Cerebrovascular

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

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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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Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral hemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial

June 30, 2016
Cerebrovascular
By: 
Stephen Grupke, MD
Source: 
The Lancet

The role of platelet transfusion after intracerebral hemorrhage associated with antiplatelet therapy remains undefined. A randomized, open-label, multicenter parallel-group trial compared 3-month functional outcome and mortality and 24-hour hemorrhage growth in patients with an acute, spontaneous, supratentoral intracerebral hemorrhage and...

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Stenting and endarterectomy have equivalent 10 year outcomes for significant carotid stenosis

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

Differences in long-term outcomes between stenting and endarterectomy for significant carotid artery stenosis remain unclear.  Recently, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) published extended 10 year results.  Among 2502 randomized patients with both symptomatic and asymptomatic significant carotid...

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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...

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