Cerebrovascular

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

CV

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, MBA, MS
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, MBA, MS
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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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, MBA, MS
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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