What is the accuracy of transcranial (color) Doppler (TC[C]D) for detecting stenosis or occlusion of intracranial arteries after acute ischemic stroke?

Transcranial Doppler (TCD) is an important tool in the armamentarium of stroke neurologists. This, bedsides modality, can help in establishing the presence, location, and severity of intracranial arterial occlusion in acute stroke cases. Various hemodynamic consequences of an acute arterial occlusion such as flow diversion and compensatory flow increase in other intracranial arteries can be monitored by TCD with reasonable accuracy. TCD monitoring during intravenous thrombolysis may demonstrate recanalization in real-time In addition, continuous ultrasound exposure during intravenous thrombolysis can enhance the rates of the recanalization of an acutely occluded intracranial artery. Therapeutic ultrasound or sonothrombolysis remains a widely debated application of TCD. We present the available evidence for sonothrombolysis as well as its current status in the hyperacute treatment of acute ischemic stroke.

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Evaluating recanalization of relevant lenticulostriate arteries in acute ischemic stroke using high-resolution MRA at 7T

International Journal of Stroke ◽

10.1177/1747493019897868 ◽

2020 ◽

pp. 174749301989786

Author(s):

Takafumi Suzuki ◽

Tatsunori Natori ◽

Makoto Sasaki ◽

Haruna Miyazawa ◽

Shinsuke Narumi ◽

...

Keyword(s):

Ischemic Stroke ◽

High Resolution ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Imaging Findings ◽

Lenticulostriate Arteries ◽

Acute Infarct ◽

Lenticulostriate Artery ◽

Intracranial Arteries

Background Occluded major intracranial arteries can spontaneously recanalize in patients with acute ischemic stroke mainly due to embolic mechanisms. However, it remains unknown whether recanalization can occur in perforating arteries, such as lenticulostriate arteries. Therefore, in the present study, we assessed changes suggesting recanalization of the lenticulostriate arteries in patients with acute ischemic stroke of the lenticulostriate artery territory using high-resolution magnetic resonance angiography (HR-MRA) at 7T. Methods We prospectively examined 39 consecutive patients with acute infarcts confined within the lenticulostriate artery territory. Using a 7T scanner during the acute period and one month thereafter, we evaluated imaging findings indicating the recanalization of the relevant lenticulostriate arteries, following which we examined differences in other imaging findings and clinical characteristics between patients with/without recanalization. Results HR-MRA findings suggestive of recanalization (i.e. patent lenticulostriate arteries within acute infarct lesions with/without hemorrhagic changes) were observed in 8 (25%) of 32 patients who were eligible for analyses. These findings were detected in three and five patients on the baseline and follow-up images, respectively. The lengths of relevant lenticulostriate arteries on the follow-up MRA were significantly larger in patients with recanalization than in those without ( P = 0.01). However, there were no significant differences in the infarct volume or clinical outcomes between the recanalization and non-recanalization groups. Conclusion HR-MRA at 7T revealed that recanalization of the relevant lenticulostriate arteries can occur in patients with acute ischemic stroke confined to the lenticulostriate artery territory.

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Novel Blood Clot Retriever for Ischemic Stroke

Micromachines ◽

10.3390/mi12080928 ◽

2021 ◽

Vol 12 (8) ◽

pp. 928

Author(s):

Ming-Ya Hung ◽

Chun-Kai Yang ◽

Jiong-Hong Chen ◽

Li-Han Lin ◽

Hao-Ming Hsiao

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Clot ◽

Proof Of Concept ◽

Retrieval Performance ◽

Retrieval Rate ◽

Blood Clots ◽

Intracranial Arteries ◽

Bench Testing ◽

Novel Design

Stroke is the second leading cause of death in the world. Ischemic stroke, caused by the blockage of intracranial arteries, accounts for approximately 80% of strokes. Among this proportion, acute ischemic stroke, usually caused by the sudden formation of blood clots, can cause fatal blockages in arteries. We proposed a unique blood clot retriever for the treatment of acute ischemic stroke, and conducted a series of tasks, including design, computer simulation, prototyping, and bench testing, for the proof of concept. Unlike most blood clot retrievers used today, our novel design deviates from traditional stent-like blood clot retrievers and uses large closed cells, irregular spikes, and strut protrusions to achieve maximum entanglement for better retrieval performance. Experimental results showed that the retrieval rate of our blood clot retriever was 79%, which demonstrated the feasibility of our new design concept.

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