Endovascular treatment of acute ischemic stroke in the posterior circulation.

Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included. Recanalization rate according to modified Treatment in Cerebral Ischemia score and neurological outcome at three months according to modified Rankin Scale were the main outcomes. Collateral circulation, procedural complications and radiological outcome were evaluated in the radiological examinations. Results The median National Institutes of Health Stroke Scale was 31 (IQR: 13-31) and median time from symptom onset to groin puncture was 300 (IQR: 175-463) minutes. Successful recanalization was seen in 80 of 110 patients (73%). Favorable outcome (modified Rankin Scale ≤2) was seen in 38 patients (35%) while moderate favorable outcome (≤3) was seen in 48 patients (44%). Symptomatic intracerebral hemorrhage occurred in 10 patients (9%). An association between collateral circulation, recanalization rate and outcome was seen. Conclusion Endovascular treatment for posterior circulation stroke in this single-center cohort is relatively safe and effective with decreased mortality and increased favorable outcome compared to natural history.

General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke).

BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score, intraprocedural blood pressure, blood glucose, Paco2 and Pco2 modified Thrombolysis in Cerebral Ischemia score, and relevant time intervals were recorded. RESULTS: In the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (P=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (P=0.57); blood glucose (P=0.94); PaCO2 (P=0.68); time intervals (P=0.78); degree of successful recanalization, 91.1% versus 88.9% (P=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3-5) versus 9 (2-15; P=0.60); infarction volume, 20 (10-100) versus 20(10-54) mL (P=0.53); and hospital mortality (13.3% in both groups; P=1.00). CONCLUSIONS: In endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01872884.

Transarterial embolectomy in acute stroke.

BACKGROUND AND PURPOSE: An embolus causing cerebral ischemia is a major cause of death and disability, and the search for methods to reestablish blood flow is of major importance. A technique for the emergent primary treatment of cerebral emboli causing stroke is presented in detail. METHODS: The method developed implies the mechanical extraction of the embolus with a standard vascular retrieval snare via the endovascular route without the use of thrombolytic agents. RESULTS: Five consecutive patients were treated to extract an embolus. All patients had substantial improvement in their clinical status. No revascularization hemorrhages occurred. CONCLUSION: In this small series, the embolectomy method described was reproducible, rapid, and safe. It may offer an alternative to other methods of vascular recanalization.

[Venous malformations in the head and neck should be treated]. / Venösa kärlmissbildningar i huvud och hals bör behandlas.

Vascular lesions are tumours or malformations. Haemangioma is the most common tumour. It disappears at the age of seven. Malformations may be arterial, capillary, venous, arteriovenous, lymphatic or mixed. The vascular malformations do not disappear. There are several options for treating venous or lymphatic malformations. One of them is sclerosing therapy with Sotradecol by direct puncture. We have 15 years' experience of this method but present only the last 60 patients, treated between 1997 and 2001. Excellent or good results were seen in 59 patients. No permanent complications occurred. It is important to know the nomenclature and the different options for treatment as discussed in the International Society for the Study of Vascular Anomalies.