Cerebrovascular

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

CV

Non-inferiority of stenting vs endarterectomy for asymptomatic carotid stenosis in non-high-risk patients

March 8, 2016
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
New England Journal of Medicine

Previous clinical trials suggest that carotid artery stenting is an effective alternative to endarterectomy in patients who are at average or high risk for surgical complications. The Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Patients Trial was carried out...

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Induced Hypertension does not significantly increase cerebral perfusion after aneurysmal subarachnoid hermorrhage

November 2, 2015
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
The Lancet

Induced hypertension is a common treatment modality in patients with delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (SAH).  The efficacy of this therapeutic modality is based on limited case series.  Gathier et al. randomized aneurysmal SAH to induced (N=12)...

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Stenting vs. medical treatment in patients with symptomatic vertebral artery stenosis: a randomized open-label phase 2 trial

October 5, 2015
Cerebrovascular
By: 
Alexander A. Khalessi, MD
Source: 
Pubmed

The VAST trial randomized patients suffering a minor stroke or transient ischemic attack due to >50% vertebral artery stenosis to medical therapy versus vertebral artery stenting. It enrolled 115 patients and was halted prematurely due to insufficient funding.  The primary...

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Superiority of thrombectomy within 8 hours of anterior circulation large vessel occlusion over medical therapy

June 29, 2015
Cerebrovascular
By: 
Alexander A. Khalessi, MD
Source: 
The New England Journal of Medicine

REVASCAT was a multicenter randomized controlled trial enrolling patients within 8 hours of symptom onset and confirmed anterior circulation, large vessel occlusion.  Patients were randomized to medical therapy versus medical therapy plus thrombectomy with the Solitaire FR Stent Retriever device....

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Carotid stenting and endarterectomy are functionally equivalent, but stenting is associated with more radiographic changes

April 29, 2015
Cerebrovascular
By: 
Justin F. Fraser, MD
Source: 
Wiley Online Library

Kuliha et al. performed a randomized, blinded, controlled trial comparing carotid endarterectomy (CEA) and carotid stenting (CAS) for the treatment of asymptomatic and symptomatic severe (>70%) stenosis at a single institution.  The primary endpoint was new DWI-positive strokes on MRI...

CV

Long term follow-up of carotid endartectomy vs stenting

April 29, 2015
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
The Lancet

Atherosclerotic stenosis of the internal carotid artery accounts for 10–15% of strokes. Prior trials comparing stenting with CEA for symptomatic carotid stenosis demonstrated that stenting was associated with a higher risk of stroke, but lower rates of myocardial infarction, access...

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Antiplatelet and anticoagulant therapy confer similar benefit for cervical artery dissection

April 29, 2015
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
The Lancet Neurology

Extracranial carotid and vertebral artery dissection is a significant etiology of stroke in young people.  Antiplatelet and anticoagulants are commonly prescribed to reduce the risk of recurrent stroke, but the optimal therapy is unclear.  At 39 stroke centers in the...

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Balloon-mounted stents are not superior to antiplatelet therapy for symptomatic intracranial stenosis

April 28, 2015
Cerebrovascular
By: 
Alexander A. Khalessi, MD
Source: 
Journal of American Medical Association

The VISSIT trial examined the safety and efficacy of intracranial stenting versus antiplatelet medical therapy for symptomatic intracranial atherosclerotic disease (ICAD), similar to the SAMMPRUS trial.  Target lesions included stenosis greater than 70%; primary endpoint was the secondary prevention of...

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Long term functional equivalence of carotid endarterectomy and stenting for symptomatic stenosis.

February 26, 2015
Cerebrovascular
By: 
Alexander A. Khalessi, MD
Source: 
PubMed

The ICSS trial randomized 1710 patients across 50 centers with symptomatic carotid artery disease to stenting versus endarterectomy.  Given the 10-year study horizon, substantial variability in stenting procedural strategy and devices occurred.  The intention-to-treat analysis was high fidelity.  Only 9...

CV

EXTEND-IA: Rapid endovascular treatment based on perfusion imaging improves functional outcomes in stroke

February 26, 2015
Cerebrovascular
By: 
Alexander A. Khalessi, MD
Source: 
PubMed

The Extend-IA multicenter randomized trial conducted in Australia and New Zealand included patients with a confirmed anterior circulation occlusion who received IV alteplase (0.9 mg/kg) within 4.5 hours of symptom onset.  All patients received CT perfusion imaging and we’re excluded...

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