Vascular Neurology Notes @vascularnotes
Notes and Clinical Pearls gathered while reading articles and books covering Vascular Neurology, Neuroanatomy, and Neurointervention • Fellow run Joined June 2020-
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Large vessel occlusion stroke patients should be taken for thrombectomy within 7 hours, even if imaging doesn’t look favorable…
Honored to present LASTE results @slice_inr together with @CostalatV @CarolineArquiz1 @lapergue6. Strong benefit of thrombectomy within 7 hrs in unlimitedly large core.NNT 4.Equal benefit in ASPECTS 0-2 vs 3-5 & lower mortality. No more reasons to exclude pts based on imaging !!
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They are limited and are only used to assist in decision making but important to be familiar with them. Clinical Scales in Aneurysm Rupture Prediction | Stroke: Vascular and Interventional Neurology ahajournals.org/doi/full/10.11…
Workflow for patients with symptoms concerning for aSAH. ahajournals.org/doi/epdf/10.11…
13% of patients will die in the hospital of aneurysmal subarachnoid hemorrhage, and up to 26% will die before arriving at the hospital. If ≥2 first-degree relatives with cerebral aneurysms -> you have a 12% chance of having one ahajournals.org/doi/epdf/10.11…
Vascular Neurology Notes retweeted
1/ CTA. DSA. MRA. CFD. VWI. So many letters, so many ❓❓❓ & so the discussion ensues - which imaging are YOU going to use for intracranial aneurysm dx + mgt? Luckily, Beaman et. al go thru +/- of imaging modalities - both old + new🧠 Let's begin! 👇
One caveat is that mRS is unlikely to be a great assessment tool for isolated PCA infarcts. A trial should assess visual fields.
Interesting results comparing medical management to med + thrombectomy for isolated PCA strokes. Notes: -Multicenter observational -Higher symptomatic ICH and END in thrombectomy patients -mRS not better for thrombectomy patients RCT may be warranted ahajournals.org/doi/10.1161/ST…
Important arterial connections at the skull base. Be careful with embolizations of the middle meningeal artery that may cause facial paralysis or hearing loss. ahajournals.org/doi/full/10.11…
It appears that clots should be removed even when the core infarct is large, 2 new studies in NEJM: #thrombectomy for all nejm.org/doi/full/10.10… nejm.org/doi/full/10.10…
Sturge-Weber Syndrome patients may present to the hospital with stroke like episodes that often fully resolve over a period of days, weeks, or months. MRI rarely shows diffusion restriction, but impaired venous drainage is common on perfusion imaging. pubmed.ncbi.nlm.nih.gov/36263782/
A new method for ischemic stroke treatment? “Molecularly self‐fueled nano-penetrator for nonpharmaceutical treatment of thrombosis and ischemic stroke” nature.com/articles/s4146…
The thalamostriate vein does not drain the thalamus
Thrombectomy beyond 24 hours from last known well? This study demonstrated worse outcomes overall (as one might expect), but similar hemorrhages/complications compared to the 6–24 hours group. Study by @ashabanmd et al. jnis.bmj.com/content/early/…
Are you at the SVIN conference in LA?! @svinsociety great opportunity to meet leaders/friends in the field
Which component of Wallenberg Syndrome is the most disabling? Tough disease for such a small infarct... Most occur with V4 segment occlusion, remainder with PICA occlusion or lateral medullary arteries.
The U.S. neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). jnis.bmj.com/content/early/…
New CASSISS study from China compares medical management to medicine + Wingspan stenting in patients with ICAD. ->No significant difference ->Relatively low stroke rates in both groups (see SAMMPRIS) ->Question remains:why do some patients still fail? jamanetwork.com/journals/jama/…
Cinematic rendering reconstruction of intracranial arteries showing right paraclinoid aneurysm Read More: ajronline.org/doi/10.2214/AJ…
The era of TNK begins! 0.25 mg/kg thelancet.com/journals/lance…
“The M1 segment of the middle cerebral artery precedes by a few hundred million years the appearance of the M2 segment.” -Lasjaunias, Berenstein, and Ter Brugge
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