Stroke: Vascular and Interventional Neurology最新文献

{"title":"Prevalence and Angiographic Outcomes of Rescue Intracranial Stenting in Large Vessel Occlusion Following Stroke Thrombectomy – STRATIS","authors":"Hamidreza Saber, M. Froehler, Osama O. Zaidat, Ali Aziz‐Sultan, R. Klucznik, J. Saver, N. Sanossian, Frank R Hellinger, Dileep R. Yavagal, Tom L Yao, Reza Jahan, Diogo C. Haussen, Raul G. Nogueira, N. Mueller-Kronast, David S. Liebeskind","doi":"10.1161/svin.124.001378","DOIUrl":"https://doi.org/10.1161/svin.124.001378","url":null,"abstract":"\u0000 \u0000 Large vessel occlusion secondary to underlying intracranial atherosclerotic disease (ICAD‐LVO) has an estimated prevalence of 7% to30%. There is a large variation in the use of intracranial rescue stenting in interventional practice. We aimed to characterize the frequency and characteristics of intracranial rescue stenting in a large cohort of endovascular therapy for stroke.\u0000 \u0000 \u0000 \u0000 The Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) angiography core lab adjudicated the location of the occlusion, hyperdense vessel sign on initial imaging, the use of angioplasty and stenting, and imaging outcomes following endovascular therapy. Underlying cause of stroke was categorized into intracranial atherosclerosis, cardioembolic, and other subtypes. Statistical analyses examined the relationship between intracranial rescue stenting and imaging outcomes including intracranial hemorrhage, and arterial reperfusion using expanded Thrombolysis in Cerebral Infarction reperfusion score in patients with ICAD‐LVO.\u0000 \u0000 \u0000 \u0000 \u0000 Among 978 patients with LVO stroke undergoing endovascular therapy, 91 (9.3%) patients had ICAD‐LVO. Baseline hyperdense vessel sign was observed among 44 (62.7%) with ICAD versus 178 (68.2%) with cardioembolic LVO (\u0000 P\u0000 =\u00000.4). Final successful reperfusion (expanded Thrombolysis in Cerebral Infarction 2b50 or more) was significantly lower among ICAD‐LVO as compared with cardioembolic‐LVO (74.2% versus 87.5%;\u0000 P\u0000 = 0.007). Intracranial rescue stenting was used among 14/665 (2.1%) of patients with LVO (5 ICA terminus, 7 M1 middle cerebral artery, 1 M2 middle cerebral artery, 1 proximal basilar artery). Among 14 intracranial rescue stenting cases, 5/70 (7.1%) belonged to the ICAD group, 3/261 (1.1%) cardioembolic group, and 6/334 (1.8%) in other or undetermined group. Successful reperfusion following rescue stenting was achieved in all cases with ICAD‐LVO. Among ICAD‐LVO, the rate of 24 hours symptomatic intracranial hemorrhage was 0% with acute intracranial stenting versus 7.7% in the nonstenting subgroup.\u0000 \u0000 \u0000 \u0000 \u0000 In STRATIS, nearly 1 of every 11 thrombectomies were performed in patients with underlying ICAD, among whom 7.1% underwent rescue intracranial stenting concomitant with thrombectomy. Acute intracranial stenting as rescue therapy in ICAD‐LVO was associated with favorable angiographic outcomes and low symptomatic hemorrhage rates.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 90","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141671188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long‐Term Hemorrhagic Morbidity for Children With Moyamoya Treated With Revascularization Surgery in a Single Center Retrospective Cohort","authors":"Alfred P. See, Sophia D. Kocher, Paulina Piwowarczyk, S. Alexandrescu, Keith L. Ligon, Darren B. Orbach, Edward R. Smith, Laura L. Lehman","doi":"10.1161/svin.124.001348","DOIUrl":"https://doi.org/10.1161/svin.124.001348","url":null,"abstract":"\u0000 \u0000 Children with moyamoya arteriopathy have reduced subsequent ischemic risk after revascularization surgery and it is also suggested that hemorrhagic risk may also be reduced by minimizing hemodynamic stress on collateral vasculature recruited within the brain parenchyma, but this has been studied only in intermediate follow‐up or follow‐up for more than a decade in East Asian populations. We aimed to evaluate the incidence of hemorrhagic stroke in long‐term follow‐up and identify at‐risk subpopulations.\u0000 \u0000 \u0000 \u0000 A single surgeon's personal case series with decades of follow‐up was reviewed for children (18 years or younger) treated with revascularization surgery. This included medical records and the surgeon's personal correspondence.\u0000 \u0000 \u0000 \u0000 Hemorrhagic stroke occurred in 2.6% of 302 children followed for a median of 21 years after surgery. Occurring at a median of 19 years (interquartile range 14–22.75) after surgery, these hemorrhages would not be recognized in series that discontinue follow‐up at transition from pediatric to adult neurosurgical care. There was a higher proportion (5.5‐fold hazard, 95% CI, 1.1–27.6) of patients who had prior radiation therapy in the group with hemorrhagic stroke compared with the overall group. Close retrospective evaluation of vascular imaging suggests aneurysms of the collateral periventricular vessels as a common culprit.\u0000 \u0000 \u0000 \u0000 Children who have moyamoya treated with revascularization surgery remain at long‐term risk of hemorrhagic stroke during adulthood, even though their ischemic stroke risk is significantly mitigated. These patients would benefit from continued clinical and radiological follow‐up, potentially with advanced imaging modalities.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"125 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking the 2023 American Heart Association Guidelines: The Ascendancy of Neuroendovascular and Neurocritical Care in Aneurysmal Subarachnoid Hemorrhage Management","authors":"F. Al‐Mufti, Stephan A. Mayer","doi":"10.1161/svin.123.001264","DOIUrl":"https://doi.org/10.1161/svin.123.001264","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"31 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large‐Vessel Occlusion","authors":"Sebastian Sanchez","doi":"10.1161/svin.124.001391","DOIUrl":"https://doi.org/10.1161/svin.124.001391","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"45 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of nBCA and Onyx for Embolization of Spinal Dural Arteriovenous Fistulas","authors":"J. Baranoski, J. Catapano, C. Rutledge, T. Cole, N. Majmundar, B. Hendricks, D. Wilkinson, Daniel D. Cavalcanti, Alfred P. See, B. Flores, A. Jadhav, A. Ducruet, F. Albuquerque","doi":"10.1161/svin.123.001019","DOIUrl":"https://doi.org/10.1161/svin.123.001019","url":null,"abstract":"\u0000 \u0000 \u0000 Endovascular embolization can effectively treat spinal dural arteriovenous fistulas (SDAVFs). One factor limiting the success and durability of endovascular treatments is reliably casting and occluding the draining vein. We sought to compare the efficacies of\u0000 n\u0000 ‐butyl‐2‐cyanoacrylate (nBCA) and Onyx in the treatment of SDAVFs.\u0000 \u0000 \u0000 \u0000 \u0000 We retrospectively analyzed patients with SDAVFs treated with endovascular embolization for whether a “durable cure” was achieved, defined as complete obliteration, clinical improvement, and sustained radiologic cure on follow‐up. We compared the outcomes of patients treated with Onyx to those treated with nBCA.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 40 embolizations for SDAVFs were performed in 38 patients. All patients were treated exclusively with liquid embolysates: Onyx alone (n = 22), nBCA alone (n = 16), or nBCA and Onyx combined (n = 2). For 45% (10/22) of patients treated with Onyx only, complete obliteration of the fistula with casting of the vein was not achieved. These patients were referred for microsurgical ligation. For all 16 patients treated with nBCA only, complete obliteration of the fistula was achieved. All 16 patients exhibited a durable cure compared with 11 of 22 patients (50%) in the Onyx‐only group (\u0000 P\u0000  = 0.002).\u0000 \u0000 \u0000 \u0000 \u0000 nBCA may be superior to Onyx for the embolization of SDAVFs. nBCA embolization is safe and effective for a subset of SDAVFs. Prospective studies comparing SDAVF treatment strategies are warranted.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"16 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141342072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of White Matter Hyperintensity Volume on Prognosis After Mechanical Thrombectomy in Ischemic Stroke Patients","authors":"Théo Hancer, Maéva Kyheng, Julien Labreuche, Maxime Gauberti, Emmanuel Touzé, Grégoire Boulouis, Bertrand Lapergue, Marion Boulanger","doi":"10.1161/svin.123.001267","DOIUrl":"https://doi.org/10.1161/svin.123.001267","url":null,"abstract":"\u0000 \u0000 Uncertainties remain about the impact of white matter hyperintensity (WMH) on prognosis after mechanical thrombectomy.\u0000 \u0000 \u0000 \u0000 In this retrospective study from a national prospective registry of patients with ischemic stroke due to large vessel occlusion treated with mechanical thrombectomy, we assessed WMH volume using a quantitative semi‐automatized segmentation on baseline magnetic resonance imaging. We determined the association between WMH volume and the prognosis of patients with ischemic stroke presenting between 2019 and 2022.\u0000 \u0000 \u0000 \u0000 Among 902 patients (mean age 70.4 years, 50% women) with a baseline magnetic resonance imaging, the median WMH volume was 2.79 (0.75–9.14) mL. In multivariate analyses, increasing WMH volume was associated with a reduced probability of favorable outcome (modified Rankin Scale score 0–2) (adjusted odds ratio per 1 log+1 increase = 0.66, 95% confidence interval 0.54–0.82) and an increased risk of mortality at 90 days (adjusted odds ratio per 1 log+1 increase = 1.53, 95% confidence interval 1.23–1.90), with the greatest risk in patients with the highest WMH volume (>11 mL) compared to those with the lowest WMH volume (<2 mL) (adjusted odds ratio = 0.38, 95% confidence interval 0.21–0.67 and adjusted odds ratio = 3.04, 95% confidence interval 1.66–5.59, respectively). There was no association between WMH volume and recanalization success and risks of any post treatment intracranial hemorrhage, symptomatic intracranial hemorrhage, and parenchymal hemorrhage.\u0000 \u0000 \u0000 \u0000 WMH volume is associated with increased risks of poor functional outcome and death at 90 days post mechanical thrombectomy but not with the probability of recanalization success and posttreatment intracranial hemorrhage. The use of semi‐automatized tool to assess WMH volume may help better identify patients who would benefit the most from mechanical thrombectomy and predict their prognosis.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex‐Specific Effects of Endovascular Treatment in Large‐Vessel Occlusion Stroke","authors":"A. Bonkhoff","doi":"10.1161/svin.124.001398","DOIUrl":"https://doi.org/10.1161/svin.124.001398","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141369092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue Stenting after Unsuccessful Recanalization of Endovascular Thrombectomy of the Posterior Circulation: A Systematic Review and Meta Analysis","authors":"A. Brake, Emmanuel Danso, William Liu, V. Galate, Lane Fry, M. Abraham","doi":"10.1161/svin.124.001356","DOIUrl":"https://doi.org/10.1161/svin.124.001356","url":null,"abstract":"\u0000 \u0000 The role of rescue stenting (RS) in acute ischemic strokes due to intracranial atherosclerotic disease–related large vessel occlusion is an area of active investigation. This study evaluates the efficacy and safety of RS under these circumstances.\u0000 \u0000 \u0000 \u0000 A systematic literature review, conforming to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, was conducted across PubMed, EMBASE, Cochrane, and OVID databases. Common and random effects analyses were conducted to compare outcomes including modified Rankin Scale score, 90‐day mortality, and symptomatic intracranial hemorrhage between patients receiving and those not receiving RS after failed endovascular thrombectomy within posterior circulation.\u0000 \u0000 \u0000 \u0000 \u0000 Ten studies comprising 1202 patients (730 RS, 472 control) were analyzed. RS was associated with a statistically significant improvement in functional outcomes, evidenced by a higher proportion of patients achieving modified Rankin Scale score ≤2 at 90 days (32.74% versus 21.19% in controls;\u0000 P\u0000 <0.001). Additionally, RS showed a significant reduction in 90‐day mortality (33.28% versus 54.66% in controls;\u0000 P\u0000 <0.001) and a lower incidence of symptomatic intracranial hemorrhage (3.74% versus 9.49% in controls;\u0000 P\u0000 <0.001).\u0000 \u0000 \u0000 \u0000 \u0000 RS for acute ischemic stroke in the context of intracranial atherosclerotic diseaserelated posterior circulation large vessel occlusion after failed endovascular thrombectomy is associated with improved functional outcomes, reduced mortality, and decreased symptomatic intracranial hemorrhage rates. These findings suggest RS as a beneficial intervention in this patient population. However, the retrospective nature of the included studies and their heterogeneity underline the need for further research, particularly through randomized controlled trials.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"52 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141273865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Emphysema and Intracranial Aneurysms in Smokers With Hypertension","authors":"P. de Jong, Coen S. den Hertog, M. Vergouwen, R. V. van Hamersvelt, B. Velthuis, G. Rinkel, Y. Ruigrok","doi":"10.1161/svin.124.001429","DOIUrl":"https://doi.org/10.1161/svin.124.001429","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"16 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141272837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities of Mortality Trends Due to Cerebrovascular Diseases and Cerebrovascular Infarction in the United States","authors":"S. Doddi, Nicholas D. Henkel, Oscar Salichs, Richard Burgess, Taryn Hibshman, Jonathan Wright, Isa Malik, Sami K. Al Kasab, M. Jumaa","doi":"10.1161/svin.123.001158","DOIUrl":"https://doi.org/10.1161/svin.123.001158","url":null,"abstract":"\u0000 \u0000 Cerebrovascular diseases are a major cause of morbidity and mortality worldwide and are the fifth leading cause of death in the United States. Understanding demographic differences in mortality rate trends can raise awareness of demographic disparities. We sought to investigate age‐adjusted mortality trends due to cerebrovascular diseases and ischemic stroke for demographic disparities in trend from 1999 to 2020.\u0000 \u0000 \u0000 \u0000 We used the publicly accessible Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database to gather mortality data to determine trends in cerebrovascular diseases and cerebral infarction mortality in the United States from 1999 to 2020. Using the Joinpoint program, temporal trends for cerebrovascular diseases and cerebral infarction mortality were calculated for each demographic group and reported as both annual percentage changes (APCs) or average APC from 1999 to 2020. In addition, trends were compared between groups for significant differences.\u0000 \u0000 \u0000 \u0000 We found an overall decrease in mortality rate for cerebrovascular diseases with average APC −1.9%. In 2020, age‐adjusted mortality rates due to cerebrovascular diseases in the Black population was 1031 per 1 000 000 compared with 679 in the White population. Similarly in 2020, cerebral infarction for the Black population had an age‐adjusted mortality rate of 256.3 compared with the White population's 170.4. When assessing overall trends by race and ethnic group: American Indian/Alaska Native had average APC −2.5%, Asian Pacific Americans had 2.4%, White population had −1.9%, and the Black population had −1.8%. We found a statistically significant difference in trend of decline between the Black and White population cerebrovascular diseases age‐adjusted mortality rates. No significant average APCs were found for cerebral infarction. The results of this study showcase disparities in cerebrovascular diseases mortality in the United States and where additional effort, research, and care should be focused.\u0000 \u0000 \u0000 \u0000 The results of this study showcase disparities in mortality in the United States and where additional effort, research, and care should be focused.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"39 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141117202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}