EVT selection 6-24 hours after stroke: no thanks!

Key point: In this post, we have seen that DAWN (and DEFUSE-3) trials results opened a great debate and left us with a big question: We concluded that the development of strict selection criteria could reduce the “therapy effect” of the treatment, despite it could increase the rate of patients with a good outcome. Meanwhile Read more about EVT selection 6-24 hours after stroke: no thanks![…]

The future of neurosurgery

When the news got out that Edison was developing the first practical electric light bulb, not everyone was impressed. A British Parliament Committee noted that Edison’s light bulb was “unworthy of the attention of practical or scientific men” and a chief engineer for the British Post Office said that the “subdivision of the electric light is an Read more about The future of neurosurgery[…]

ISUIA: the old problem.

Key point:
 In the last post, we have concluded that when an unruptured intracranial aneurysm is identified we have to decide whether the “patient” (and not only the aneurysm) should be treated and whether it should be treated with endovascular or neurosurgical techniques. But for years our decision making has been influenced by results of Read more about ISUIA: the old problem.[…]

An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms

Key point: The widespread use of neurovascular imaging has increased the amount of intracranial aneurysms eccidentally detected. Although the lifetime risk of aneurysmal rupture in many cases is relatively small (approximately 1% per year), rupture can results in permanent neurological deficits or death, the reason why often patients may desire the treatment of unruptured aneurysms Read more about An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms[…]

DAWN trial: solution or problem?

Key point: The main results of the “magnificent seven” (MR-CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE, THERAPY) regarding stroke therapy showed that endovascular thrombectomy had a clinical benefit when it was performed within 6 hours after the onset of stroke symptoms and that there is an inverse relation between time and the benefit of the Read more about DAWN trial: solution or problem?[…]

Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis

Key point: Despite recently published trials showed the sizeable treatment effect of the endovascular mechanical thrombectomy, several studies suggest that the choice of anesthetic management during the endovascular recanalization procedure may have a substantial effect on patient outcomes. Preliminary retrospective observational studies have suggested that general anesthesia (GA) is associated with poorer outcomes than conscious sedation Read more about Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis[…]

Sex, Smoking, and Risk for Subarachnoid Hemorrhage

Key points: According to prospective cohort studies, smoking is the most important risk factor for unruptured intracranial aneurysms, correlating with their appearance, growth and rupture. In addition, earlier studies report that women are at higher risk for SAH with adjusted hazard ratios (HRs) from 1.4 to 1.9 compared with men. In this paper, published August, 2016, Read more about Sex, Smoking, and Risk for Subarachnoid Hemorrhage[…]

A raised bar for aneurysm surgery in the endovascular era

Key points: Despite microsurgical treatment of cerebral aneurysms has a documented history, the impressive progression of endovascular technology, techniques and skills, and the results of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT) has altered the paradigm for treating intracranial aneurysms. These neurointerventional option have raised the bar for aneurysm surgery, in an era when most Read more about A raised bar for aneurysm surgery in the endovascular era[…]

Collateral leptomeningeal arteries: where are the anastomosis?

Key point: More than 300 years ago, Willis T. characterized the arterial ring at the base of the brain and began debate concerning whether the circle functions primarily as a flow equalizer or as an anastomosis. Heubner O., in 1874, was the first to produce a well-documented study demonstrating the existence of LMA; he was trying to Read more about Collateral leptomeningeal arteries: where are the anastomosis?[…]