Cerebrovascular

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

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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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2 Year Outcomes of MR CLEAN trial for ischemic stroke

May 2, 2017
Cerebrovascular
By: 
Robert Starke, MD, MSc
Source: 
The New England Journal of Medicine

Several trials involving patients with acute ischemic stroke and large vessel occlusion have shown better short-term functional outcomes with endovascular treatment than with conventional treatment.  Recently, the MR CLEAN Investigators published 2 year outcomes from patients randomized to receive either...

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Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations

May 2, 2017
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
Pubmed

This report addresses 5 key topics for cerebral cavernous malformations: epidemiology and natural history, genetic testing and counseling, diagnostic criteria and radiology standards, neurosurgical considerations, and neurologic considerations.  Search terms were derived for each key topic by the Angioma Alliance...

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Hemorrhage risk and Radiosurgery outcomes for Pediatric AVM

March 1, 2017
Cerebrovascular, Pediatrics, Stereotactic & Functional
By: 
Brandon G. Rocque, MD, MS
Source: 
Journal of Neurosurgery

The International Gamma Knife Research Foundation presented 2 pediatric brain arteriovenous malformations (AVM) reports: 1) the incidence and risk for hemorrhagic presentation, and 2) radiosurgery outcomes. Retrospective review of 357 patients (mean age of 12.6 years) from 7 centers: all...

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Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomised trials

February 1, 2017
Cerebrovascular
By: 
Robert Starke, MD, MSc
Source: 
Lancet

 In 2015, five randomized trials showed efficacy of endovascular thrombectomy over medical care in patients with acute ischemic stroke caused by large vessel occlusion (LVO) of arteries of the proximal anterior circulation. A recent publication in the Lancet from the trial investigators from these trials, reported the pooled patient analysis of these studies...

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Effect of Anesthesia on Outcomes of Endovascular Thrombectomy: A Randomized Clinical Trial

February 1, 2017
Cerebrovascular
By: 
Michelle J. Smith, MD
Source: 
JAMA

Mechanical thrombectomy in select patients with acute ischemic stroke is a proven treatment. However, optimal anesthesia during this procedure is debated. Schonenberger et al. performed a prospective, randomized, blinded outcome trial assessing the use of general endotracheal anesthesia versus conscious...

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The Optimal Timing of Endovascular Thrombectomy For Ischemic Stroke: A Meta-analysis

February 1, 2017
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
JAMA

Saver et al. analyzed pooled data of 1,287 patients from five large randomized phase 3 trials evaluating the use of mechanical thrombectomy vs medical management in the emergent treatment of acute ischemic stroke secondary to large vessel occlusion (MR CLEAN,...

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Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

August 1, 2016
Cerebrovascular
By: 
Robert Starke, MD, MSc
Source: 
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage June 8, 2016DOI: 10.1056/NEJMoa1603460

Optimal blood pressure management for intracerebral hemorrhage (ICH) patients remains unclear. In a prospective randomized clinical trial, patients with ICH volume <60 cm3 and Glasgow Coma Scale (GCS) score of >5 were randomized to a systolic blood pressure of 110-139...

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