Cerebrovascular

Read the latest cerebrovascular clinical findings in Neurosurgery Watch and improve your practice with new approaches and techniques.

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Comparison of General Anesthesia vs. Conscious Sedation during Endovascular Therapy on Infarct Growth and Clinical Outcomes in Acute Ischemic Stroke

August 2, 2018
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
Neurosurgery

Previous studies have yielded conflicting results regarding patient outcomes after endovascular therapy for acute ischemic stroke depending on whether general anesthesia (GA) or conscious sedation (CS) was administered. The GOLIATH trial (General or Local Anesthesia in Intra Arterial Therapy) is...

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Restenosis & risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study: secondary analysis of a RCT

July 5, 2018
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
Lancet Neurology

The International Carotid Stenting Study examined 1713 patients across 50 centers with symptomatic carotid stenosis (50% or greater) who were randomized to angioplasty and stenting vs endarterectomy in a 1:1 ratio.  Patients were followed at 30 days, 6 months, and...

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Tenectaplase versus Alteplase before Thrombectomy for Ischemic Stroke: EXTEND-IA TNK Trial

July 5, 2018
Cerebrovascular
By: 
Andrew W. Grande, MD
Shailesh Male, MD
Source: 
NEJM

EXTEND-IA TNK is a multicenter, randomized, open-label, blinded-outcomes, non-inferiority trial of acute ischemic stroke patients with internal carotid, middle cerebral, or basilar artery occlusion eligible for both intravenous thrombolysis. Patients were randomized 1:1 to receive IV tenecteplase (0.25mg/kg; max dose...

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Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial

July 5, 2018
Cerebrovascular
By: 
Vincent Y. Wang, MD, PhD
Source: 
Lancet

Spontaneous intracerebral hemorrhage (ICH) is a common cause of mortality and disability.  Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to reduce mortality in patients with traumatic injury and postpartum hemorrhage.  The Tranexamic acid for hyperacute primary...

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Contact Aspiration Versus Stent Retriever in Patients with Acute Ischemic Stroke with M2 Occlusion in the ASTER Randomized Clinical Trial.

May 1, 2018
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
JAMA

Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy in distal occlusions remains unclear. In a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent...

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DEFUSE 3: Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging

February 1, 2018
Cerebrovascular
By: 
Andrew W. Grande, MD
Shailesh Male, MD

DEFUSE-3 is a randomized clinical trial comparing endovascular therapy and standard medical management with medical management alone in anterior circulation large vessel occlusion (LVO) acute ischemic stroke (AIS) patients presenting within 6 to 16 hours from last well-known time with...

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National Patterns of Carotid Revascularization Before and After the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST)

February 1, 2018
Cerebrovascular
By: 
Stephen Grupke, MD

CREST demonstrated subtle advantage of carotid endarterectomy (CEA) compared to carotid artery stenting (CAS) in subgroup analysis. Specifically, patients receiving CEA had lower rates of stroke despite no difference in composite outcomes which included myocardial ischemia. In the present study,...

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DAWN Trial: Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

December 4, 2017
Cerebrovascular
By: 
Andrew W. Grande, MD
Shailesh Male, MD
Source: 
NEJM

In 2015, five major randomized controlled trials showed that thrombectomy for anterior large vessel ischemic strokes within 6 hours provided benefit. What about patients who present beyond 6 hours? The DAWN a multicenter, prospective, randomized, open-label, blinded endpoint trial was...

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Guidelines for Post-thrombectomy Management of ELVO Patients

December 4, 2017
Cerebrovascular
By: 
Michelle J. Smith, MD
Source: 
NCBI

Patients with emergent large vessel occlusions (ELVO) benefit from mechanical thrombectomy and appropriate postoperative care is necessary to optimize outcomes.  Recent SNIS guidelines covered post-thrombectomy care, ischemic penumbra, therapeutic hypertension, complication management, malignant cerebral edema, access site complications, and rehabilitation. ...

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Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER Randomized Clinical Trial

September 28, 2017
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
JAMA

This randomized, multicenter, open-label, blinded endpoint trial examines 381 patients with emergent M1 or M2 middle cerebral artery occlusions across 8 comprehensive stroke centers in France.  Eligible patients were randomized to undergo thrombectomy via stent retriever or contact aspiration with...

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