Neurovascular Intervention

Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient’s preferences.

MindRhythm, a US medical technology company focused on preventing neurological injury in stroke, has announced the enrolment of the first patient in a multicentre trial. Through this trial, MindRhythm intends to demonstrate the effectiveness of its proprietary Harmony technology in rapidly identifying patients with large vessel occlusion (LVO) strokes, at the prehospital stage, for direct dispatch to a Comprehensive Stroke Center (CSC) hospital.

Vascular disease contributes to neurodegeneration, which is associated with decreased blood pressure in older humans. Plasmalogens, ether phospholipids produced by peroxisomes, are decreased in Alzheimer’s disease, Parkinson’s disease and other neurodegenerative disorders. However, the mechanistic links between ether phospholipids, blood pressure, and neurodegeneration are not fully understood. Here, we show that endothelium-derived ether phospholipids affect blood pressure, behavior, and neurodegeneration in mice.

The transcatheter Pipeline Flex embolization device has received a new FDA approval to cover what the medtech giant calls Shield Technology: a chemically bonded, synthetic coating that helps camouflage the metal implant from blood cells and hide it from the body’s typical responses to an invading object.
The coating also makes the device slipperier, allowing it to more easily slide through curving vasculature during placement and deploy with less force compared to earlier generations. Initial clinical data have shown zero major strokes in the arteries downstream from the implant site as well as no recurrence of the aneurysm itself, according to the company.

A national study led by Cedars-Sinai provides further support that a specialized stenting system for opening blocked brain arteries has a low rate of complications and may be as good or better than traditional medical therapy for certain patients with a stroke history.

Here we show that stents releasing exosomes derived from mesenchymal stem cells in the presence of reactive oxygen species enhance vascular healing in rats with renal ischaemia-reperfusion injury, promoting endothelial cell tube formation and proliferation, and impairing the migration of smooth muscle cells. Compared with drug-eluting stents and bare-metal stents, the exosome-coated stents accelerated re-endothelialization and decreased in-stent restenosis 28 days after implantation. We also show that exosome-eluting stents implanted in the abdominal aorta of rats with unilateral hindlimb ischaemia regulated macrophage polarization, reduced local vascular and systemic inflammation, and promoted muscle tissue repair.

In-stent restenosis (ISR) is one of the main limitations of percutaneous coronary intervention (PCI) therapy with drug-eluting stents (DES) implantation. The aim of this study was to determine if circulating microRNAs (miRNAs) have diagnostic capability for determining ISR in a cohort of matched patients. Blood samples were collected from 55 patients who underwent previously PCI and were readmitted for a new coronary angiography.

There are drug-eluting stents currently in use coated with drugs that discourage cell proliferation, but these anti-proliferative drugs also delay stent coverage by endothelial cells - which are the cells healthcare providers want to coat the stent.

To solve this problem, Cheng and his team developed a stent coating composed of exosomes derived from mesenchymal stem cells. Exosomes are tiny nano-sized sacs secreted by most cell types. The idea behind the coating was two-fold: first, since the exosomes are composed of materials not much different from cell membranes they 'camouflage' the stent to trick smooth muscle cells and the body's immune system. Second, the exosomes promote coverage of the stent by endothelial cells and, in the case of injury, travel downstream to the site to promote tissue repair.

Whether imaging findings translate into outcomes of clinical importance is often a point of contention in imaging-dependent medical specialties such as neurology and neurosurgery. As techniques and technologies for acute ischaemic stroke (AIS) thrombectomy continue to improve, whether some of these advances result in better patient outcomes deserve further investigation. Due to its strong correlation with clinical outcome, recanalisation is often regarded as an important surrogate marker for therapeutic activity in recent AIS thrombectomy trials. As higher rates of recanalisation led to concomitant improvements in patient outcomes, efforts to increase recanalisation rates, through improvements in catheters and thrombectomy techniques, have garnered increasing attention.

“This study suggested that, although rarely performed at comprehensive stroke centres, mechanical thrombectomy for posterior circulation DMVO is a safe and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.”

According to Aesculap, the DIR800 is an accessory for the Aesculap Aeos robotic digital microscope and is used in viewing intraoperative blood flow in the cerebral vascular area including, but not limited to, assessing cerebral aneurysm and vessel branch occlusion, as well as patency in neurosurgery. The company further states that it also aids in the visual assessment of intraoperative blood flow and vessel patency in bypass neurosurgical procedures.

Mechanical thrombectomy is now well - established first - line treatment for selected patients with large artery occlusions of the anterior circulation. However, number of technical and procedural issues remains open to assure optimal outcomes in majority of patients including those suffering from posterior circulation perfusion defects. This brief review addresses some of the open issues and refers to the ongoing trials to close the existing knowledge gaps.

Patients who survive aneurysmal subarachnoid hemorrhage (aSAH) are at risk for delayed neurological deficits (DND) and cerebral infarction. In this exploratory cohort comparison analysis, we compared in-hospital outcomes of aSAH patients administered a low-dose intravenous heparin (LDIVH) infusion (12 U/kg/h) vs those administered standard subcutaneous heparin (SQH) prophylaxis for deep vein thrombosis (DVT; 5000 U, 3 × daily).

In an earlier human trial (the ESCAPE-NA1 trial), NA1, a small peptide designed to save brain cells from death after stroke, showed mixed results when NA1 was administered to patients undergoing clot removal for severe stroke. Some patients in the trial also received the intravenous clot-busting medication tissue plasminogen activator (tPA), and these patients, in particular, showed a lack of improvement in functional outcomes from NA1.

Patient with suspected large-vessel occlusion stroke who were taken directly to the angiography suite, bypassing the emergency department, received endovascular treatment faster and had better 90-day functional outcomes in a new study. The study involved patients suspected of having a large-vessel occlusion, as assessed in the prehospital setting by paramedics using the Rapid Arterial Occlusion Evaluation (RACE) score.

For mechanical thrombectomy stroke patients, consensus guidelines favoring general anesthesia over conscious sedation during the pandemic might need revisiting.That was the argument presented at the virtual International Stroke Conference (ISC) in a debate over what should be the first-line strategy.
Conscious sedation minimizes delays to treatment, which have been a problem for COVID-19 patients, and provides at least as good outcomes, argued Tudor Jovin, MD, of the Cooper Neurological Institute in Cherry Hill, New Jersey.

A late-breaking abstract presented at the International Stroke Conference (ISC) 2021 (17–19 March, virtual) reports results from the MR CLEAN-NO IV trial, which is assessing the efficacy and safety of direct endovascular thrombectomy (EVT) compared with intravenous thrombolysis (IVT) followed by EVT in patients with acute ischaemic stroke caused by an occlusion of the anterior circulation. Researchers found no statistically significant difference in outcomes between these groups.

The study report on Global Medical Thrombus Aspiration Catheter Market 2020 to 2027 would cover every big geographical, as well as, sub-regions throughout the world. The report has focused on market size, value, product sales and opportunities for growth in these regions. The market study has analysed the competitive trend apart from offering valuable insights to clients and industries. These data will undoubtedly help them to plan their strategy so that they could not only expand but also penetrate into a market.

For patients with acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best technique for the first attempt at mechanical thrombectomy remains a matter of debate. In this study, we evaluated the efficacy of a modified version of a stent-retrieving into an aspiration catheter with a proximal balloon (ASAP) technique.

We found that the modified ASAP technique yielded fast recanalization, minimal complications, and good clinical outcomes of mechanical thrombectomy in this case series.

Immediate and long-term functional outcomes after percutaneous treatment of small vessel disease (SVD) with drug-coated balloon (DCB) versus drug-eluting stent (DES) remain unknown. The study sought to investigate whether treatment of de novo SVD with DCB yields similar functional results compared with DES, as judged with angiography-based quantitative flow ratio (QFR).

Treatment of coronary SVD with DCB resulted in similar 9-month functional results compared with DES. This study provides evidences to the value of QFR as a mean of evaluating device performance after coronary revascularization.

MedAlliance SA, the company commercialising Selution SLR, has raised over $50 million in equity funding. Selution SLR is a sirolimus-eluting balloon that provides a controlled sustained release of a limus drug, with a similar elution time to that of a drug-eluting stent (DES).

Offering a new option for physicians to address arterial thrombus removal, the Indigo System Lightning 7 combines the new Indigo System CAT™7 Aspiration Catheter with Lightning Intelligent Aspiration powered by Penumbra ENGINE®. CAT7 is a high power, low profile catheter that features laser-cut hypotube technology and circumferential sweep designed for dependable delivery and maximized clot extraction. The Indigo System’s proprietary Separator™ technology is also available with Lightning 7 (Separator 7) and is designed to enable unobstructed aspiration for the duration of the procedure. Lightning Intelligent Aspiration features Penumbra’s proprietary clot detection technology that enables the operator to identify thrombus location and is also designed for blood loss reduction.