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1.
Medicine (Baltimore) ; 99(2): e18665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914055

RESUMO

We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ±â€Š1.53 vs 3.49 ±â€Š1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.


Assuntos
Revascularização Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Imagem de Difusão por Ressonância Magnética , Procedimentos Endovasculares/métodos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico
2.
World Neurosurg ; 133: e835-e841, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31614218

RESUMO

BACKGROUND: Several independent randomized controlled trials have shown superior efficacy of mechanical thrombectomy (MT) for management of acute ischemic stroke (AIS). However, elderly patients have been underrepresented or excluded in these trials. The aim of this study was to investigate the feasibility and safety of MT in patients with AIS ≥90 years old. METHODS: A retrospective review was performed of patients ≥90 years old presenting with AIS who underwent MT between 2010 and 2018. RESULTS: Of 453 patients with AIS, 5.74% (n = 26) were ≥90 years old, and 69.32% (n = 314) were 60-89 years old. Of baseline characteristics between both groups, there was a significant difference in age, sex, body mass index, smoking, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Mean National Institutes of Health Stroke Scale score on admission was higher in the nonagenarians (17 vs. 15). Similar proportions of both groups received tissue plasminogen activator, 57.69% (n = 15) versus 42.68% (n = 134), P = 0.14). There was no difference in periprocedural and postprocedural complications, good Thrombolysis In Cerebral Infarction scores (88.46% [n = 23] vs. 87.58% [n = 275], P = 1.00), good modified Rankin Scale scores (34.62% [n = 4] vs. 49.36% [n = 155], P = 0.40), or mortality (11.54% [n = 3] vs. 13.06% [n = 41], P = 0.82). CONCLUSIONS: Age is a factor that affects functional outcome following MT. Advancements in catheter techniques, technical experience, and great outcomes with MT allow for pushing the boundaries to consider age as one factor, rather than an exclusion criterion. Our results show that MT is safe and feasible in nonagenarians.


Assuntos
Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
3.
World Neurosurg ; 133: e576-e582, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31561042

RESUMO

OBJECTIVE: To investigate the factors associated with futile recanalization after stent retriever thrombectomy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We retrospectively analyzed the medical records of 56 patients with an acute anterior circulation macrovascular occlusion who underwent successful stent retriever thrombectomy. Patients were classified as successful recanalization or futile recanalization at the follow-up. Univariate analysis and binary logic regression analysis were used to explore the association between patients' demographic and clinical characteristics and futile recanalization. RESULTS: The rate of futile recanalization was significantly higher after stent retrieval thrombectomy in patients with an Alberta Stroke Program Early CT (ASPECT) score ≤7 points versus >7 points (P < 0.001), ≥5 passes with the stent retriever versus <5 passes with the stent retriever (P = 0.036), or a longer recanalization time (P = 0.008). The influence of number of stent retriever pass is foremost, followed by ASPECT and occurrence to recanalization. CONCLUSIONS: Improving technical expertise with mechanical thrombectomy and shortening the therapeutic time window may improve the prognosis of patients with acute ischemic stroke due to large vessel occlusion.


Assuntos
Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents
4.
Radiol Med ; 125(1): 57-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31473929

RESUMO

INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.


Assuntos
Isquemia Encefálica/cirurgia , Cateteres , Reperfusão/instrumentação , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Reperfusão/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/métodos , Resultado do Tratamento , Adulto Jovem
7.
Ideggyogy Sz ; 72(11-12): 407-412, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31834684

RESUMO

Background and purpose: Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Methods: We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centers before 31st August 2016. Results: Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion: Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro-intervention capacity needing improvement.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Humanos , Hungria , Resultado do Tratamento
8.
No Shinkei Geka ; 47(11): 1143-1149, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761775

RESUMO

OBJECTIVE: The purpose of this study was to investigate the current status of thrombectomy calls for acute ischemic stroke for a single neurointerventionist in a regional hospital. METHODS: We retrospectively evaluated patients with thrombectomy calls for a neurointerventionist from January to November 2016 in our hospital, where a single board-certified neurointerventionist conducts endovascular interventions. Number, frequency, and time of thrombectomy calls were analyzed. Patients ineligible for revascularization were still used in analysis even though the neurointerventionist did not perform thrombectomy. RESULTS: Over 11 months(334 days), there were 105 calls, of which 48 were during duty hours and 57 during off-duty hours. The neurointerventionist was called once every 3.2 days in total, once every 4.7 days during duty hours, once every 5.7 days during off-duty hours of working days, and once every 6.2 days during holidays. Thrombectomies were performed in 37 cases(35%). Thrombectomies were performed once every 9.1 days and once every 2.8 calls. Twenty-four patients presented with ischemic stroke with large vessel occlusion, but they were determined to be ineligible for thrombectomy because of progressed ischemia in 7 patients, poor clinical condition in 7, or symptom recovery or recanalization in 10. Diagnoses of 42 patients who were not indicated for thrombectomy included ischemic stroke without major artery occlusion in 24 patients and intracerebral hemorrhage in 14. CONCLUSION: In a regional hospital with a single neurointerventionist, the frequency of thrombectomy calls was about once in every 3 days, and approximately half of them occurred during off-duty hours. A thrombectomy was performed about once every 9 days and about once every 3 thrombectomy-calls. Measures should be taken to reduce the burden on neurointerventionists in stroke centers, especially in understaffed institutes.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Isquemia Encefálica/cirurgia , Hemorragia Cerebral , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
9.
West Afr J Med ; 36(3): 286-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622495

RESUMO

Stroke is a leading cause of disability and mortality globally. In the first few hours after ischaemic stroke, the severity and irreversibility of brain injury increase as time passes. The primary goal of the emergent management of acute ischaemic stroke is stabilization and reperfusion of the ischaemic penumbra if eligibility criteria are met and contraindications are ruled out. The primary reperfusion strategies are administration of intravenous tissue plasminogen activator (IV tPA) and endovascular thrombectomy (EVT). Close monitoring is warranted prior to, during, and after these reperfusion procedures to detect early neurologic deterioration that may signify complications from treatment.


Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Fibrinolíticos/administração & dosagem , Reperfusão/métodos , Acidente Vascular Cerebral/cirurgia , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Administração Intravenosa , Isquemia Encefálica/diagnóstico , Humanos , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
10.
West Afr J Med ; 36(3): 290-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31625582

RESUMO

Stroke is a leading cause of disability and mortality globally. In the first few hours after ischaemic stroke, the severity and irreversibility of brain injury increase as time passes. The primary goal of the emergent management of acute ischaemic stroke is stabilization and reperfusion of the ischaemic penumbra if eligibility criteria are met and contraindications are ruled out. The primary reperfusion strategies are administration of intravenous tissue plasminogen activator (IV tPA) and endovascular thrombectomy (EVT). Close monitoring is warranted prior to, during, and after these reperfusion procedures to detect early neurologic deterioration that may signify complications from treatment.


Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Fibrinolíticos/administração & dosagem , Reperfusão/métodos , Acidente Vascular Cerebral/cirurgia , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Administração Intravenosa , Isquemia Encefálica/diagnóstico , Humanos , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
11.
JAMA ; 322(13): 1283-1293, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573636

RESUMO

Importance: General anesthesia during thrombectomy for acute ischemic stroke has been associated with poor neurological outcome in nonrandomized studies. Three single-center randomized trials reported no significantly different or improved outcomes for patients who received general anesthesia compared with procedural sedation. Objective: To detect differences in functional outcome at 3 months between patients who received general anesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke. Data Source: MEDLINE search for English-language articles published from January 1, 1980, to July 31, 2019. Study Selection: Randomized clinical trials of adults with a National Institutes of Health Stroke Scale score of at least 10 and anterior circulation acute ischemic stroke assigned to receive general anesthesia or procedural sedation during thrombectomy. Data Extraction and Synthesis: Individual patient data were obtained from 3 single-center, randomized, parallel-group, open-label treatment trials with blinded end point evaluation that met inclusion criteria and were analyzed using fixed-effects meta-analysis. Main Outcomes and Measures: Degree of disability, measured via the modified Rankin Scale (mRS) score (range 0-6; lower scores indicate less disability), analyzed with the common odds ratio (cOR) to detect the ordinal shift in the distribution of disability over the range of mRS scores. Results: A total of 368 patients (mean [SD] age, 71.5 [12.9] years; 163 [44.3%] women; median [interquartile range] National Institutes of Health Stroke Scale score, 17 [14-21]) were included in the analysis, including 183 (49.7%) who received general anesthesia and 185 (50.3%) who received procedural sedation. The mean 3-month mRS score was 2.8 (95% CI, 2.5-3.1) in the general anesthesia group vs 3.2 (95% CI, 3.0-3.5) in the procedural sedation group (difference, 0.43 [95% CI, 0.03-0.83]; cOR, 1.58 [95% CI, 1.09-2.29]; P = .02). Among prespecified adverse events, only hypotension (decline in systolic blood pressure of more than 20% from baseline) (80.8% vs 53.1%; OR, 4.26 [95% CI, 2.55-7.09]; P < .001) and blood pressure variability (systolic blood pressure >180 mm Hg or <120 mm Hg) (79.7 vs 62.3%; OR, 2.42 [95% CI, 1.49-3.93]; P < .001) were significantly more common in the general anesthesia group. Conclusions and Relevance: Among patients with acute ischemic stroke involving the anterior circulation undergoing thrombectomy, the use of protocol-based general anesthesia, compared with procedural sedation, was significantly associated with less disability at 3 months. These findings should be interpreted tentatively, given that the individual trials examined were single-center trials and disability was the primary outcome in only 1 trial.


Assuntos
Anestesia Geral/efeitos adversos , Sedação Consciente/efeitos adversos , Pessoas com Deficiência/estatística & dados numéricos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Idoso , Isquemia Encefálica/cirurgia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
J Clin Neurosci ; 70: 247-249, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31540859

RESUMO

We present a case demonstrating histopathological clot findings after endovascular thrombectomy for acute ischaemic stroke in a 38 year-old male with systemic lupus erythematosus and antiphospholipid syndrome (APS). The differential diagnosis was embolism of a suspected Libman-Sacks vegetation or less likely an in-situ thrombosis. Clot analysis provided guidance with patient management and anticoagulation was commenced. The utility of clot analysis in this case provides support for routine clot analysis, which has been standard practice at our institution, and is likely to evolve as endovascular thrombectomy becomes more widely accessible.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Acidente Vascular Cerebral/etiologia , Trombose/patologia , Adulto , Procedimentos Endovasculares , Humanos , Masculino , Acidente Vascular Cerebral/cirurgia , Trombectomia
13.
World Neurosurg ; 132: 368-370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541757

RESUMO

BACKGROUND: Hemiballism is a rare hyperkinetic movement disorder characterized by involuntary, high-amplitude, unilateral flailing of upper or lower extremities or both. In the case of hemiballism refractory to pharmaceutical interventions, deep brain stimulation (DBS) is an effective primary neurosurgical treatment. DBS targets for hemiballism include the thalamus, subthalamic nucleus, and globus pallidus internus (GPi). CASE DESCRIPTION: We present a case of a patient who sustained a posterior cerebral artery ischemic stroke that eventually led to uncontrolled hemiballism, which was then successfully treated by unilateral GPi stimulation. We include a video depicting the patient preoperatively, intraoperatively with stimulation off, and intraoperatively with stimulation on. We also review published cases of hemiballism treated by GPi-DBS, which support the claim that GPi-DBS is an effective method for treating hemiballism. CONCLUSIONS: Evidence gathered from the literature indicates that GPi-DBS is an effective treatment for hemiballism, especially after neuroleptics have failed. Results from various case studies of GPi-DBS used to treat hemiballism reveal improved motor ability and decreased dyskinesia, although degree of improvement may vary. More studies are required to establish which DBS target requires the least amount of stimulation to treat hemiballism.


Assuntos
Estimulação Encefálica Profunda/métodos , Discinesias/terapia , Globo Pálido , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Discinesias/complicações , Discinesias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Destreza Motora , Procedimentos Neurocirúrgicos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
14.
World Neurosurg ; 132: 165-168, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505295

RESUMO

BACKGROUND: Bilateral hemispheric dysfunction is devastating to consciousness. We present a unique case of a patient who developed bilateral middle cerebral artery infarcts with significant neurological improvement post bilateral thrombolysis in cerebral infarction (TICI) 3 thrombectomies. CASE DESCRIPTION: The patient is a 64-year-old woman who presented 3 hours after her husband was awakened and found her with left hemiplegia. She had a history of atrial fibrillation and had her apixaban held for 5 days before the coronary angiogram that she received the day before arrival. Upon presentation, she was antigravity on the right side and withdrawing on the left side. Computed tomography angiogram showed a right M1 occlusion and an left M2 occlusion. Computed tomography perfusion revealed a mismatch with large penumbra, and she was taken for mechanical thrombectomy. Mechanical thrombectomy was performed using a combination of stent retriever and aspiration catheter with a TICI 3 revascularization. By the following morning, the patient was full strength on the right and antigravity on the left with a left facial droop. The patient recovered her speech and was fully oriented before leaving for rehabilitation on postoperative day 3. CONCLUSIONS: The transient hypercoagulable state that was created with the withdrawal of apixaban likely increased our patient's risk of stroke. The literature supports continuing oral anticoagulants for endovascular procedures. The devastating consequences of thromboembolic events, whether stroke or pulmonary embolism, can be catastrophic, but luckily, mechanical thrombectomy provides the means to minimize the morbidity and mortality from bilateral infarctions.


Assuntos
Infarto da Artéria Cerebral Média/cirurgia , Trombectomia/métodos , Angiografia Digital , Angiografia por Tomografia Computadorizada , Feminino , Hemiplegia/etiologia , Humanos , Pessoa de Meia-Idade , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Sucção , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
World Neurosurg ; 132: e1-e4, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31525481

RESUMO

OBJECTIVE: Conventional carotid catheterization is impossible in 2%-5% of acute stroke cases. Surgical carotid cutdown may be a necessary bailout strategy to allow for carotid access. We assessed the effectiveness and safety of surgical carotid cutdown for vascular access in interventional acute stroke treatment. METHODS: We compare imaging and clinical data of 15 consecutive patients, in whom we performed a carotid cutdown for acute stroke treatment with 10 consecutive patients, in whom treatment was discontinued because transfemoral access to the occlusion site was not possible. RESULTS: Baseline characteristics of both groups were comparable (P ≥ 0.065). Cutdown patients had significantly smaller infarctions (P = 0.031), significantly more often favorable clinical outcome (38% vs. 0% modified Rankin score 0-2, P = 0.046), and a lower mortality (31% vs. 60%, P = 0.222) at 3 months. Other than a small hematoma at the operation site, there were no procedure-related complications. CONCLUSIONS: Carotid cutdown is an effective bailout strategy for acute stroke patients, in whom conventional catheterization is not possible.


Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Infarto Cerebral/complicações , Infarto Cerebral/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento
16.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(3): 233-240, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31496153

RESUMO

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.


Assuntos
Isquemia Encefálica , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Isquemia Encefálica/cirurgia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/tendências , Humanos , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
17.
World Neurosurg ; 132: 245-250, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476466

RESUMO

BACKGROUND: Little literature is available on mechanical thrombus aspiration in acute ischemic stroke with coincident ipsilateral unruptured aneurysm, especially with aneurysm proximal to the occlusion site. In this report, we describe a case of ischemic stroke in a patient with acute occlusion of M1 segment of the middle cerebral artery with coincident ipsilateral internal carotid artery-posterior communicating artery aneurysm who was successfully treated by mechanical clot retrieval using the Sofia (6F) PLUS technique (MicroVention Terumo, Tustin, California, USA). CASE DESCRIPTION: A 52-year-old woman presented at our hospital 6 hours after sudden onset of dysarthria and right limb hemiplegia on waking up in the morning. She was managed using a direct aspiration first pass technique for distal middle cerebral artery mechanical aspiration using the Sofia (6F) PLUS catheter. The thrombus was manually aspirated in 2 minutes, and Thrombolysis in Cerebral Infarction scale 3 flow was restored. Next, LVIS (MicroVention Terumo, Tustin, California, USA) stent-assisted coiling of the aneurysm of the posterior communicating segment of the left internal carotid artery was immediately undertaken. The National Institutes of Health Stroke Scale score was 4 at day 1 and 0 at day 7 postoperatively. No device-related or catheter-related complications occurred. CONCLUSIONS: Ischemic stroke patients with coincident aneurysm are at increased risk of aneurysmal rupture and should be managed with tailored endovascular strategies. Our case shows that a direct aspiration first pass technique using the Sofia (6F) PLUS catheter provides a safe, effective approach for thrombus aspiration in stroke patients.


Assuntos
Achados Incidentais , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Resultado do Tratamento
19.
Neurology ; 93(11): e1068-e1075, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31409735

RESUMO

OBJECTIVE: To determine whether dual energy CT with a combined approach (cDECT) using a plain noncontrast monochromatic CT (pCT), a water-weighted image after iodine removal, and an iodine-weighted image changes the diagnosis and classification of intracranial hemorrhage (ICH) after endovascular thrombectomy (EVT) in acute ischemic stroke compared to a pCT image alone without separate water and iodine weighting. METHOD: During 2012 to 2016, 372 patients at our comprehensive stroke center underwent DECT scans within 36 hours after EVT. Two readers evaluated pCT compared to a second reading with cDECT, establishing the diagnosis of ICH and grading it per the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classifications. RESULT: Using cDECT changed the ICH diagnosis to contrast staining only in 34% (52 of 152), modified the ICH grade in 10% (15 of 152), and diagnosed initially undetected ICH in 2% (5 of 220). pCT alone had 95% sensitivity, 80% specificity, 66% positive predictive value, 98% negative predictive value, and 85% accuracy for ICH compared to cDECT. Interreader agreement on the presence of ICH increased with cDECT compared to pCT (Cohen κ = 0.77 [95% confidence interval 0.69-0.84] vs 0.68 [0.61-0.76]). CONCLUSION: cDECT within 36 hours after EVT changes the radiologic report regarding posttreatment ICH in a considerable proportion of patients undergoing EVT compared to pCT alone. This could affect decision-making regarding monitoring, secondary prevention, and prognostication. The cDECT scan could improve the interpretation consistency of high-attenuating changes on post-EVT images.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/tendências , Tomografia Computadorizada por Raios X/tendências , Idoso , Isquemia Encefálica/cirurgia , Hemorragia Cerebral/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos
20.
BMC Neurol ; 19(1): 197, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419959

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes. We present our experience with SAVE for large vessel occlusions (LVO) of the posterior circulation. METHODS: We retrospectively analyzed 66 consecutive MT patients suffering from LVO of the posterior circulation. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints contained number of passes, time interval from groin puncture to reperfusion and rate of postinterventional symptomatic intracranial hemorrhage (sICH). RESULTS: Median age was 75 years (interquartile range (IQR) 54-81 years). Baseline median National Institutes of Health stroke scale (NIHSS) was 13 (IQR 8-21). Fifty-five (83%) patients had LVO of the basilar artery and 11 (17%) of the posterior cerebral artery. Eighteen (27%) patients were treated with SAVE and 21 (32%) with aspiration only. First pass mTICI2c or 3 and overall mTICI2c or 3 were documented in 11/18 (61%) and 14/18 (78%) with SAVE and in 4/21 (19%) and 13/21 (33%) with aspiration only. Median attempt was 1 (IQR 1-2) with SAVE and 2 (IQR 1-4) with aspiration (p = 0.0249). Median groin to reperfusion time did not differ significantly between groups. The rate of sICH was 5% without any complications in the SAVE cohort. CONCLUSION: Mechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.


Assuntos
Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Trombectomia/instrumentação , Resultado do Tratamento
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