Endovascular Management of Hemorrhagic Stroke

Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that surpassed open surgery. Stent-assisted coiling and balloon remodeling techniques have made the treatment of wide-necked aneurysms more durable. With the introduction of flow diverters and flow disrupters, many aneurysms with complex geometrics can now be reliably managed. Arteriovenous malformations and fistulae can also benefit from endovascular therapy by embolization using n-butyl cyanoacrylate (NBCA), Onyx, polyvinyl alcohol (PVA), and coils. In this article, we describe the role of endovascular treatment for the most common causes of intracerebral and subarachnoid hemorrhages, particularly ruptured aneurysms and vascular malformations.

Timing of Acute Stroke in COVID-19—A Health System Registry Study

Background and Purpose: The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis. Methods: We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed. Results: Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome. Conclusions: A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.

Efficacy and Mechanism of Butylphthalide Combined with Atorvastatin Calcium Tablets in the Diagnosis of Cerebral Infarction Using Iodol/Fe3O4 Nanometric Contrast Agent

To determine serum proteolytic activity, NO (nitric oxide) levels, TAC (total antioxidant capacity), and TOS (total oxidant status) in acute hemorrhagic stroke, the in vivo oxidative stress response mechanism of atorvastatin was studied in a rat model with cerebral infarction. All patient contrast agents are Iodol/Fe3O4 nanometric contrast agents. Serum prolinease activity, catalase activity, NO levels, TAC, and TOS were spectrophotometrically determined and the OSI (oxidative stress index) calculated. In this study, the serum TAC level and catalase activity with acute hemorrhagic stroke were significantly lower than in the control group (each P = 0.001), while the level of NO, TOS, OSI, and protease were significantly higher than in the control group (P = 0.01). When patients were classified for acute hemorrhagic stroke by gender, there was no difference in serum prolinease activity, meanwhile, NO, TAC, and TOS levels, and OSI differed between men and women (as mentioned with details acknowledged by all, P = 0.05). The results of this study indicate that compared with the control group, elevated oxidative stress levels, decreased antioxidants levels, and elevated prolinease activity are correlated with acute hemorrhagic stroke. Additionally, further research is needed to elucidate the mechanisms of oxidative stress with acute hemorrhagic stroke.