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​This book contains a compilation of the revolution of mechanical thrombectomy (MT) in the treatment of strokes. The initial chapters summarize information about the best medical management of acute ischemic stroke, imaging modalities and patient selection for MT. The book then focuses on the nuances of MT, providing detailed information about the best approaches for anesthesia during MT, access, intra-arterial thrombolysis, recent devices and catheters and technical pitfalls of MT. A specific chapter is dedicated to MT in the venous system. This is followed by a chapter about the most common complications of MT and post-procedural care of these patients. The last chapter covers different aspects of acute stroke care and MT in the developing world. The authors of this book comprise of a multidisciplinary group of world experts in the field and were encouraged to include teaching cases to deliver a book with a practical approach. Acute Stroke Management in the Era of Thrombectomy is intended for all healthcare providers who care for patients with stroke; with special emphasis for the proceduralists who are interested in technical tips to improve outcomes and minimize complications.
BackgroundRecent studies demonstrated efficacy of thrombectomy in selected patients who have salvageable brain between 6 and 24 hs after symptoms onset. We aimed to evaluu00adate the clinical outcomes of acute ischemic stroke due to large vessel occlusion (LVO) and NIHSS score u2264 10 undergoing endovascular treatment (EVT) within 24 hs. Materials and methodsWe retrospectively analysed our prospectively maintained database of patients with LVO strokes of the anterior and posterior circulation with NIHSS u2264 10 who underwent EVT within 24 hs. The primary outcome was defined as good outcome (modified Rankin Scale score 0u20132) at day 90. Secondary outcomes included a successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction scale 2b/3) and mortality at day 90. Safety outcome was symptomatic intracranial hemorrhage (sICH). ResultsWe included 61 patients. The mean age was 67 u00b1 14 (SD), with 31 male patients. Median baseline NIHSS was 7 (IQR 5u20138); median time from symptom onset to groin puncture was 296 min (IQR 202-455). Twenty-three patients (38 %) were treated beyond 6 hours after symptoms onset. The rate of mRS u2264 2 was 79 %. Successful reperfusion was achieved in 75 %. Mortality rate at 90 days and sICH were 7 %. ConclusionThis study suggests that EVT within 24 hs after symptoms onset is safe and feasible for LVO strokes presenting with NIHSS u2264 10. Future controlled studies are warranted.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
A complete guide to improving stroke treatment and patient outcomes from international experts! Of the more than 795,000 estimated strokes that occur annually in the U.S., 87% are ischemic due to blockages, while the remaining 13% are hemorrhagic associated with spontaneous bleeding in the brain. Ischemic Stroke Management: Medical, Interventional and Surgical Management by esteemed neurosurgeons Alejandro Spiotta, Roberto Crosa, and an impressive group of international contributors details evidence-based medical, interventional, and neurosurgical treatment of ischemic stroke. Twelve chapters cover complete management of ischemic stroke, from symptom manifestation to interventions in the ER, OR, and NICU. The first chapters cover stroke epidemiology, intravenous thrombolysis in stroke, and the crucial role stroke centers play in ensuring timely treatment of this devastating disease. Subsequent chapters discuss diagnostic imaging techniques in acute ischemic stroke, neurosurgical interventions for hemorrhagic and ischemic stroke, and neuroanesthesia considerations. Key Features With contributions from South America to Europe, North America to Asia, authors share diverse experiences treating stroke patients, delivering a unique international perspective Endovascular neurosurgery ischemic stroke approaches and discussion of scientific evidence Mechanical thrombectomy utilizing Catch, Trevo, and Solitaire stent retrievers and the evolution of direct clot aspiration approaches Special topics include neurocritical care of acute ischemic stroke, pediatric stroke, and emerging state-of-the-art techniques Truly global viewpoints encompassed in this unique book make it a must-read for trainee and veteran neurosurgeons and interventional neuroradiologists across the world. This resource is also an essential bookshelf addition for medical centers worldwide that treat stroke patients.
This book presents state of the art knowledge on stroke management in a unique organizational style. Ischemic stroke is extensively covered, with inclusion of overviews that dynamically describe all relevant diagnostic and therapeutic processes in a time sequence mirroring real practice. The individual components of management and key issues are fully discussed with the aid of complementary illustrations that facilitate understanding of practical aspects and enable the reader to retrieve fundamental information quickly. In addition, the book considers the various causes of stroke and provides detailed guidance on means of secondary prevention. The recent demonstration of the substantial benefit of intra-arterial thrombectomy using stentrievers in patients with acute ischemic stroke represents a great moment in the history of stroke management. As we embark on a new era, there is an urgent need to review and evaluate current modalities for stroke diagnosis and treatment. In tackling this task, this book will be invaluable for physicians, angiographic interventionists, surgeons, and students seeking to acquire up-to-date knowledge on stroke.
An essential companion for busy professionals seeking to navigate stroke-related clinical situations successfully and make quick informed treatment decisions.
This book approaches the topic of management of acute ischemic stroke in an interdisciplinary manner, explaining how best to utilize the methods currently available for medical, surgical, and endovascular care. After an opening section on basics such as pathophysiology, radiological assessment, and pathology, comprehensive and up-to-date information is provided on each of the available therapies, techniques, and practices. Special attention is paid to recent advances in neurointerventional and neurosurgical procedures, with clear description of important technical details.The book includes plentiful high-quality case illustrations and a wealth of practical information that will prove of value in emergency rooms, angiography suites, operating rooms, and intensive care units. It will aid not only neurologists, neurointerventionists, and neurosurgeons, but also all others who are involved in the management of acute ischemic stroke, from radiologists and emergency physicians to healthcare providers.
Acute Stroke Management in the First 24 hours bridges the clinical application gap by offering a practice-based approach to treating ischemic and hemorrhagic stroke. The comprehensive text, written by international experts in the field of stroke care, covers all aspects of stroke care, including review of stroke systems, clinic features, neuroimaging diagnostic characteristics, and pre-hospital care and challenges. Practical clinical studies in each chapter engage readers in the discussion of common diagnostic pitfalls and work challenges. Chapters also include detailed figures and management algorithms, making this book an easy-to-use reference guide ideal for first responders and clinicians working in emergency medicine, neurology, neurosurgery, and critical care.
This comprehensive, case-based resource provides the state-of-the-art knowledge that can help readers improve access and optimize delivery of stroke thrombectomy. Improving access to stroke is of particular importance because patients often misinterpret their symptoms or cannot speak for themselves if they have aphasia. More importantly, access needs to be organized because stroke therapies are all extremely time-sensitive. Scalable, choreographed protocols are necessary for emergency medical systems to ‘capture’ stroke patients and automatically transport and triage to time-sensitive treatments. Many of the chapters in the first section on Fundamentals and Systems provide valuable insight in improving access to stroke care. Replete with illustrative case studies and emphasizing that treatment approaches to stroke should not be comprised of a one-size-fits-all approach, this illuminating title provides the complete thought, detail, insight and organization that will help readers meet the needs of stroke patients with large vessel occlusions. 12 Strokes: A Case-based Guide to Acute Ischemic Stroke Management examines the primary technical principles that underlie the current thrombectomy approaches. Instead of continuing the conceptual dichotomy of stent vs. aspiration, many of the chapters look at underlying principles and then discuss ways in which the currently available devices and approaches can best exploit them. The variety, creativity and detail in many of these chapters will help the reader develop a deeper understanding that might assist their ability to successfully take care of their next patient that ‘doesn’t follow the textbook.’ In addition, the anatomic and pathophysiologic classification of the core Twelve Chapters will help readers organize their thinking and approach. This knowledge, particularly because it is organized based on common, challenging syndromes, will arm the reader to quickly recognize patterns and deftly adapt their management approaches to the needs of the patient. An invaluable contribution to the clinical literature, 12 Strokes: A Case-based Guide to Acute Ischemic Stroke Management will be of great interest to not only neurosurgeons and neurologists but other specialists, primary care providers, and trainees as well.