scholarly journals Introduction: Endovascular approaches to cerebral ischemia

2009 ◽  
Vol 26 (3) ◽  
pp. E1
Author(s):  
Aaron S. Dumont ◽  
Avery J. Evans
Keyword(s):  
Cerebral Ischemia ◽  
Natural History ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Endovascular Therapy ◽  
Treatment Options ◽  
Operator Experience ◽  
The Past ◽  
Increasing Operator ◽  
Angioplasty And Stenting

Thetreatment of stroke has rapidly evolved over the past decade, particularly as data concerning the natural history have emerged and endovascular treatment options have matured. Therapies for acute stroke have expanded as intraarterial thrombolysis and mechanical clot retrieval have been validated. Furthermore, angioplasty and stenting of intra- and extracranial vessels have evolved with the development of new devices coupled with increasing operator experience. Endovascular therapy is now a widely accepted treatment option for cerebral ischemia in many clinical situations.

Intensive Care After Neuroendovascular Procedures

2019 ◽  
pp. 753-758
Author(s):  
Mithun Sattur ◽  
Chandan Krishna ◽  
Bernard R. Bendok ◽  
Brian W. Chong
Keyword(s):  
Intensive Care ◽  
Radiation Dose ◽  
Cerebrovascular Disease ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Endovascular Therapy ◽  
Vascular Malformations ◽  
Arterial Puncture ◽  
Contrast Nephrotoxicity ◽  
Brain Aneurysms

Endovascular therapy for cerebrovascular disease is widespread. Patients with brain aneurysms, acute stroke, brain vascular malformations, and tumors are treated with endovascular techniques primarily or in conjunction with other traditional surgical and medical approaches. Postprocedural concerns unique to endovascular treatment include complications related to access or arterial puncture, contrast nephrotoxicity, and radiation dose complications (eg, alopecia and skin burns). Other complications, such as stroke and hemorrhage, that are not unique are discussed below.

Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old

2009 ◽  
Vol 3 (6) ◽  
pp. 501-506 ◽  
Author(s):  
R. Webster Crowley ◽  
Avery J. Evans ◽  
Mary E. Jensen ◽  
Neal F. Kassell ◽  
Aaron S. Dumont
Keyword(s):  
Endovascular Treatment ◽  
Transarterial Embolization ◽  
Treatment Options ◽  
Endovascular Techniques ◽  
Vascular Abnormalities ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Endovascular Approach ◽  
Embolic Materials ◽  
Extensive Surgery

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.

Recurrent glioblastoma multiforme: a review of natural history and management options

2006 ◽  
Vol 20 (4) ◽  
pp. E3 ◽  
Author(s):  
Lewis C. Hou ◽  
Anand Veeravagu ◽  
Andrew R. Hsu ◽  
Victor C. K. Tse
Keyword(s):  
Glioblastoma Multiforme ◽  
Natural History ◽  
Research Effort ◽  
Treatment Options ◽  
Recurrent Glioblastoma ◽  
Recurrent Glioblastoma Multiforme ◽  
Management Options ◽  
Fatal Disease ◽  
The Past ◽  
Recurrent Gbm

✓ Glioblastoma multiforme (GBM) is one of the most aggressive primary brain tumors, with a grim prognosis despite maximal treatment. Advancements in the past decades have not significantly increased the overall survival of patients with this disease. The recurrence of GBM is inevitable, its management often unclear and case dependent. In this report, the authors summarize the current literature regarding the natural history, surveillance algorithms, and treatment options of recurrent GBM. Furthermore, they provide brief discussions regarding current novel efforts in basic and clinical research. They conclude that although recurrent GBM remains a fatal disease, the literature suggests that a subset of patients may benefit from maximal treatment efforts. Nevertheless, further research effort in all aspects of GBM diagnosis and treatment remains essential to improve the overall prognosis of this disease.

Diagnosis and investigation in suspected heart disease

2018 ◽  
Author(s):  
Colin Forfar
Keyword(s):  
Natural History ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Case Fatality ◽  
The Past ◽  
Good Patient Care ◽  
History Of ◽  
Coronary Syndromes ◽  
Complete Physical Examination ◽  
And Function

The past 20 years have seen significant changes in both the demographics and natural history of many cardiovascular diseases. Important reductions in case-fatality rates (such as in acute coronary syndromes) have resulted from improved diagnostics and treatment options and better understanding of natural history. For others (such as infective endocarditis), improvements have been limited and disappointing. While advances in therapy and the scientific evidence underpinning treatments have been crucial, the importance of accurate diagnosis has remained a key element for progress. Many of the principles needed for diagnosis are constant: the pre-eminence of a focused, accurate history, complete physical examination, and timely and relevant investigation endures. It is essential to have a secure knowledge of the strengths and limitations of interpretation of a frequently bewildering array of tests. Progress in this field has been rapid; advances in ultrasound, scintigraphy, and cardiac magnetic resonance stand out at the interface between structure and function central to good patient care.

Update on the natural history of cavernous malformations and factors predicting aggressive clinical presentation

2010 ◽  
Vol 29 (3) ◽  
pp. E7 ◽  
Author(s):  
Chad W. Washington ◽  
Kathleen E. McCoy ◽  
Gregory J. Zipfel
Keyword(s):  
Natural History ◽  
Clinical Characteristics ◽  
Conservative Therapy ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Patient Treatment ◽  
Cavernous Malformations ◽  
The Past ◽  
Neurological Risk ◽  
History Of

Cavernous malformations (CMs) are angiographically occult, low-pressure neurovascular lesions with distinct imaging and clinical characteristics. They present with seizure, neurological compromise due to lesion hemorrhage or expansion, or as incidental findings on neuroimaging studies. Treatment options include conservative therapy, medical management of seizures, surgical intervention for lesion resection, and in select cases stereotactic radiosurgery. Optimal management requires a thorough understanding of the natural history of CMs including consideration of issues such as mode of presentation, lesion location, and genetics that may impact the associated neurological risk. Over the past 2 decades, multiple studies have been published, shedding valuable light on the clinical characteristics and natural history of these malformations. The purpose of this review is to provide the reader with a concise consolidation of this published material such that they may better understand the risks associated with CMs and their implications on patient treatment.

scholarly journals Current state of acute stroke care in Southeast Asian countries

2018 ◽  
Vol 25 (3) ◽  
pp. 291-296
Author(s):  
Justin Christopher Ng ◽  
Anchalee Churojana ◽  
Sirintara Pongpech ◽  
Luu Dang Vu ◽  
Cindy Sadikin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Endovascular Therapy ◽  
Stroke Care ◽  
Southeast Asian ◽  
Asian Countries ◽  
Acute Stroke Care ◽  
The Past ◽  
Current State ◽  
Care Systems ◽  
Southeast Asian Countries

Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits. Accordingly, the practice of acute endovascular stroke interventions needs to take into account these considerations. Acute stroke care systems in Southeast Asia also face a unique challenge of huge stroke burden against a background of ageing population, differing political landscape and healthcare systems in these countries. Building on existing published data, further complemented by multi-national interaction and collaboration over the past few years, the current state of acute stroke care systems with existing endovascular therapy services in Southeast Asian countries are consolidated and analysed in this review. The challenges facing acute stroke care strategies in this region are discussed.

Abstract T MP13: Chagas Disease Related Stroke: Safety of Intravenous Thrombolysis and Endovascular Treatment

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Pedro T Cougo-Pinto ◽  
Bruno L Dos Santos ◽  
Francisco A Dias ◽  
Millene R Camilo ◽  
Frederico F Alessio-Alves ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Chagas Disease ◽  
Endovascular Therapy ◽  
Single Case ◽  
Case Reports ◽  
Intravenous Thrombolysis ◽  
Endovascular Recanalization ◽  
Intravenous Tissue Plasminogen Activator ◽  
Iv Tpa

Background: AND AIM: Chagas disease (CD) is a common cause of stroke in undeveloped countries and has become more frequent in the US, where it is largely underestimated. CD related strokes are believed to be mainly cardioembolic but some studies have suggested concomitant cerebral vasculitis. Data on the safety of recanalization therapies in patients with acute stroke related to CD is still restricted to single case reports. We aimed to assess the rate of symptomatic intracranial hemorrhage (SIH) in a group of patients with CD-related stroke treated with intravenous tissue plasminogen activator (IV TPA) and/or endovascular therapy. METHODS: We performed a retrospective analysis of a prospective, single-center, hospital-based registry of acute stroke patients treated with IV TPA and/or endovascular therapy and routinely tested for CD. Demographics, medical history and clinical data were obtained from the registry. CT scans at admission and after 24-48 hours were blindly reviewed by two experienced stroke neurologists, who rated the presence of hemorrhage transformation according to the European Cooperative Acute Stroke Study criteria. RESULTS: From 2001 to 2012, 197 patients met the inclusion criteria for this study. CD was diagnosed in 30 patients (15.2%). Patients with CD had higher admission scores on the National Institute of Health Stroke Scale [median: 19; interquartile range (IR): 16-22; no CD: 14; IR: 9-19; P<0.01]. Among patients treated with IV TPA, the rate of SIH was similar among patients with CD (1/24; 4.2%) and patients without CD (8/150; 5.3%; OR: 0.77, 95% CI: 0.09-6.46; P=0.99). Among those treated with rescue endovascular treatment, SIH occurred in 2/6 (33.3%) patients with CD and in 3/17 (17.6%) patients without CD (OR: 2.33, 95%CI: 0.28-19.17, P=0.58). Overall, there was no difference in mortality between groups [CD: 6 (20%); no CD: 24 (14.4%); OR: 1.49; 95% CI: 0.55-4.0; P=0.42]. CONCLUSIONS: In the largest series of patients with acute stroke related to CD treated with recanalization therapies ever reported, we found that IV TPA appears to be safe in these patients. Further studies are necessary to confirm the safety and efficacy of endovascular recanalization strategies in patients with CD.

scholarly journals Endovascular strategies for carotid cavernous and intracerebral dural arteriovenous fistulas

2003 ◽  
Vol 15 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Perry P. Ng ◽  
Randall T. Higashida ◽  
Sean Cullen ◽  
Reza Malek ◽  
Van V. Halbach ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Treatment Options ◽  
Interventional Neuroradiology ◽  
Standard Of Care ◽  
Arteriovenous Fistulas ◽  
Wide Range ◽  
Dural Arteriovenous Fistulas ◽  
Embolic Materials

Interventional neuroradiology is a less invasive modality than open neurosurgery for the treatment of a wide range of neurovascular disorders. Refinements in technique and improvements in the design of microcatheters, guide wires, and embolic materials have yielded superior clinical outcomes and provided an impetus to treat more of these lesions endovascularly rather than surgically. Endovascular therapy is the standard of care for direct and indirect carotid artery cavernous sinus fistulas and may also be curative for dural arteriovenous fistulas (AVFs) in other locations. The authors provide review of the clinical features, pathophysiology, and management of intracranial AVFs focusing on contemporary endovascular treatment options.

On the assembly and structural modulation of lens fiber junctions

1984 ◽  
Vol 42 ◽  
pp. 110-113
Author(s):  
E.L. Benedetti ◽  
I. Dunia ◽  
Do Ngoc Lien ◽  
O. Vallon ◽  
D. Louvard ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Natural History ◽  
Intercellular Junctions ◽  
Eye Lens ◽  
Membrane Domains ◽  
Functional Polymorphism ◽  
Lens Fiber ◽  
The Past ◽  
Structural Modulation ◽  
Biochemical Difference

In the eye lens emerging molecular and structural patterns apparently cohabit with the remnants of the past. The lens in a rather puzzling fashion sums up its own natural history and even transient steps of the differentiation are memorized. A prototype of this situation is well outlined by the study of the lenticular intercellular junctions. These membrane domains exhibit structural, biochemical and perhaps functional polymorphism reflecting throughout life the multiple steps of the differentiation of the epithelium into fibers and of the ageing process of the lenticular cells.The most striking biochemical difference between the membrane derived from the epithelium and from the fibers respectively, concerns the presence of the 26,000 molecular weight polypeptide (MP26) in the latter membranes.

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