Safety and efficacy of drug coated balloon angioplasty for intracranial atherosclerotic disease jnis.bmj.com Oct. 3, 2022, 10:16 a.m.
Background Drug coated balloon (DCB) angioplasty can provide sustained anti-restenotic efficacy without the limitations of permanent vascular implantation and is presumably ideal for treating intracranial atherosclerotic disease. However, the safety of paclitaxel in the neurovasculature remains a concern.
Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment www.thelancet.com Oct. 3, 2022, 10:16 a.m.
Intracranial atherosclerotic stenosis (ICAS) is one of the most frequent causes of stroke worldwide and confers one of the greatest risks of recurrent stroke compared with other causes of stroke. Asymptomatic ICAS is increasingly recognised as a risk factor for silent brain infarctions and dementia, magnifying the global burden of ICAS. Although ICAS is a lumen-based diagnosis, newer diagnostic imaging techniques, such as high-resolution MRI, might help to identify high-risk population subgroups to test interventions that might reduce the risk of stroke recurrence. Secondary stroke prevention in patients with ICAS currently consists of intensive management of modifiable risk factors and dual antiplatelet therapy, which is subsequently reduced to aspirin alone.
Safety and efficacy of drug coated balloon angioplasty for intracranial atherosclerotic disease jnis.bmj.com Sept. 30, 2022, 4:08 p.m.
After treatment with DCB angioplasty, complications were no different from those after standard balloon angioplasty or stenting. This study suggests that DCB angioplasty may be a safe and effective procedure for intracranial arterial stenosis.
Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial eurointervention.pcronline.com Sept. 24, 2022, 3:53 p.m.
In patients with severely calcified coronary artery lesions, preparation with a super high-pressure balloon versus a scoring balloon was associated with comparable stent expansion on intravascular imaging and a trend towards improved angiographic performance.
Statin Treatment and the Occurrence of Hemorrhagic in Patients With a History of Cerebrovascular Disease www.ahajournals.org Sept. 12, 2022, 3:56 p.m.
The recently published Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that statins exert a marginally beneficial effect on stroke prevention in patients with a history of cerebrovascular disease. Interestingly, the magnitude of the beneficial effect shown in this study is smaller than in similar studies, which included patients without a history of cerebrovascular disease. In SPARCL, an increased occurrence of hemorrhagic strokes in patients on statin treatment was observed, an effect that was also earlier described in the Heart Protection Study in a subgroup of patients with a history of cerebrovascular disease.
Lipid-Lowering Therapy and Hemorrhagic Risk www.ahajournals.org Sept. 12, 2022, 3:55 p.m.
Statins increase the risk of HS in a medication dose- and type of index brain vascular injury-dependent manner; PCSK9Is do not increase HS risk. PCSK9Is may be a preferred lipid-lowering medication class in patients with elevated HS risk, including patients with prior HS.
Lipid-lowering treatment in secondary prevention of ischaemic cerebrovascular disease www.elsevier.es Sept. 12, 2022, 3:52 p.m.
Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events.
A Decade On: The Evolving Renaissance in Intracranial Atherosclerotic Disease www.ahajournals.org Sept. 12, 2022, 1 p.m.
Intracranial atherosclerotic disease is the most common cause of stroke worldwide. The past decade of research in intracranial atherosclerotic disease has led to marginally improved medical therapy, yet recurrent stroke rates remain high. Despite the enormous global burden of disease, we lack effective clinical acumen to appropriately risk stratify patients and optimize the therapeutic approach. In this review, we examine our current understanding of intracranial atherosclerotic disease pathophysiology, imaging techniques, lifestyle, medical therapy, and endovascular strategies.
Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion: data from ANGEL-ACT registry svn.bmj.com Sept. 10, 2022, 4:35 p.m.
Patients with MeVO achieved similar 90-day mRS, SICH rate and successful recanalisation rate after EVT compared with patients with LVO. Several independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined, which should be highly considered in MeVO stroke management.
A Decade On: The Evolving Renaissance in Intracranial Atherosclerotic Disease www.ahajournals.org Sept. 10, 2022, 4:28 p.m.
Intracranial atherosclerotic disease is the most common cause of stroke worldwide. The past decade of research in intracranial atherosclerotic disease has led to marginally improved medical therapy, yet recurrent stroke rates remain high. Despite the enormous global burden of disease, we lack effective clinical acumen to appropriately risk stratify patients and optimize the therapeutic approach. In this review, we examine our current understanding of intracranial atherosclerotic disease pathophysiology, imaging techniques, lifestyle, medical therapy, and endovascular strategies. We also present steps needed to incorporate imaging and serum biomarkers in intracranial atherosclerotic disease to facilitate individualized treatment plans and realize the potential of precision medicine in this global health disorder. Trials in the next decade should be targeted to help us gain a better understanding of key mechanisms and disease course with an ultimate goal of improving long‐term patient outcomes.
Blood Type and Stroke Risk: Meta-Analysis Found Link Between the 2 Factors in People Under 60 Years Old www.sciencetimes.com Sept. 5, 2022, 6:31 a.m.
The blood type describes the variety of chemicals in the red blood cells. The most familiar blood types are A, B, AB, and O. However, there could be subtle variations due to mutation in genes that may make a person susceptible to certain diseases.
In Vitro Blood Clot Formation and Dissolution for Testing New Stroke-Treatment Devices www.mdpi.com Aug. 29, 2022, 9:10 a.m.
Strokes are among the leading causes of death worldwide. Ischemic stroke, due to plaque or other buildup blocking blood flow to the brain, is the most common type. Although ischemic stroke is treatable, current methods have severe shortcomings with high mortality rates. Clot retrieval devices, for example, can result in physically damaged vessels and death. This study aims to create blood clots that are representative of those found in vivo and demonstrate a new method of removing them.
Endovascular treatment of intracranial vertebral artery unruptured dissecting aneurysms: Comparison of flow diversion and stent-assisted coiling or stenting alone www.frontiersin.org Aug. 26, 2022, 7:15 a.m.
Flow diverters with or without selective adjunctive coiling for the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery may be safe and effective with good occlusion effects not inferior to those of stent-assisted coiling and stenting alone even though the long-term effect still warrants confirmation.
Remote Ischemic Conditioning Neuroprotective After Stroke? www.medscape.com Aug. 26, 2022, 7:13 a.m.
Remote ischemic conditioning (RIC), a process that involves repeated occlusion/release cycles on bilateral upper limb arteries, is superior to usual care in optimizing neurologic function for patients who have had an acute moderate ischemic stroke, new research suggests.
Imperative Care Announces Positive New Data Underscoring the Safety and Efficacy of the Zoom Stroke Solution to Treat Distal Occlusions in Ischemic Stroke Patients www.dicardiology.com Aug. 26, 2022, 7:09 a.m.
Endovascular approaches for distal occlusions can be more challenging and are associated with a higher risk of periprocedural complications as a result of a longer path to the occlusion and a smaller vessel diameter.1 This study was undertaken to assess the safety and reperfusion success of aspiration thrombectomy in patients with these occlusions.
New data shows COVID-19 vaccine does not raise stroke risk medicalxpress.com Aug. 26, 2022, 7:04 a.m.
Newly compiled data evaluated by researchers in the Department of Neurology and the Smidt Heart Institute at Cedars-Sinai shows that COVID-19 vaccines do not raise stroke risk—but that severe COVID-19 infection does. Physician-scientists hope this growing body of evidence, highlighted today in an editorial in the journal Neurology, will ease the minds of individuals still hesitant to be vaccinated.
RAPID Automated CT Perfusion in Clinical Practice practicalneurology.com Aug. 24, 2022, 10:18 a.m.
When executed consistently and interpreted correctly, RAPID automated CT perfusion studies can identify appropriate candidates for thrombectomy.
Expansion of open-source neuroimaging dataset aims to boost stroke research healthimaging.com Aug. 23, 2022, 7:04 a.m.
With accurate lesion segmentation in mind, the USC-led expansion built upon the Anatomical Tracings of Lesion After Stroke (ATLAS), version 1.2. ATLAS 1.2 contained hundreds of stroke T1w MRIs and manually segmented lesion masks, and though the intentions were good the results were less so. Many algorithms developed using that dataset did not yield acceptable accuracy or were improperly invalidated, limiting the usefulness of the data in stroke research.
Dual pathway inhibition in atherothrombosis prevention: yes, now we can! www.minervamedica.it Aug. 15, 2022, 3:16 p.m.
Despite ongoing developments, prevention and treatment of atherothrombotic cardiovascular disease remains a common challenge. Antithrombotic options for cardiocerebrovascular disease prevention involves a choice between dual antiplatelet therapy (DAPT) and dual pathway inhibition (DPI), which includes an antiplatelet agent and a reduced dose anticoagulant agent. In selected patients at high risk of event and low risk of bleeding, especially those undergoing recent and complex coronary revascularization using drug-eluting stents (DES) (“revascularization-driven effect”), DAPT is superior to single antiplatelet therapy with aspirin. DPI involves a wider potential range of treatment and is superior to single antiplatelet therapy with aspirin, particularly in patients with atherothrombotic involvement in different vascular beds both previously revascularized and not (“no revascularization-driven effect”). After nearly thirty years of randomized trials and observational registries, we have sufficient data to customize antithrombotic therapy in patients at high cardiovascular risk. Therefore, “atherothrombosis stakeholders” must identify the right patient for the right therapy to ensure high levels of efficacy and safety with the best of current therapeutic opportunities.