Endovascular Therapy for Acute Stroke

Politi, Maria; Kastrup, Andreas; Marmagkiolis, Konstantinos; Grunwald, Iris Q.; Papanagiotou, Panagiotis

doi:10.1016/j.pcad.2017.03.004

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…For stroke patients entering the emergency room, the goal for "door-to-needle time" is less than <60 min. In practice, less than one-third of the patients meet this goal [33].…”

Section: Preoperative Planningmentioning

confidence: 99%

“…In more recent years, the data has continued to reveal mixed results. A major multicenter retrospective study in 2021 showed improved functional outcomes and reduced complications and mortality with conscious sedation compared with general anesthesia [ 33]. Other studies conducted around the same time period showed no difference in outcomes or mortality between these strategies [34].…”

Section: Anesthetic Strategiesmentioning

confidence: 99%

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Updates in Neuroanesthesia

Schill¹,

Bates²,

Lovett³

et al. 2023

Updates in Anesthesia - The Operating Room and Beyond

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Providing anesthesia care to neurosurgical and neurocritical care patients presents unique challenges to the anesthesiologist. Over the last century, anesthetic care for such patients has become a robustly studied field, with tools and techniques to keep patients safe and comfortable in the perioperative period. A review of the major updates and considerations for perioperative care for awake craniotomies, thrombectomy for stroke, and endoscopic neurosurgery is critical for the anesthesiologist. Additionally, newly developed enhanced recovery after surgery procedures have improved patient experiences and outcomes after both cranial and spinal neurosurgery. Finally, post-operative delirium is a major neurologic complication in elderly patients undergoing all types of procedures which all anesthesiologists should be well versed in. Here, such topics are reviewed with a focus on recent updates to the literature which are important for clinical practice.

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“…For stroke patients entering the emergency room, the goal for "door-to-needle time" is less than <60 min. In practice, less than one-third of the patients meet this goal [33].…”

Section: Preoperative Planningmentioning

confidence: 99%

Section: Anesthetic Strategiesmentioning

confidence: 99%

Updates in Neuroanesthesia

Schill¹,

Bates²,

Lovett³

et al. 2023

Updates in Anesthesia - The Operating Room and Beyond

View full text Add to dashboard Cite

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“…Ischemic strokes, which account for 87% of all strokes, result from an obstruction or narrowing in an artery that carries blood to the brain [ 3 ]. Two reperfusion therapies, pharmaceutical dissolution and mechanical blood clot removal, are the only ones currently approved for treating acute ischemic stroke [ 4 , 5 ]. Thus, transient focal cerebral ischemia has become one of the most common types of ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Light Alcohol Consumption Promotes Early Neurogenesis Following Ischemic Stroke in Adult C57BL/6J Mice

Subedi

et al. 2023

Biomedicines

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Ischemic stroke is one of the leading causes of death and disability worldwide. Neurogenesis plays a crucial role in postischemic functional recovery. Alcohol dose-dependently affects the prognosis of ischemic stroke. We investigated the impact of light alcohol consumption (LAC) on neurogenesis under physiological conditions and following ischemic stroke. C57BL/6J mice (three months old) were fed with 0.7 g/kg/day ethanol (designed as LAC) or volume-matched water (designed as control) daily for eight weeks. To evaluate neurogenesis, the numbers of 5-bromo-2-deoxyuridine (BrdU)+/doublecortin (DCX)+ and BrdU+/NeuN+ neurons were assessed in the subventricular zone (SVZ), dentate gyrus (DG), ischemic cortex, and ischemic striatum. The locomotor activity was determined by the accelerating rotarod and open field tests. LAC significantly increased BrdU+/DCX+ and BrdU+/NeuN+ cells in the SVZ under physiological conditions. Ischemic stroke dramatically increased BrdU+/DCX+ and BrdU+/NeuN+ cells in the DG, SVZ, ischemic cortex, and ischemic striatum. The increase in BrdU+/DCX+ cells was significantly greater in LAC mice compared to the control mice. In addition, LAC significantly increased BrdU+/NeuN+ cells by about three folds in the DG, SVZ, and ischemic cortex. Furthermore, LAC reduced ischemic brain damage and improved locomotor activity. Therefore, LAC may protect the brain against ischemic stroke by promoting neurogenesis.

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“…Acute ischemic stroke (AIS) due to tandem occlusion (TO) is defined as high grade stenosis or occlusion of the cervical segment of the internal carotid artery (ICA) associated with concurrent ipsilateral intracranial large vessel occlusion (LVO) along the anterior cerebral circulation (primarily in the distal ICA or middle cerebral artery (MCA) segments) [1,2]. This type of AIS accounts for 15-20% of all ischemic strokes [3].…”

Section: Introductionmentioning

confidence: 99%

Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects

Kalmar

Tarkanyi

Nagy

et al. 2021

Life

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Introduction: Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15–20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management. Methods: We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients’ data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes. Results: A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, p = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, p < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, p = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, p = 0.382) and 90-day mortality (23.5% vs. 13.8%, p = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, p = 0.043) in patients with ACS. In the overall population age (p = 0.013), atrial fibrillation (AF) (p = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline (p = 0.029), and successful recanalization (p = 0.023) were associated with favorable outcome. Conclusion: Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.

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Endovascular Therapy for Acute Stroke

Cited by 10 publications

References 36 publications

Updates in Neuroanesthesia

Updates in Neuroanesthesia

Light Alcohol Consumption Promotes Early Neurogenesis Following Ischemic Stroke in Adult C57BL/6J Mice

Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects

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