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Background and purposeEndovascular techniques are frequently employed to treat large artery occlusion in acute ischemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial hemorrhage (ICH) after endovascular therapy.MethodsRetrospective analysis of consecutive patients presenting to 13 high volume stroke centers with AIS due to proximal occlusion in the anterior circulation who underwent endovascular treatment within 8 h from symptom onset. Logistic regression was performed to determine the variables associated with ICH, hemorrhagic infarction (HI), and parenchymal hematomas (PHs), as well as 90 day poor outcome (modified Rankin Scale score ≥3) and mortality.ResultsThere were a total of 363 ICHs (overall rate 32.3%; HI=267, 24%; PH=96, 8.5%) among the 1122 study patients (mean age 67±15 years; median National Institutes of Health Stroke Scale score 17 (IQR 13-20)). Independent predictors for HI included diabetes mellitus (OR 2.27, 95% CI (1.58 to 3.26), p

Background and purpose Intracranial stenting and angioplasty has been increasingly utilized for the treatment of symptomatic intracranial atherosclerotic disease (ICAD). The use of self-expanding stents (SES) has been reported to have a high technical success rate but there are concerns with restenosis. We sought to determine if the use of balloon mounted stents (BMS) was associated with higher technical complication rates compared with self-expanding stents. Methods Three academic institutions contributed data on patients treated for symptomatic ICAD over a 3 year period (2006–2009). 259 consecutive patients were identified. Demographics, type of stent placed, periprocedural complications, per cent stenosis prior to treatment and after treatment, if the treatment was within 2 weeks of clinical symptomatology, lesion classification with the Mori scale and follow-up imaging for restenosis were collected retrospectively. A univariate analysis was performed to determine predictors of periprocedural stroke and also for restenosis at follow-up. Variables with a p value Results 259 patients with a mean age of 61±13 years with 168 (65%) patients presenting with strokes and the rest with transient ischemic attacks. The distribution of the lesions were as follows: vertebrobasilar 109 (42%), middle cerebral artery 85 (33%) and intracranial internal carotid artery 65 (25%). 79 (31%) BMS were implanted and 180 (69%) SES. A total of 17 (6.5%) patients developed a periprocedural stroke with no difference noted between use of type of stent. Patients in whom a BMS was implanted had a significant reduction in stenosis compared with SES (81±10% to 7±11% vs 80±12% to 24±9%; p Conclusions The use of BMS was not associated with higher complication rates but was associated with lower restenosis rates. Placement of stents in patients with more complex lesions is associated with higher periprocedural stroke rates and restenosis. Further prospective studies comparing BMS with SES are warranted.

Background and purpose The use of endovascular techniques to treat large artery occlusion in acute ischemic stroke has become more frequently employed as a treatment option. We sought to determine the predictors of intracranial hemorrhage after these procedures were performed. Methods This is a retrospective review of data from 13 high volume stroke centers that perform endovascular treatments for acute ischemic stroke. Patients with anterior circulation strokes treated under 8 h from symptom onset with endovascular therapy were included. Hemorrhages were classified as parenchymal hematoma (PH) types 1 and 2 and hemorrhagic infarction (HI) types 1 and 2. Patients with PH bleeds were considered symptomatic and HI bleeds were asymptomatic. Binary logistic regression modeling was performed to determine the variables associated with symptomatic and asymptomatic hemorrhages after correcting for multiple comparisons. Results A total of 1122 patients met the inclusion criterion for this study. Mean age for the cohort was 67±15 years with a median National Institutes of Health Stroke Scale (NIHSS) of 17 (IQR 13–20). The distribution for thrombus location at the initiation of endovascular therapy was as follows: M1 segment of the middle cerebral artery (MCA) 561 (50%), carotid terminus 214 (19%), M2 MCA 171 (15%), tandem occlusions 141 (13%) and isolated extracranial internal carotid artery occlusion 35 (3%). Parenchymal hematomas occurred in 96 (8.5%) patients and HI in 265 (24%) patients. There were no variables associated with symptomatic hemorrhages while the following variables were predictors of asymptomatic hemorrhage: diabetes mellitus (OR 2.02; 95% CI 1.46 to 2.79; p Conclusions Diabetic patients and those who have been treated with intravenous tPA prior to the procedure or intraprocedural use of thrombolytics or the Merci device appear to be at a higher risk for asymptomatic hemorrhage. Moreover, patients with asymptomatic hemorrhage appear to be at a higher risk for a worse clinical outcome at the 90 day follow-up.

Objective: CT angiography (CTA) has recently gained popularity for detection of stenotic and occlusive diseases in intracranial and neck vessels. With 3D reconstruction, CT angiogram can provide reasonably reliable estimates of vascular pathology. We wanted to look at the sensitivity and specificity of CTA in evaluating atherosclerotic diseases of the head and neck …

Objective: Dominance of arteries has been studied in different tissues/organs of body. Diagnostic, therapeutic and prognostic implications are hypothesized to be related to symmetry or asymmetry of circulation. One major implication in the case of the brain is the hypotheses that asymmetry exists …

Objective: Dominance of arteries has been studied in different tissues/organs of body. Diagnostic, therapeutic and prognostic implications are hypothesized to be related to symmetry or asymmetry of circulation. One major implication in the case of the brain is the hypotheses that asymmetry exists due to differences in vascular requirements of the brain tissue. Vertebral artery origin and …