm the catheter’s safety, speed and effectiveness in revascularisation.

“The publications on our NET micro-filtration technology highlight the significant value it brings to patients,” said Gustavo Prado, vice president of Development and Operations at Vesalio. “Both studies show higher first-pass rates and fewer distal emboli compared to competitors, with notable success in preventing emboli larger than 1mm. As clinical research consistently reiterates the importance of rapid, high-quality recanalisation for better patient outcomes, these findings are very encouraging.”

According to the company, Sensome’s clot-sensing guidewire integrates the world’s smallest electrical impedance sensor with machine learning, and is being developed to instantly identify clot composition and clot length, in real time, in order to inform treatment approaches during mechanical thrombectomy. The smart guidewire has the potential to be the first device to accurately identify clot length in fully occluded arteries in situ, as well as the first to characterise clots that remain in the body after failed removal attempts, the release adds.

Astrocytes, star-shaped glial cells in the brain, play a crucial role in learning and memory by regulating synaptic plasticity. Researchers developed a biophysical model showing how astrocytes interact with nerve cells to facilitate rapid adaptation to new information. The study reveals that astrocyte dysfunction can significantly impair cognitive processes. This research bridges the gap between theoretical models of plasticity and experimental findings, offering new therapeutic possibilities targeting astrocytes to enhance cognitive functions.

Anaconda Biomed S.L., a medical technology company developing next-generation thrombectomy systems, has announced that it has received conditional IDE approval from the U.S. Food and Drug Administration to begin the ATHENA study of its ANA Funnel Catheter. The prospective, randomised, dual-arm, multi-center study will assess the safety and effectiveness of mechanical thrombectomy using the ANA5 Advanced Neurovascular Access (ANA Funnel Catheter) in combination with a stent retriever.

There are preventative measures you can take to reduce your risk of having a stroke. Expert provides knowledge on what happens in the body when a stroke occurs, and insight on the recovery process.