Stroke: Vascular and Interventional Neurology最新文献

{"title":"Is Thrombectomy Worth It for Isolated Posterior Cerebral Artery Occlusion? Meta‐Analysis and Trial Sequential Analysis","authors":"Hong‐Jie Jhou, Cho-Hao Lee, Yu‐Chi Tsai, Po‐Huang Chen, Li‐Yu Yang","doi":"10.1161/svin.123.001084","DOIUrl":"https://doi.org/10.1161/svin.123.001084","url":null,"abstract":"\u0000 \u0000 Thrombectomy is well‐established management for acute ischemic stroke involving large vessel occlusion. However. the potential efficacy of thrombectomy for isolated posterior cerebral artery occlusion remains limited. The study aims to evaluate the benefits of thrombectomy for isolated posterior cerebral artery occlusion.\u0000 \u0000 \u0000 \u0000 We searched PubMed, Cochrane, and Embase for articles published until September 2023. The primary outcome was good functional outcome at 3 months. The secondary outcomes included excellent functional outcome at 3 months and early neurological improvement. The safety outcomes were symptomatic intracerebral hemorrhage, and mortality at 3 months.\u0000 \u0000 \u0000 \u0000 Seven retrospective studies involving 2560 patients with isolated posterior cerebral artery occlusion were included (876 patients receiving thrombectomy). The odds ratio (OR) of good functional outcome at 3 months was 0.93 (95% CI, 0.68–1.28) between 2 groups. The OR of excellent functional outcome (OR 1.23; 95% CI 0.92–1.64) and early neurological improvement (OR 1.82; 95% CI 0.97–3.40) were not different between the 2 groups. Compared with patients with best medical management, those with thrombectomy demonstrated a significantly increased risk of mortality (OR 1.81; 95% CI 1.24–2.65), whereas the risk of symptomatic intracerebral hemorrhage (OR 2.033; 95% CI 0.996–4.148) did not show an increase. Additionally, the results of trial sequential analysis indicated all outcomes were inconclusive.\u0000 \u0000 \u0000 \u0000 Thrombectomy stands as an available procedure for patients with isolated posterior cerebral artery occlusion; however, it shows no notable benefits in reducing symptomatic intracerebral hemorrhage risk or enhancing function and may raise mortality compared with standard medical management. Further randomized controlled trials are necessary to yield more conclusive evidence.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"121 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139786322","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":"Is Thrombectomy Worth It for Isolated Posterior Cerebral Artery Occlusion? Meta‐Analysis and Trial Sequential Analysis","authors":"Hong‐Jie Jhou, Cho-Hao Lee, Yu‐Chi Tsai, Po‐Huang Chen, Li‐Yu Yang","doi":"10.1161/svin.123.001084","DOIUrl":"https://doi.org/10.1161/svin.123.001084","url":null,"abstract":"\u0000 \u0000 Thrombectomy is well‐established management for acute ischemic stroke involving large vessel occlusion. However. the potential efficacy of thrombectomy for isolated posterior cerebral artery occlusion remains limited. The study aims to evaluate the benefits of thrombectomy for isolated posterior cerebral artery occlusion.\u0000 \u0000 \u0000 \u0000 We searched PubMed, Cochrane, and Embase for articles published until September 2023. The primary outcome was good functional outcome at 3 months. The secondary outcomes included excellent functional outcome at 3 months and early neurological improvement. The safety outcomes were symptomatic intracerebral hemorrhage, and mortality at 3 months.\u0000 \u0000 \u0000 \u0000 Seven retrospective studies involving 2560 patients with isolated posterior cerebral artery occlusion were included (876 patients receiving thrombectomy). The odds ratio (OR) of good functional outcome at 3 months was 0.93 (95% CI, 0.68–1.28) between 2 groups. The OR of excellent functional outcome (OR 1.23; 95% CI 0.92–1.64) and early neurological improvement (OR 1.82; 95% CI 0.97–3.40) were not different between the 2 groups. Compared with patients with best medical management, those with thrombectomy demonstrated a significantly increased risk of mortality (OR 1.81; 95% CI 1.24–2.65), whereas the risk of symptomatic intracerebral hemorrhage (OR 2.033; 95% CI 0.996–4.148) did not show an increase. Additionally, the results of trial sequential analysis indicated all outcomes were inconclusive.\u0000 \u0000 \u0000 \u0000 Thrombectomy stands as an available procedure for patients with isolated posterior cerebral artery occlusion; however, it shows no notable benefits in reducing symptomatic intracerebral hemorrhage risk or enhancing function and may raise mortality compared with standard medical management. Further randomized controlled trials are necessary to yield more conclusive evidence.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"4 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139846106","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":"Association Between MR‐Based Thrombus Imaging Characteristics and Endovascular Therapy Outcome in Acute Ischemic Stroke: A Systematic Review and Meta‐Analysis","authors":"Mohammad Hossein Abbasi, Adrienne N Dula, Steven J. Warach, Hamidreza Saber","doi":"10.1161/svin.123.001142","DOIUrl":"https://doi.org/10.1161/svin.123.001142","url":null,"abstract":"\u0000 \u0000 Prediction of successful revascularization and achieving a favorable functional outcome may help determine the optimal treatment strategy and improve the management of stroke. A growing body of literature has implicated a predictive value for thrombus imaging characteristics for stroke outcomes.\u0000 \u0000 \u0000 \u0000 We conducted an electronic search using PubMed, Ovid MEDLINE, and EMBASE, previously published meta‐analyses, and systematic review studies that intervened by endovascular thrombectomy or intravenous thrombolysis following large vessel occlusion stroke from 2000 to 2023 and involved magnetic resonance‐based thrombus imaging, then screened 2007 studies against our eligibility criteria. We extracted the enrollees’ characteristics and the association between clot features and radiological and functional outcome measures.\u0000 \u0000 \u0000 \u0000 \u0000 Thirty‐three studies were found eligible, with a total number of 6902 enrollees. Susceptibility vessel sign was found in 3531 subjects (51.2%). Nine studies involved only the administration of intravenous thrombolysis, whereas 24 studies intervened by endovascular thrombectomy. Seventeen studies found at least an association between thrombus imaging characteristics and successful revascularization, whereas the others reported no association. only 13 studies found at least one thrombus characteristic associated with functional outcome, while the others showed no association between  the thrombus characteristics and functional outcome after stroke. Pooled meta‐analysis of studies that involved endovascular thrombectomy with or without intravenous thrombolysis showed a statistically significant association between the presence of susceptibility vessel sign and both successful reperfusion (odds ratio [OR]: 1.57 [1.09–2.27];\u0000 P\u0000 = 0.02) and favorable functional outcome (OR: 1.76 [1.17–2.66];\u0000 P\u0000 = 0.007).\u0000 \u0000 \u0000 \u0000 \u0000 The presence of susceptibility vessel sign on magnetic resonance‐based clot imaging was associated with functional outcome and successful reperfusion following thrombectomy.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"40 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139846741","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":"Association Between MR‐Based Thrombus Imaging Characteristics and Endovascular Therapy Outcome in Acute Ischemic Stroke: A Systematic Review and Meta‐Analysis","authors":"Mohammad Hossein Abbasi, Adrienne N Dula, Steven J. Warach, Hamidreza Saber","doi":"10.1161/svin.123.001142","DOIUrl":"https://doi.org/10.1161/svin.123.001142","url":null,"abstract":"\u0000 \u0000 Prediction of successful revascularization and achieving a favorable functional outcome may help determine the optimal treatment strategy and improve the management of stroke. A growing body of literature has implicated a predictive value for thrombus imaging characteristics for stroke outcomes.\u0000 \u0000 \u0000 \u0000 We conducted an electronic search using PubMed, Ovid MEDLINE, and EMBASE, previously published meta‐analyses, and systematic review studies that intervened by endovascular thrombectomy or intravenous thrombolysis following large vessel occlusion stroke from 2000 to 2023 and involved magnetic resonance‐based thrombus imaging, then screened 2007 studies against our eligibility criteria. We extracted the enrollees’ characteristics and the association between clot features and radiological and functional outcome measures.\u0000 \u0000 \u0000 \u0000 \u0000 Thirty‐three studies were found eligible, with a total number of 6902 enrollees. Susceptibility vessel sign was found in 3531 subjects (51.2%). Nine studies involved only the administration of intravenous thrombolysis, whereas 24 studies intervened by endovascular thrombectomy. Seventeen studies found at least an association between thrombus imaging characteristics and successful revascularization, whereas the others reported no association. only 13 studies found at least one thrombus characteristic associated with functional outcome, while the others showed no association between  the thrombus characteristics and functional outcome after stroke. Pooled meta‐analysis of studies that involved endovascular thrombectomy with or without intravenous thrombolysis showed a statistically significant association between the presence of susceptibility vessel sign and both successful reperfusion (odds ratio [OR]: 1.57 [1.09–2.27];\u0000 P\u0000 = 0.02) and favorable functional outcome (OR: 1.76 [1.17–2.66];\u0000 P\u0000 = 0.007).\u0000 \u0000 \u0000 \u0000 \u0000 The presence of susceptibility vessel sign on magnetic resonance‐based clot imaging was associated with functional outcome and successful reperfusion following thrombectomy.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139786806","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":"Variation in Vessel Size and Angiographic Outcomes Following Stent‐Retriever Thrombectomy in Acute Ischemic Stroke: STRATIS Registry","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, Alicia M. Hall, Nils H. Mueller Kronast, David S. Liebeskind","doi":"10.1161/svin.123.000978","DOIUrl":"https://doi.org/10.1161/svin.123.000978","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy is established for large‐vessel occlusions in acute ischemic stroke, but the potential role in distal vessel occlusions of medium arteries is less well established. Such medium or distal arterial segments have not been assessed with respect to thrombectomy devices used during endovascular therapy. We conducted an analysis of arterial size, segmental anatomy, and stent‐retriever device performance with respect to vessel size during thrombectomy.\u0000 \u0000 \u0000 \u0000 The STRATIS registry angiography core laboratory adjudicated the exact location of the occlusion, proximal, and distal device deployment, relationship to arterial bifurcations, and anatomic nomenclature. Arterial diameters were measured at all these sites. Statistical analyses examined the relationship between vessel and stent size, and arterial recanalization using expanded Thrombolysis in Cerebral Infarction reperfusion score.\u0000 \u0000 \u0000 \u0000 \u0000 Overall, 665 patients with stroke were included following thrombectomy using various Solitaire device sizes, including Solitaire 4×40, Solitaire 6×30, Solitaire 4×20, Solitaire 6×20, and Solitaire 4×15. Arterial diameter at the occlusion site was a median of 2.17 mm (interquartile range [IQR], 1.88–2.60 mm) in the distal M1, 1.67 mm (IQR, 1.47–2.06 mm) in the proximal M2 middle cerebral artery, 1.50 mm (IQR, 1.15–1.61 mm) in the distal M2 middle cerebral artery, 1.24 mm (IQR, 1.11–1.24 mm) in the M3 middle cerebral artery, and 1.88 mm (IQR, 1.49–1.94 mm) in the P1 posterior cerebral artery. Expanded Thrombolysis in Cerebral Infarction 2b to 3 reperfusion was achieved in all M3 or P1 segment occlusions. The rate of first‐pass recanalization was significantly higher in patients with medium (0.75–2 mm) versus large (>2 mm) vessel occlusion (69.5% versus 57.1%;\u0000 P\u0000  = 0.003).\u0000 \u0000 \u0000 \u0000 \u0000 Considerable overlap was noted between arterial sizes at occlusion sites carrying different segmental arterial nomenclature or vessel names. Substantial reperfusion may be achieved with currently available mechanical thrombectomy devices in medium arteries.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139859732","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":"Proliferative Angiopathy: A Systematic Review","authors":"Nolan J. Brown, Brian V. Lien, Jeff Ehresman, Redi Rahmani, J. Catapano, Michael T. Lawton","doi":"10.1161/svin.123.001186","DOIUrl":"https://doi.org/10.1161/svin.123.001186","url":null,"abstract":"\u0000 \u0000 First described over 4 decades ago as a diffuse form of arteriovenous malformation, cerebral proliferative angiopathy (CPA) is now categorized as a distinct vascular anomaly. Unlike arteriovenous malformation, which typically forms a well‐developed vascular nidus with feeder vessels and distinct venous outflow, CPA is the product of disorganized angiogenesis; thus, it lacks a true nidus. Its characteristic cycle of ischemia, angiogenesis, and aberrant perfusion can lead to abnormal blood flow patterns that characterize the disease. Treatment of CPA has historically relied on conservative management (antiepileptic drugs), and efforts to effectively manage this pathology have been hindered by an incomplete understanding of its natural history.\u0000 \u0000 \u0000 \u0000 A systematic search of 4 databases was performed. The following variables were extracted when present: study sample size, year of publication, age(s) of patient(s), sex, presenting signs and symptoms, neurological deficits (pre‐ and postoperative), type of intervention, average follow‐up time, and patient‐reported as well as functional outcomes at last follow‐up.\u0000 \u0000 \u0000 \u0000 Following the search and screen, 48 studies reporting 105 CPA cases remained eligible for inclusion. These studies consisted of 41 case reports, 6 case series, and 1 retrospective cohort study. The most common modality used in treatment of CPA was conservative management (53.4%). The second most common treatment modality was endovascular embolization (36.9%). The least common treatment modality was gamma knife radiosurgery, which was used in only 2 patients. Eleven patients experienced intracranial hemorrhage as a complication of CPA; 10 of the 11 patients underwent decompressive craniectomy. Finally, revascularization surgery was reportedly used in 5 patients (4.9%).\u0000 \u0000 \u0000 \u0000 Although there remains a dearth of studies reporting CPA, several clearly defined traits have been identified that characterize this pathology and distinguish it from arteriovenous malformation. Nonetheless, the verdict has not yet been reached regarding the effectiveness of surgical interventions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"67 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139861023","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":"Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases","authors":"Y. Takenobu, Noriko Nomura, Yoshito Sugita, Akihiro Okada, Takeshi Kawauchi, Tao Yang, Kenji Hashimoto","doi":"10.1161/svin.123.001180","DOIUrl":"https://doi.org/10.1161/svin.123.001180","url":null,"abstract":"\u0000 \u0000 Carotid artery stenting for heavily calcified lesions is challenging for interventionists. A calcium burden is associated with suboptimal dilatation, periprocedural complications, high rates of restenosis, and poor outcomes. We describe the first report of 2 cases of successful carotid artery stenting for heavily calcified lesions using a scoring balloon.\u0000 \u0000 \u0000 \u0000 The patients were both aged 75 years, 1 male and 1 female, who had experienced ipsilateral stroke prior to the procedures. They had dense calcifications at the lesions, stenosis rates of 95% (near occlusion) and 86% according to the North American Symptomatic Carotid Endarterectomy Trial criteria, and calcification arcs of 270° and 360°, respectively. Considering the heavy calcification, predilation with scoring balloons (NSE PTA balloon; Nipro, Osaka, Japan) at the rated burst pressure was performed in both cases. Sufficient dilatation was achieved, followed by carotid stent deployment (Precise Pro RX; Cordis, Miami Lakes, FL, USA). After postdilatation, the stenosis rates decreased to 21% and 23%, respectively. Although 1 patient experienced prolonged bradycardia and hypotension, they were well managed with anticholinergic and vasoconstrictive agents. Both patients remained asymptomatic.\u0000 \u0000 \u0000 \u0000 Carotid artery stenting using a scoring balloon obtained acceptable improvements in severe stenosis with heavily calcified lesions. This method could be a useful option for the revascularization of heavily calcified lesions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"17 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139861899","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":"Variation in Vessel Size and Angiographic Outcomes Following Stent‐Retriever Thrombectomy in Acute Ischemic Stroke: STRATIS Registry","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, Alicia M. Hall, Nils H. Mueller Kronast, David S. Liebeskind","doi":"10.1161/svin.123.000978","DOIUrl":"https://doi.org/10.1161/svin.123.000978","url":null,"abstract":"\u0000 \u0000 Mechanical thrombectomy is established for large‐vessel occlusions in acute ischemic stroke, but the potential role in distal vessel occlusions of medium arteries is less well established. Such medium or distal arterial segments have not been assessed with respect to thrombectomy devices used during endovascular therapy. We conducted an analysis of arterial size, segmental anatomy, and stent‐retriever device performance with respect to vessel size during thrombectomy.\u0000 \u0000 \u0000 \u0000 The STRATIS registry angiography core laboratory adjudicated the exact location of the occlusion, proximal, and distal device deployment, relationship to arterial bifurcations, and anatomic nomenclature. Arterial diameters were measured at all these sites. Statistical analyses examined the relationship between vessel and stent size, and arterial recanalization using expanded Thrombolysis in Cerebral Infarction reperfusion score.\u0000 \u0000 \u0000 \u0000 \u0000 Overall, 665 patients with stroke were included following thrombectomy using various Solitaire device sizes, including Solitaire 4×40, Solitaire 6×30, Solitaire 4×20, Solitaire 6×20, and Solitaire 4×15. Arterial diameter at the occlusion site was a median of 2.17 mm (interquartile range [IQR], 1.88–2.60 mm) in the distal M1, 1.67 mm (IQR, 1.47–2.06 mm) in the proximal M2 middle cerebral artery, 1.50 mm (IQR, 1.15–1.61 mm) in the distal M2 middle cerebral artery, 1.24 mm (IQR, 1.11–1.24 mm) in the M3 middle cerebral artery, and 1.88 mm (IQR, 1.49–1.94 mm) in the P1 posterior cerebral artery. Expanded Thrombolysis in Cerebral Infarction 2b to 3 reperfusion was achieved in all M3 or P1 segment occlusions. The rate of first‐pass recanalization was significantly higher in patients with medium (0.75–2 mm) versus large (>2 mm) vessel occlusion (69.5% versus 57.1%;\u0000 P\u0000  = 0.003).\u0000 \u0000 \u0000 \u0000 \u0000 Considerable overlap was noted between arterial sizes at occlusion sites carrying different segmental arterial nomenclature or vessel names. Substantial reperfusion may be achieved with currently available mechanical thrombectomy devices in medium arteries.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"71 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139800182","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":"Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases","authors":"Y. Takenobu, Noriko Nomura, Yoshito Sugita, Akihiro Okada, Takeshi Kawauchi, Tao Yang, Kenji Hashimoto","doi":"10.1161/svin.123.001180","DOIUrl":"https://doi.org/10.1161/svin.123.001180","url":null,"abstract":"\u0000 \u0000 Carotid artery stenting for heavily calcified lesions is challenging for interventionists. A calcium burden is associated with suboptimal dilatation, periprocedural complications, high rates of restenosis, and poor outcomes. We describe the first report of 2 cases of successful carotid artery stenting for heavily calcified lesions using a scoring balloon.\u0000 \u0000 \u0000 \u0000 The patients were both aged 75 years, 1 male and 1 female, who had experienced ipsilateral stroke prior to the procedures. They had dense calcifications at the lesions, stenosis rates of 95% (near occlusion) and 86% according to the North American Symptomatic Carotid Endarterectomy Trial criteria, and calcification arcs of 270° and 360°, respectively. Considering the heavy calcification, predilation with scoring balloons (NSE PTA balloon; Nipro, Osaka, Japan) at the rated burst pressure was performed in both cases. Sufficient dilatation was achieved, followed by carotid stent deployment (Precise Pro RX; Cordis, Miami Lakes, FL, USA). After postdilatation, the stenosis rates decreased to 21% and 23%, respectively. Although 1 patient experienced prolonged bradycardia and hypotension, they were well managed with anticholinergic and vasoconstrictive agents. Both patients remained asymptomatic.\u0000 \u0000 \u0000 \u0000 Carotid artery stenting using a scoring balloon obtained acceptable improvements in severe stenosis with heavily calcified lesions. This method could be a useful option for the revascularization of heavily calcified lesions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"91 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139801996","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":"Proliferative Angiopathy: A Systematic Review","authors":"Nolan J. Brown, Brian V. Lien, Jeff Ehresman, Redi Rahmani, J. Catapano, Michael T. Lawton","doi":"10.1161/svin.123.001186","DOIUrl":"https://doi.org/10.1161/svin.123.001186","url":null,"abstract":"\u0000 \u0000 First described over 4 decades ago as a diffuse form of arteriovenous malformation, cerebral proliferative angiopathy (CPA) is now categorized as a distinct vascular anomaly. Unlike arteriovenous malformation, which typically forms a well‐developed vascular nidus with feeder vessels and distinct venous outflow, CPA is the product of disorganized angiogenesis; thus, it lacks a true nidus. Its characteristic cycle of ischemia, angiogenesis, and aberrant perfusion can lead to abnormal blood flow patterns that characterize the disease. Treatment of CPA has historically relied on conservative management (antiepileptic drugs), and efforts to effectively manage this pathology have been hindered by an incomplete understanding of its natural history.\u0000 \u0000 \u0000 \u0000 A systematic search of 4 databases was performed. The following variables were extracted when present: study sample size, year of publication, age(s) of patient(s), sex, presenting signs and symptoms, neurological deficits (pre‐ and postoperative), type of intervention, average follow‐up time, and patient‐reported as well as functional outcomes at last follow‐up.\u0000 \u0000 \u0000 \u0000 Following the search and screen, 48 studies reporting 105 CPA cases remained eligible for inclusion. These studies consisted of 41 case reports, 6 case series, and 1 retrospective cohort study. The most common modality used in treatment of CPA was conservative management (53.4%). The second most common treatment modality was endovascular embolization (36.9%). The least common treatment modality was gamma knife radiosurgery, which was used in only 2 patients. Eleven patients experienced intracranial hemorrhage as a complication of CPA; 10 of the 11 patients underwent decompressive craniectomy. Finally, revascularization surgery was reportedly used in 5 patients (4.9%).\u0000 \u0000 \u0000 \u0000 Although there remains a dearth of studies reporting CPA, several clearly defined traits have been identified that characterize this pathology and distinguish it from arteriovenous malformation. Nonetheless, the verdict has not yet been reached regarding the effectiveness of surgical interventions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"99 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139801290","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}