Purpose: To determine the safety and feasibility of intraarterial stroke therapy for acute ischemic strokes at a community-based medical center.
Materials And Methods: This is a retrospective analysis of data gathered from consecutive stroke patients treated between June 2004 and April 2007. The following therapies were used to treat acute ischemic stroke within 6 hours of symptom onset: intraarterial thrombolytic drugs, intraarterial vasodilators, mechanical clot retrieval, intravascular stents, and angioplasty. The outcomes measured included posttherapy National Institutes of Health Stroke Score (NIHSS), neurologic function at 90 days graded according to the modified Rankin Scale (mRS), recanalization, symptomatic intracranial hemorrhage, and 90-day mortality.
Results: Eighty-three patients with a median baseline NIHSS of 17 (range, 3-30) were treated with intraarterial therapy. The median posttherapy NIHSS was 5 (range, 0-33). Forty-two patients (51%) [corrected] had an mRS score of 2 or less at 90 days. The recanalization rate was 76%. Five patients (6%) had symptomatic intracranial hemorrhage, and the 90-day mortality was 22%.
Conclusions: The results of this review showed that an intraarterial therapeutic approach to acute ischemic stroke was feasible at a community-based heath center and demonstrated encouraging data for outcome and safety.
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http://dx.doi.org/10.1016/j.jvir.2008.11.021 | DOI Listing |
Radiologie (Heidelb)
January 2025
Klinik für diagnostische und interventionelle Neuroradiologie, Universitätskliniken des Saarlandes, Kirrberger Str., 66421, Homburg Saar, Deutschland.
Performance: Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications.
View Article and Find Full Text PDFEur Heart J
January 2025
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark.
Cardiogenic shock represents a critical condition in which the heart is unable to maintain adequate circulation leading to insufficient tissue perfusion and end-organ failure. Temporary mechanical circulatory support offers the potential to stabilize patients, provide a bridge-to-recovery, provide a bridge-to-decision, or facilitate definitive heart replacement therapies. Although randomized controlled trials have been performed in infarct-related cardiogenic shock and refractory cardiac arrest, the optimal timing, appropriate patient selection, and optimal implementation of these devices remain complex and predominantly based on observational data and expert consensus, especially in non-ischaemic shock.
View Article and Find Full Text PDFEur Heart J
January 2025
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability.
View Article and Find Full Text PDFJ Am Heart Assoc
January 2025
Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin Berlin Germany.
Background: Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection.
Methods And Results: The investigator-initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in Ischemic Stroke) study randomized 3465 patients with acute ischemic stroke without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter monitoring in hospital for up to 7 days, analyzed in a core laboratory. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding, and all-cause death within 24 months in patients with ESVEA (defined as ectopic supraventricular beats ≥480/day or atrial runs of 10-29 seconds or both) versus patients with newly diagnosed AF versus patients without ESVEA or AF (non-ESVEA/AF), randomized to the intervention group.
Background: Meta-analyses have suggested that the risk of cardiovascular disease events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation, but the populations at highest risk have not been well characterized to date.
Methods And Results: The authors analyzed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and patient factors associated with ASCVD hospitalizations after COPD hospitalization among 2 high-risk patient cohorts. The primary outcome was risk of an ASCVD hospitalization composite outcome (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, stroke, transient ischemic accident) after COPD hospitalization relative to before COPD hospitalization.
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