Etiology of recurrent large vessel occlusions treated with repeated thrombectomy.

BACKGROUND: Repeated mechanical thrombectomy for acute stroke treatment in individual patients has been proven feasible. However, less is known about the etiology of recurrent vessel occlusions after prior thrombectomy. We aimed to understand if the etiology of such recurrent events differs from the first stroke. METHODS: Retrospectively, we identified all patients at our center who received a repeated mechanical thrombectomy between 2007 and 2019. Clinical data were retrieved from medical records. Etiology of stroke was evaluated retrospectively, and angiographic studies were revisited. RESULTS: Twenty-three patients (1.5%) were identified. Median age was 68 years (IQR 56-77). Median NIHSS at first admission was 11 points (IQR 5-15). In nine cases (39.1%), the recurrent vessel occlusion was located exactly at the same position as the prior occlusion. Overall, five (21.7%) patients had a remarkable extracranial pathology as likely cause of stroke recurrence. In 16 patients (69.6%), the etiology of the first stroke and its recurrence was considered as likely being the same, mostly of cardioembolic or unknown origin. In the seven remaining patients (30.4%), the cause of stroke possibly differed from the first event, with five patients (21.7%) having a postinterventional intracranial intimal lesion as possible cause of stroke. CONCLUSION: Incidence of repeated thrombectomy was low. However, the high number of patients with known origin of stroke etiology raises the question how their monitoring may be optimized. The number of patients with remarkable extracranial pathologies or intracranial endothelial lesions supports current clinical practice to pay attention to final angiographic series.

The complexities of pain after stroke--a review with a focus on central post-stroke pain.

Pain is frequently reported following stroke, but seems to be an underemphasized phenomenon since it can importantly impact rehabilitation and long-term outcomes. Two major forms of pain have to be distinguished in patients with post-stroke pain: central, neuropathic pain, arising from the vascular lesion defined as central post-stroke pain (CPSP) and pain primarily triggered by peripheral mechanisms such as hemiplegic shoulder pain and spasticity-related pain. Headache after stroke is difficult to classify since the pathophysiology is unclear. The suggested underlying mechanisms as well as treatment strategies of post-stroke pain differ according to the origin (peripheral versus central). This article aims at reviewing the pertinent evidence regarding clinical characteristics and mechanisms of post-stroke pain generation with a focus on CPSP. We discuss possible treatment options and highlight current pathophysiological concepts.

[Contact heat evoked potentials for the evaluation of pain pathways]. / Kontakthitzeevozierte Potenziale. Diagnostische Option für die Evaluation des Schmerzsystems.

Pain evoked potentials offer a possibility for the evaluation of nociceptive pathways. Contact heat evoked potentials (CHEPS) represent a novel technique allowing to investigate peripheral pain pathways represented by small-diameter nerve fibers (A-delta and C fibers) and to study the spinothalamic tract. In contrast to more time-consuming methods such as quantitative sensory testing, CHEPS enables an objective investigation of pain pathways. This article reviews and discusses the technique, possible indications, and pitfalls in the context of clinical cases.

Neutrophil labeling: problems and pitfalls.

The use of neutrophils labeled with gamma-emitting radionuclides has been shown to be acceptable for in vivo kinetic studies as well as for imaging inflammatory foci. Among the gamma-emitting radionuclides, indium-111 appears to be the agent of choice. Labeling neutrophils with 111In, however, is a relatively new technique. Although simple to perform, it involves several stages, none of which could be carried out without problems. These are discussed and the current research aimed at eliminating the problems is outlined. The knowledge of specific chemotactic receptors and surface antigens has stimulated investigations into selective neutrophil labeling that will continue to be challenging and exciting.