Wichmannjuel5336

Background Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time. Copyright © 2018 by S. Karger AG, Basel.Purpose We assess the impact of retrievable stent (RS) compared to first-generation devices on in-hospital mortality and disability in patients with acute ischemic stroke (AIS). Methods Using the National Inpatient Sample, data were obtained for patients with a primary diagnosis of AIS who underwent mechanical thrombectomy (MT) and were admitted to US hospitals between 2010 and 2014. Two time periods were compared 2010-2012 (pre-RS Food and Drug Administration [FDA] approval) and 2013-2014 (post-RS FDA approval). Disability level was used to classify outcomes as minimal disability, moderate to severe disability, or in-hospital mortality. Weighted, multivariable logistic regression was used to assess the association between MT device type and disability. Results A total of 2,443,713 weighted patients admitted with AIS were identified; 148,923 (4.9%) of these received intravenous tissue plasminogen activator; and 23,719 (0.8%) underwent MT. In multivariable logistic regression analysis, the odds of in-hospital mortality decreased (OR 0.69, 95% CI 0.59-0.82) in the post-RS time-period compared with pre-RS time. The odds of moderate-to-severe disability decreased (OR 0.88, 95% CI 0.73-1.06) compared with minimal disability. In-hospital mortality rates decreased successively over the 4 years in the MT-treated patients (p less then 0.001). Conclusions The FDA approval of RS technology after 2012 was associated with decreased in-hospital mortality when compared with the 3-year interval prior. These findings provide an indication that the RCT data on the efficacy of RS technology are translating into improved real-world outcomes. Copyright © 2018 by S. Karger AG, Basel.Background Flow-diverting stents (FDS) have revolutionized the endovascular management of unruptured, complex, wide-necked, and giant aneurysms. There is no consensus on management of complications associated with the placement of these devices. This review focuses on the management of complications of FDS for the treatment of intracranial aneurysms. Summary We performed a systematic, qualitative review using electronic databases MEDLINE and Google Scholar. Complications of FDS placement generally occur during the perioperative period. Key Message Complications associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. We sought to review these complications and novel management strategies that have been reported in the literature. Copyright © 2018 by S. Karger AG, Basel.Background/Aims Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. Ferrostatin-1 We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods Of a consecutive series of 223 patients who were admitted with acute ische-mic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries' stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions. Copyright © 2018 by S. Karger AG, Basel.