Mechanical and Aspiration Thrombectomy in a 2-day-old Neonate with Perinatal Stroke

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

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Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration

Journal of Neurosurgery ◽

10.3171/2019.1.jns182905 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1202-1208 ◽

Cited By ~ 4

Author(s):

Dong-Hun Kang ◽

Woong Yoon ◽

Byung Hyun Baek ◽

Seul Kee Kim ◽

Yun Young Lee ◽

...

Keyword(s):

Binary Logistic Regression ◽

Stent Retriever ◽

Large Vessel ◽

Binary Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Front Line ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Atherosclerotic Stenosis ◽

Antegrade Flow

OBJECTIVEThe optimal front-line thrombectomy choice for primary recanalization of a target artery remains unknown for patients with acute large-vessel occlusion (LVO) and an underlying intracranial atherosclerotic stenosis (ICAS). The authors aimed to compare procedural characteristics and outcomes between patients who received a stent-retriever thrombectomy (SRT) and patients who received a contact aspiration thrombectomy (CAT), as the front-line approach for treating LVO due to severe underlying ICAS.METHODSOne hundred thirty patients who presented with acute LVO and underlying severe ICAS at the occlusion site were included. Procedural characteristics and treatment outcomes were compared between patients treated with front-line SRT (n = 70) and those treated with front-line CAT (n = 60). The primary outcomes were the rate of switching to an alternative thrombectomy technique, time from groin puncture to initial reperfusion, and duration of the procedure. Initial reperfusion was defined as revealing the underlying culprit stenosis with an antegrade flow after thrombectomy.RESULTSThe rate of switching to an alternative thrombectomy after failure of the front-line technique was significantly higher in the CAT group than in the SRT group (40% vs 4.3%; OR 2.543, 95% CI 1.893–3.417, p < 0.001). The median time from puncture to initial reperfusion (17 vs 31 minutes, p < 0.001) and procedure duration (39 vs 75.5 minutes, p < 0.001) were significantly shorter in the SRT group than in the CAT group. In the binary logistic regression analysis, a longer time from puncture to initial reperfusion was an independent predictor of a 90-day poor (modified Rankin Scale score 3–6) functional outcome (per 1-minute increase; OR 1.029, 95% CI 1.008–1.050, p = 0.006).CONCLUSIONSThe authors’ results suggest that SRT may be more effective than CAT for identifying underlying culprit stenosis and therefore considered the optimal front-line thrombectomy technique in acute stroke patients with LVO and severe underlying ICAS.

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Neuroplasticity

The Oxford Handbook of Neurolinguistics ◽

10.1093/oxfordhb/9780190672027.013.10 ◽

2019 ◽

pp. 230-260

Author(s):

Judy S. Reilly ◽

Lara R. Polse

Keyword(s):

Neural Plasticity ◽

Late Onset ◽

Neural Substrates ◽

Brain Regions ◽

Developing Brain ◽

Perinatal Stroke ◽

Alternative Pathways ◽

Affective Expression ◽

Unilateral Brain ◽

Irreparable Damage

With respect to language, it has long been observed that children who experience early unilateral brain injury do not show the same irreparable damage as do adults with homologous late-onset strokes. Neural plasticity has been proposed as the explanation for such differential linguistic profiles; that is, the plasticity of the young, developing brain allows the possibility for extensive adaptation and organization following a neural insult. Recent research, however, suggests that there are limits to this ability to adapt and organize. Results from a another communicative system, affect, suggest that children with unilateral pre- or perinatal stroke show similar (albeit subtler) effects to adults with homologous late-onset injuries. This chapter presents findings on language development in children who sustained a pre- or perinatal unilateral stroke, and complements these studies with a discussion of affective expression in these same children. These prospective studies of children with perinatal stroke provide a unique window into the development of the neural substrates for language and affect. Specifically, they afford a context to investigate the degree to which particular brain regions may be privileged for specific behavioral functions, as well as how the developing brain adapts to organize alternative pathways in the wake of an early insult.

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