Weakness

2018 ◽  
pp. 94-100
Author(s):  
Aaron Farney
Keyword(s):  
Intracranial Pressure ◽  
Therapeutic Option ◽  
Critical Role ◽  
Large Vessel ◽  
Morbidity And Mortality ◽  
Large Vessel Occlusion ◽  
Significant Morbidity ◽  
Vessel Occlusion ◽  
The Unconscious

Acute ischemic strokes have significant morbidity and mortality, particularly when they involve a large vessel occlusion. This case reviews the prehospital presentation of a patient with a large vessel occlusion stroke, the critical role prehospital personnel have in recognizing a stroke, determining the most appropriate facility, and identifying the most appropriate transport modality. Approaches to managing the unconscious patient’s airway are discussed, with particular attention to the effects intubation may have on intracranial pressure. As large vessel occlusion ischemic strokes have a therapeutic option not previously available, the role of prehospital identification and destination determination is even more critical ,and this case reviews those considerations.

Role of Non-Perfusion Factors in Mildly Symptomatic Large Vessel Occlusion Stroke

2020 ◽  
Vol 29 (10) ◽  
pp. 105172
Author(s):  
Omar Hussein ◽  
Ahmed Abd Elazim ◽  
Khalid Sawalha ◽  
Smeer Salam ◽  
Kasser Saba ◽  
...  
Keyword(s):  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Role of Radiological Eye Deviation in Imaging Occult Cases of Acute Large Vessel Occlusion

2020 ◽  
Vol 29 (5) ◽  
pp. 104687
Author(s):  
Nan N. Jiang ◽  
Wei Wu ◽  
Crystal Fong ◽  
Demetrios J. Sahlas ◽  
Ramiro Larrazabal
Keyword(s):  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment

2021 ◽  
Vol 23 (3) ◽  
pp. 343-357
Author(s):  
Beom Joon Kim ◽  
Nishita Singh ◽  
Bijoy K. Menon
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Endovascular Treatment ◽  
Critical Role ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Pial Arteries ◽  
Research Perspectives

Endovascular therapy (EVT) is an effective treatment for ischemic stroke due to large vessel occlusion (LVO). Unlike intravenous thrombolysis, EVT enables visualization of the restoration of blood flow, also known as successful reperfusion in real time. However, until successful reperfusion is achieved, the survival of the ischemic brain is mainly dependent on blood flow from the leptomeningeal collaterals (LMC). It plays a critical role in maintaining tissue perfusion after LVO via pre-existing channels between the arborizing pial small arteries or arterioles overlying the cerebral hemispheres. In the ischemic territory where the physiologic cerebral autoregulation is impaired and the pial arteries are maximally dilated within their capacity, the direction and amount of LMC perfusion rely on the systemic perfusion, which can be estimated by measuring blood pressure (BP). After the EVT procedure, treatment focuses on mitigating the risk of hemorrhagic transformation, potentially via BP reduction. Thus, BP management may be a key component of acute care for patients with LVO stroke. However, the guidelines on BP management during and after EVT are limited, mostly due to the scarcity of high-level evidence on this issue. In this review, we aim to summarize the anatomical and physiological characteristics of LMC to maintain cerebral perfusion after acute LVO, along with a landscape summary of the literature on BP management in endovascular treatment. The objective of this review is to describe the mechanistic association between systemic BP and collateral perfusion after LVO and thus provide clinical and research perspectives on this topic.

scholarly journals Role of Favorable Perfusion Imaging in Predicting the Outcome of Patients with Acute Ischemic Stroke due to Large Vessel Occlusion Undergoing Effective Thrombectomy: A Single-Center Study

2021 ◽  
pp. 1-8
Author(s):  
Riccardo Di Iorio ◽  
Fabio Pilato ◽  
Iacopo Valente ◽  
Andrea Laurienzo ◽  
Simona Gaudino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Controlled Study ◽  
Ischemic Penumbra ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Single Center Study

<b><i>Introduction:</i></b> We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT). <b><i>Methods:</i></b> We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days. <b><i>Results:</i></b> Sixty-four percent of the study patients had an mRS score of 0–1 at 90 days versus 12% of the control patients (<i>p</i> &#x3c; 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0–2] vs. 2 [2–3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (<i>p</i> &#x3c; 0.001) with a better neurological outcome. <b><i>Conclusions:</i></b> In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.

scholarly journals Thrombectomy for Treatment of Acute Stroke in the COVID-19 Pandemic

2020 ◽  
pp. 1-6
Author(s):  
Panagiotis Papanagiotou ◽  
Guillermo Parrilla ◽  
L. Creed Pettigrew
Keyword(s):  
Acute Stroke ◽  
Embolic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Novel Coronavirus

This commentary will focus on the role of thrombectomy for the treatment of embolic stroke during the 2019 novel coronavirus disease (COVID-19). We will begin with review of recently promulgated guidelines for use of thrombectomy in COVID-19-associated stroke. We will then survey the reported experience of thrombectomy applied to treatment of large-vessel occlusion (LVO) stroke in COVID-19. We will conclude by discussing unusual challenges confronted by neuro-interventionalists seeking to perform thrombectomy in COVID-19 patients with acute LVO stroke.

scholarly journals Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 963-969 ◽  
Author(s):  
Ajay Malhotra ◽  
Xiao Wu ◽  
Seyedmehdi Payabvash ◽  
Charles C. Matouk ◽  
Howard P. Forman ◽  
...  
Keyword(s):  
Large Vessel ◽  
Morbidity And Mortality ◽  
Sensitivity Analyses ◽  
Tissue Type ◽  
Perfect Health ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
The Difference ◽  
The Impact

Background and Purpose— Strokes in patients aged ≥80 years are common, and advanced age is associated with relatively poor poststroke functional outcome. The current guidelines do not recommend an upper age limit for endovascular thrombectomy (EVT). The purpose of this study is to evaluate the effectiveness of EVT in acute stroke because of large vessel occlusion for elderly patients >age 80 years. Methods— A Markov decision analytic model was constructed from a societal perspective to evaluate health outcomes in terms of quality-adjusted life years (QALYs) after EVT for acute ischemic stroke because of large vessel occlusion in patients above age 80 years. Age-specific input parameters were obtained from the most recent/comprehensive literature. Good outcome was defined as a modified Rankin Scale score ≤2. Probabilistic, 1-way, and 2-way sensitivity analyses were performed for both healthy patients and patients with disability at baseline. Results— Base case calculation showed in functionally independent patients at baseline, intravenous thrombolysis (IVT) with tPA (tissue-type plasminogen activator) only to be the better strategy with 3.76 QALYs compared to 2.93 QALYs for patients undergoing EVT. The difference in outcome is 0.83 QALY (equivalent to 303 days of life in perfect health). For patients with baseline disability, IVT only yields a utility of 1.92 QALYs and EVT yields a utility of 1.65 QALYs. The difference is 0.27 QALYs (equivalent to 99 days of life in perfect health). Multiple sensitivity analyses showed that the effectiveness of EVT is significantly determined by the morbidity and mortality after both IVT and EVT strategies, respectively. Conclusions— Our study demonstrates the impact of relevant factors on the effectiveness of EVT in patients above 80 years of age. Morbidity and mortality after both IVT and EVT strategies significantly influence the outcomes in both healthy and disabled patients at baseline. Better identification of patients not benefiting from IVT would optimize the selective use of EVT thereby improving its effectiveness.

Response to “Role of surgical versus endovascular embolectomy for the treatment of acute large vessel occlusion”

2014 ◽  
Vol 28 (3) ◽  
pp. 431-432 ◽  
Author(s):  
Tomohiro Inoue ◽  
Akira Tamura ◽  
Isamu Saito ◽  
Kazuo Tsutsumi ◽  
Nobuhito Saito
Keyword(s):  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Endovascular therapy for anterior circulation large vessel occlusion in telestroke

2019 ◽  
pp. 1357633X1986719 ◽  
Author(s):  
Haidar Moustafa ◽  
Kristian Barlinn ◽  
Alexandra Prakapenia ◽  
Simon Winzer ◽  
Johannes Gerber ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Therapy ◽  
Favourable Outcome ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Haemorrhage

Introduction Recent exploratory analysis suggested comparable outcomes among stroke patients undergoing endovascular therapy (EVT) for anterior circulation large vessel occlusion, whether selected via the telestroke network or admitted directly to an EVT-capable centre. We further studied the role of telemedicine in selection of ischaemic stroke patients potentially eligible for EVT. Methods We prospectively included consecutive ischaemic stroke patients with anterior circulation large vessel occlusion who underwent EVT at our neurovascular centre (January 2016 to March 2018). We compared safety and efficacy including symptomatic intracerebral haemorrhage (sICH), successful reperfusion (mTICI 2b/3), 90-day favourable outcome (mRS ≤ 2) and 90-day survival between patients transferred from telestroke hospitals and patients directly admitted. Results Of 280 potentially EVT-eligible patients, 72/129 (56%) telestroke and 91/151 (60%) direct admissions eventually underwent EVT (age 76 (66–82) years, median (interquartile range), 46% men, NIHSS score 17 (13–20)). Telestroke patients had larger pre-EVT infarct cores (ASPECTS: 7 (6–8) vs. 8 (7–9); p < 0.0001) and shorter door-to-groin puncture times (71 (56–84) vs. 101 (79–133) min; p < 0.0001) than directly admitted patients. sICH (2.8% vs. 1.1%; p = 0.58), successful reperfusion (81% vs. 77%; p = 0.56), 90-day favourable outcome (25% vs. 29%; p = 0.65) and 90-day survival (73% vs. 67%; p = 0.39) rates were comparable among telestroke and direct admissions. Discussion Our data underpins the important role of telemedicine in identifying acute ischaemic stroke patients lacking immediate access to EVT-capable stroke centres. Stroke patients selected via telemedicine and those directly admitted had comparable chances of favourable outcomes after EVT for large vessel occlusion.

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