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![…]
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?[…]
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[…]
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?[…]
Key points: Nowadays there are a number of trials that have shown improved outcomes following endovascular therapy for LVO strokes compared with standard therapies alone, but only a little number of patients is treated without prior IV recombinant tissue plasminogen activator (rt-PA). For this reason the question of whether previous IV rt-PA really help the Read more about Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes[…]
González RG1. Key points: Reference – Current State of Acute Stroke Imaging. (2013). Current State of Acute Stroke Imaging, 44(11), 3260–3264. http://doi.org/10.1161/strokeaha.113.003229 [sgmb id=”1″]
Bekelis K1, Missios S2, MacKenzie TA2, Tjoumakaris S2, Jabbour P2. Pubmed BACKGROUND AND PURPOSE: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate. We investigated the association of general anesthesia with outcomes in patients undergoing mechanicalthrombectomy for ischemic stroke. METHODS: We performed a Read more about Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke.[…]
Endovascular thrombectomy is now the standard of care for patients with large vessel occlusion (LVO) in the anterior circulation. Good patients selection and rapid treatment are the key points of good outcome. All new trials show the importance of pre-procedural standardization. Ryan McTaggart et al. proposed an intra-procedural standardization to reduce time from initial groin Read more about Decreasing procedure times with a standardized approach to ELVO cases[…]
Gunning GM1, McArdle K1, Mirza M1, Duffy S1,2, Gilvarry M1, Brouwer PA3. Abstract BACKGROUND: Despite significant advancements in the procedural efficacy of mechanical thrombectomy in patients with ischemic stroke in recent years, there still remains a portion of the population that does not achieve good recanalization. The reasons for this may be varied. We hypothesized Read more about Clot friction variation with fibrin content; implications for resistance to thrombectomy.[…]
Goyal M1, Menon BK1, van Zwam WH2, Dippel DW3, Mitchell PJ4, Demchuk AM1, Dávalos A5, Majoie CB6, van der Lugt A3, de Miquel MA7, Donnan GA8, Roos YB6, Bonafe A9, Jahan R10, Diener HC11, van den Berg LA6, Levy EI12, Berkhemer OA6, Pereira VM13, Rempel J14, Millán M15, Davis SM16, Roy D17, Thornton J18, Román Read more about Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[…]