EARLY REPERFUSION IN ACUTE ISCHEMIC STROKE USING PUSH AND FLUFF TECHNIQUE IN SOLITAIRE DEVICE: TECHNICAL ASPECTS AND DISCUSSION

2017 ◽  
Author(s):  
Biplab Das
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Early Reperfusion ◽  
Technical Aspects

Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke

2015 ◽  
Vol 25 (6) ◽  
pp. 952-958 ◽  
Author(s):  
Brice Ozenne ◽  
Tae-Hee Cho ◽  
Irene Klaerke Mikkelsen ◽  
Marc Hermier ◽  
Lars Ribe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Early Reperfusion

Abstract TP317: Hyperglycemia Strongly Predicts Large Ischemic Infarct Growth Despite Full Endovascular Reperfusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mersedeh Bahr Hosseini ◽  
Graham W Woolf ◽  
Jason D Hinman ◽  
Radoslav Raychev ◽  
Latisha K Latisha K Sharma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Acute Ischemic Stroke ◽  
Glucose Level ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Early Reperfusion ◽  
Ischemic Infarct

Introduction: Ischemic infarct core grows at variable rates despite early reperfusion. The purpose of this study was to determine the predictors of infarct growth despite full recanalization of a large vessel occlusion in acute ischemic stroke. Method: Patients with acute ischemic stroke due to ICA or MCA occlusion who received endovascular therapy with Thrombolysis in Cerebral Infarction scale (TICI) scores of 2b or greater were subsequently selected between July 2012 and May 2016. The Alberta Stroke Program Early CT Score (ASPECT) was measured on the initial CT or MRI upon arrival and subsequently on the 24-hour scan. The infarct growth (delta d) was measured as initial ASPECT minus 24-hour ASPECT. Large and small infarct growth was defined as delta d of >= to3 and < 3 respectively. The relationship between the infarct growth and baseline variables of blood glucose level(BG), time of symptoms onset to recanalization time and baseline ASPECT score were assessed using statistical analysis. Results: Total of 76 patients were included. 32% had large infarct growth (25/76). The initial ASPECT score was not significantly different between the the 2 subgroups of large and small delta d (7.5 vs 6, P= 0.97). Baseline BG level was significantly higher in the group with larger infarct growth (160 vs 128, P=0.006). The baseline BG level of more than 150 was found as the threshold between the 2 subgroups (P=0.0003). No association was found between the infarct growth and history of diabetes (P= 0.7). Conclusion: Our data suggests that infarct growth occurs in relatively high percentage of ischemic stroke patients despite early full reperfusion of the large vessel occlusion. We showed that baseline blood glucose level particularly levels of higher than 150 is significantly associated with larger infarct growth. Therefore, it can be used as a strong predictive value in early recognition of this patient population.

scholarly journals Histological stroke clot analysis after thrombectomy: Technical aspects and recommendations

2019 ◽  
Vol 15 (5) ◽  
pp. 467-476 ◽  
Author(s):  
S Staessens ◽  
S Fitzgerald ◽  
T Andersson ◽  
F Clarençon ◽  
F Denorme ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Procedures ◽  
Cerebral Arteries ◽  
Research Field ◽  
Stroke Therapy ◽  
Technical Aspects ◽  
Stroke Research

The recent advent of endovascular procedures has created the unique opportunity to collect and analyze thrombi removed from cerebral arteries, instigating a novel subfield in stroke research. Insights into thrombus characteristics and composition could play an important role in ongoing efforts to improve acute ischemic stroke therapy. An increasing number of centers are collecting stroke thrombi. This paper aims at providing guiding information on thrombus handling, procedures, and analysis in order to facilitate and standardize this emerging research field.

scholarly journals Complications of Mechanical Thrombectomy in Acute Ischemic Stroke

Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S115-S125
Author(s):  
Rashi Krishnan ◽  
William Mays ◽  
Lucas Elijovich
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Mechanical Thrombectomy ◽  
Early Recognition ◽  
Care Providers ◽  
Vessel Occlusion ◽  
Large Space ◽  
Early Reperfusion ◽  
Optimal Outcomes

Multiple randomized clinical trials have supported the use of mechanical thrombectomy (MT) as standard of care in the treatment of large vessel occlusion acute ischemic stroke. Optimal outcomes depend not only on early reperfusion therapy but also on post thrombectomy care. Early recognition of post MT complications including reperfusion hemorrhage, cerebral edema and large space occupying infarcts, and access site complications can guide early initiation of lifesaving therapies that can improve neurologic outcomes. Knowledge of common complications and their management is essential for stroke neurologists and critical care providers to ensure optimal outcomes. We present a review of the available literature evaluating the common complications in patients undergoing MT with emphasis on early recognition and management.

scholarly journals Early reperfusion therapy in acute ischemic stroke after recent myocardial infarction

2016 ◽  
Vol 74 (8) ◽  
pp. 690-691 ◽  
Author(s):  
Gustavo Wruck Kuster ◽  
Antonio Claudio Baruzzi ◽  
Evelyn de Paula Pacheco ◽  
Renan Barros Domingues ◽  
Marco Pieruccetti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Early Reperfusion ◽  
Recent Myocardial Infarction

Abstract WMP13: Multiphase MRA Collateral Map: Prediction of Tissue Outcome and Penumbra in Patients With Acute Ischemic Stroke in the Anterior Circulation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hyun Jeong KIM ◽  
Taek Jun Lee ◽  
Hong Gee Roh ◽  
Jeong Jin Park ◽  
Hyung Jin Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mr Angiography ◽  
Visual Assessment ◽  
Anterior Circulation ◽  
Early Reperfusion ◽  
Infarct Area ◽  
Dynamic Mr

Background and Purpose: We developed the MRA collateral map derived from dynamic MR angiography and grading methods with significant linear association with functional outcomes of patients with acute ischemic stroke (AIS). This study is to verify the value of the MRA collateral map for predicting tissue outcome and penumbra in patients with AIS. Materials and Methods: From a prospectively maintained registry, patients with AIS due to occlusion or stenosis of the unilateral ICA and/or M1 MCA within 8 hours of symptom onset were included. The collateral-perfusion grading based on the MRA collateral map was estimated using 6-scale MAC. Changes of infarct area were divided into two groups with and without infarct growth (IG + and IG - ). Areas of baseline DWI lesion, Tmax > 6s, and decreased collateral-perfusion on each phases of the MRA collateral map, and infarct lesion on follow-up image were compared by visual assessment. Results: One hundred thirty-five patients, including 85 males (mean age, 69 years old), were included. Shorter onset-to-door times (OR=1.04, 95% CI=1.01-1.08) and successful early reperfusion (OR=0.19, 95% CI=0.05-0.66) were independently associated with IG - in multivariate analysis. In subgroup analysis, good collateral-perfusion status was associated with IG - (OR=0.30, 95% CI=0.10-0.91). In IG + group, the infarction grew within hypoperfused area on the phase of the MRA collateral map immediately before the phase that matches the baseline DWI lesion. There was no infarct growth beyond hypoperfused area on the capillary phase of the MRA collateral map in both IG + and IG - groups. The area of Tmax > 6s matched with the hypoperfused area on capillary phase of the MRA collateral map in 83% of patients. Conclusion: In this study, tissue fate in AIS was dependent on early reperfusion. In case of unsuccessful early reperfusion, it was associated with collateral-perfusion status. We suggest that the extent of penumbra can be estimated by the MRA collateral map.

scholarly journals Post-Ischemic Helium Provides Neuroprotection in Rats Subjected to Middle Cerebral Artery Occlusion-Induced Ischemia by Producing Hypothermia

2009 ◽  
Vol 29 (6) ◽  
pp. 1159-1165 ◽  
Author(s):  
Hélène N David ◽  
Benoît Haelewyn ◽  
Laurent Chazalviel ◽  
Myriam Lecocq ◽  
Mickael Degoulet ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Inert Gases ◽  
Clinical Use ◽  
Early Reperfusion ◽  
Cerebral Artery Occlusion

During the past decade, studies on the manipulation of various inhaled inert gases during ischemia and/or reperfusion have led to the conclusion that inert gases may be promising agents for treating acute ischemic stroke and perinatal hypoxia-ischemia insults. Although there is a general consensus that among these gases xenon is a golden standard, the possible widespread clinical use of xenon experiences major obstacles, namely its availability and cost of production. Interestingly, recent findings have shown that helium, which is a cost-efficient inert gas with no anesthetic properties, can provide neuroprotection against acute ischemic stroke in vivo when administered during ischemia and early reperfusion. We have investigated whether helium provides neuroprotection in rats subjected to middle cerebral artery occlusion (MCAO) when administered after reperfusion, a condition prerequisite for the therapeutic viability and possible clinical use of helium. In this study, we show that helium at 75 vol% produces neuroprotection and improvement of neurologic outcome in rats subjected to transient MCAO by producing hypothermia on account of its high specific heat as compared with air.

scholarly journals Intracranial Hemorrhage After Reperfusion Therapies in Acute Ischemic Stroke Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Benjamin Maïer ◽  
Jean Philippe Desilles ◽  
Mikael Mazighi
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Tissue Type ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Reperfusion ◽  
Iv Tpa

Reperfusion therapies are the mainstay of acute ischemic stroke (AIS) treatments and overall improve functional outcome. Among the established complications of intravenous (IV) tissue-type plasminogen activator (tPA), intracranial hemorrhage (ICH) is by far the most feared and has been extensively described by seminal works over the last two decades. Indeed, IV tPA is associated with increased odds of any ICH and symptomatic ICH responsible for increased mortality rate during the first week after an AIS. Despite these results, IV tPA has been found beneficial in several pioneering randomized trials and improves functional outcome at 3 months. Endovascular therapy (EVT) combined with IV tPA for AIS patients consecutive to an anterior circulation large-vessel occlusion does not increase ICH occurrence. Of note, EVT following IV tPA leads to significantly higher rates of early reperfusion than with IV tPA alone, with no difference in ICH, which challenges the paradigm of reperfusion as a major prognostic factor for ICH complications. However, several blood biomarkers (glycemia, platelet and neutrophil count), clinical factors (age, AIS severity, blood pressure management, diabetes mellitus), and neuroradiological factors (cerebral microbleeds, infarct size) have been identified as risk factors for ICH after reperfusion therapy. In the years to come, the ultimate goal will be to further improve either reperfusion rates and functional outcome, while reducing hemorrhagic complications. To this end, various approaches being investigated are discussed in this review, such as blood-pressure control after reperfusion or the use of new antiplatelet agents as an adjunct to IV tPA and exhibit reduced hemorrhagic potential during the early phase of AIS.

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