Cerebrovascular

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

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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ESCAPE: Rapid endovascular treatment improves functional outcomes in stroke

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

The ESCAPE Trial aimed to assess the role for thrombectomy for patients with stroke due to anterior circulation proximal vessel occlusion. The study randomized 316 patients across 22 centers worldwide who presented within 12 hours with an acute stroke syndrome...

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MR CLEAN: A Randomized Trial of Intra-arterial Treatment for Acute Ischemic Stroke

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

The MR CLEAN trial was 16 center, randomized trial conducted in the Netherlands on subjects presenting within 6 hours after onset of acute stroke syndrome, and confirmed large vessel occlusion in the anterior circulation.  Subjects received endovascular thrombectomy (81.5% received...

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Change in CT appearance over time correlates with outcomes more than initial CT findings in ischemic stroke

January 5, 2015
Cerebrovascular
By: 
Michelle J. Smith, MD
Source: 
Pub Med

Sun et al. performed a retrospective cohort study assessing the rate of pretreatment Alberta Stroke Program Early CT Scores (ASPECTS) decay and its ability to predict good outcome. ASPECTS scores <8 have been associated with worse functional outcomes in patients...

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Efficacy of combined direct and indirect revascularization for Moya Moya disease

November 4, 2014
Cerebrovascular
By: 
Robert M. Starke, MD MSC
Source: 
Pub Med

Reports of long-term outcomes following combined direct and indirect bypass for moyamoya disease are sparse.  Cho and colleagues report on 77 treated hemispheres in 60 patients with a mean follow up of approximately 6 years.  Karnofsky Performance and modified Rankin...

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Stent Retriever for Acute Stroke: Post-market validation of revascularization and outcomes

November 4, 2014
Cerebrovascular
By: 
Michelle J. Smith, MD
Source: 
Pubmed

The North American Solitaire Stent Retriever Acute Stroke (NASA) registry is the largest post-marketing study to date assessing radiographic and clinical outcomes of a stent retriever device, including 354 patients treated for acute ischemic stroke secondary to large vessel occlusion...

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