Pub Date : 2024-07-01Epub Date: 2024-06-12DOI: 10.1161/STROKEAHA.123.044386
Susanne Wegener, Jean Claude Baron, Colin P Derdeyn, Jorn Fierstra, Annette Fromm, Catharina J M Klijn, Christiaan Hendrik Bas van Niftrik, Joanna D Schaafsma
Ischemic stroke can arise from the sudden occlusion of a brain-feeding artery by a clot (embolic), or local thrombosis. Hemodynamic stroke occurs when blood flow does not sufficiently meet the metabolic demand of a brain region at a certain time. This discrepancy between demand and supply can occur with cerebropetal arterial occlusion or high-grade stenosis but also arises with systemic conditions reducing blood pressure. Treatment of hemodynamic stroke is targeted toward increasing blood flow to the affected area by either systemically or locally enhancing perfusion. Thus, blood pressure is often maintained above normal values, and extra-intracranial flow augmentation bypass surgery is increasingly considered. Still, current evidence supporting the superiority of pressure or flow increase over conservative measures is limited. However, methods assessing hemodynamic impairment and identifying patients at risk of hemodynamic stroke are rapidly evolving. Sophisticated models incorporating clinical and imaging factors have been suggested to aid patient selection. In this narrative review, we provide current state-of-the-art knowledge about hemodynamic stroke, tools for assessment, and treatment options.
{"title":"Hemodynamic Stroke: Emerging Concepts, Risk Estimation, and Treatment.","authors":"Susanne Wegener, Jean Claude Baron, Colin P Derdeyn, Jorn Fierstra, Annette Fromm, Catharina J M Klijn, Christiaan Hendrik Bas van Niftrik, Joanna D Schaafsma","doi":"10.1161/STROKEAHA.123.044386","DOIUrl":"10.1161/STROKEAHA.123.044386","url":null,"abstract":"<p><p>Ischemic stroke can arise from the sudden occlusion of a brain-feeding artery by a clot (embolic), or local thrombosis. Hemodynamic stroke occurs when blood flow does not sufficiently meet the metabolic demand of a brain region at a certain time. This discrepancy between demand and supply can occur with cerebropetal arterial occlusion or high-grade stenosis but also arises with systemic conditions reducing blood pressure. Treatment of hemodynamic stroke is targeted toward increasing blood flow to the affected area by either systemically or locally enhancing perfusion. Thus, blood pressure is often maintained above normal values, and extra-intracranial flow augmentation bypass surgery is increasingly considered. Still, current evidence supporting the superiority of pressure or flow increase over conservative measures is limited. However, methods assessing hemodynamic impairment and identifying patients at risk of hemodynamic stroke are rapidly evolving. Sophisticated models incorporating clinical and imaging factors have been suggested to aid patient selection. In this narrative review, we provide current state-of-the-art knowledge about hemodynamic stroke, tools for assessment, and treatment options.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-24DOI: 10.1161/STR.0000000000000469
{"title":"Correction to: Association of Intravenous Alteplase, Early Reperfusion, and Clinical Outcome in Patients With Large Vessel Occlusion Stroke: Post Hoc Analysis of the Randomized DIRECT-MT Trial.","authors":"","doi":"10.1161/STR.0000000000000469","DOIUrl":"https://doi.org/10.1161/STR.0000000000000469","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-24DOI: 10.1161/STR.0000000000000468
{"title":"Correction to: Inhibition of EZH2 (Enhancer of Zeste Homolog 2) Attenuates Neuroinflammation via H3k27me3/SOCS3/TRAF6/NF-κB (Trimethylation of Histone 3 Lysine 27/Suppressor of Cytokine Signaling 3/Tumor Necrosis Factor Receptor Family 6/Nuclear Factor-κB) in a Rat Model of Subarachnoid Hemorrhage.","authors":"","doi":"10.1161/STR.0000000000000468","DOIUrl":"https://doi.org/10.1161/STR.0000000000000468","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-24DOI: 10.1161/STR.0000000000000470
{"title":"Correction to: Advances in Primordial, Primary, and Secondary Prevention of Stroke in Diverse Populations.","authors":"","doi":"10.1161/STR.0000000000000470","DOIUrl":"10.1161/STR.0000000000000470","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-24DOI: 10.1161/STROKEAHA.124.046516
Violiza Inoa, Ryna Then, Nicole M Cancelliere, Gary R Spiegel, Justin F Fraser, Madihah Hepburn, Sheila C O Martins, Lauren Guff, Mindy Strong, Lucas Elijovich, Fernando González, Waldo R Guerrero, Alex Eusebio, Francene Gayle, Herbert Alejandro Manosalva Alzate, Cosme G Villamán, Luis Suazo, Romnesh de Souza, Jennifer Potter-Vig, Ameer E Hassan, Santiago Ortega-Gutierrez, Dileep R Yavagal, Gillian L Gordon Perue
Background: While mechanical thrombectomy (MT) is proven to be lifesaving and disability sparing, there remains a disparity in its access in low- to middle-income countries. We hypothesized that team-based MT workshops would improve MT knowledge and skills.
Methods: We designed a 22-hour MT workshop, conducted as 2 identical events: in English (Jamaica, January 2022) and in Spanish (Dominican Republic, May 2022). The workshops included participating neurointerventional teams (practicing neurointerventionalists, neurointerventional nurses, and technicians) focused on acute stroke due to large vessel occlusion. The course faculty led didactic and hands-on components, covering topics from case selection and postoperative management to device technology and MT surgical techniques. Attendees were evaluated on stroke knowledge and MT skills before and after the course using a multiple choice exam and simulated procedures utilizing flow models under fluoroscopy, respectively. Press conferences for public education with invited government officials were included to raise stroke awareness.
Results: Twenty-two physicians and their teams from 8 countries across the Caribbean completed the didactic and hands-on training. Overall test scores (n=18) improved from 67% to 85% (P<0.002). Precourse and postcourse hands-on assessments demonstrated reduced time to completion from 36.5 to 21.1 minutes (P<0.001). All teams showed an improvement in measures of good MT techniques, with 39% improvement in complete reperfusion. Eight teams achieved a Thrombolysis in Cerebral Infarction score of 3 on pre-course versus 15 of 18 teams on post-course. There was a significant reduction in total potentially dangerous maneuvers (70% pre versus 20% post; P<0.002). Universally, the workshop was rated as satisfactory and likely to change practice in 93% Dominican Republic and 75% Jamaica.
Conclusions: A team-based hands-on simulation approach to MT training is novel, feasible, and effective in improving procedural skills. Participants viewed these workshops as practice-changing and instrumental in creating a pathway for increasing access to MT in low- to middle-income countries.
{"title":"Mechanical Thrombectomy Workshops Improve Procedural Knowledge and Skills Among Neurointerventional Teams in Low- to Middle-Income Countries.","authors":"Violiza Inoa, Ryna Then, Nicole M Cancelliere, Gary R Spiegel, Justin F Fraser, Madihah Hepburn, Sheila C O Martins, Lauren Guff, Mindy Strong, Lucas Elijovich, Fernando González, Waldo R Guerrero, Alex Eusebio, Francene Gayle, Herbert Alejandro Manosalva Alzate, Cosme G Villamán, Luis Suazo, Romnesh de Souza, Jennifer Potter-Vig, Ameer E Hassan, Santiago Ortega-Gutierrez, Dileep R Yavagal, Gillian L Gordon Perue","doi":"10.1161/STROKEAHA.124.046516","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.046516","url":null,"abstract":"<p><strong>Background: </strong>While mechanical thrombectomy (MT) is proven to be lifesaving and disability sparing, there remains a disparity in its access in low- to middle-income countries. We hypothesized that team-based MT workshops would improve MT knowledge and skills.</p><p><strong>Methods: </strong>We designed a 22-hour MT workshop, conducted as 2 identical events: in English (Jamaica, January 2022) and in Spanish (Dominican Republic, May 2022). The workshops included participating neurointerventional teams (practicing neurointerventionalists, neurointerventional nurses, and technicians) focused on acute stroke due to large vessel occlusion. The course faculty led didactic and hands-on components, covering topics from case selection and postoperative management to device technology and MT surgical techniques. Attendees were evaluated on stroke knowledge and MT skills before and after the course using a multiple choice exam and simulated procedures utilizing flow models under fluoroscopy, respectively. Press conferences for public education with invited government officials were included to raise stroke awareness.</p><p><strong>Results: </strong>Twenty-two physicians and their teams from 8 countries across the Caribbean completed the didactic and hands-on training. Overall test scores (n=18) improved from 67% to 85% (<i>P</i><0.002). Precourse and postcourse hands-on assessments demonstrated reduced time to completion from 36.5 to 21.1 minutes (<i>P</i><0.001). All teams showed an improvement in measures of good MT techniques, with 39% improvement in complete reperfusion. Eight teams achieved a Thrombolysis in Cerebral Infarction score of 3 on pre-course versus 15 of 18 teams on post-course. There was a significant reduction in total potentially dangerous maneuvers (70% pre versus 20% post; <i>P</i><0.002). Universally, the workshop was rated as satisfactory and likely to change practice in 93% Dominican Republic and 75% Jamaica.</p><p><strong>Conclusions: </strong>A team-based hands-on simulation approach to MT training is novel, feasible, and effective in improving procedural skills. Participants viewed these workshops as practice-changing and instrumental in creating a pathway for increasing access to MT in low- to middle-income countries.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-02-08DOI: 10.1161/STROKEAHA.123.044265
Joseph P Broderick, Eva A Mistry
{"title":"Evolution and Future of Stroke Trials.","authors":"Joseph P Broderick, Eva A Mistry","doi":"10.1161/STROKEAHA.123.044265","DOIUrl":"10.1161/STROKEAHA.123.044265","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-05-01DOI: 10.1161/STROKEAHA.123.042385
Ivy Anne Sebastian, Ana Claudia de Souza, Meron Awraris Gebrewold, Dorcas B C Gandhi, Vanessa Cano-Nigenda, Caleb Ferguson, Mehari Gebreyohanns, Vasileios-Arsenios Lioutas
{"title":"Fostering a Culture of Research: From Recommendations to Implementation.","authors":"Ivy Anne Sebastian, Ana Claudia de Souza, Meron Awraris Gebrewold, Dorcas B C Gandhi, Vanessa Cano-Nigenda, Caleb Ferguson, Mehari Gebreyohanns, Vasileios-Arsenios Lioutas","doi":"10.1161/STROKEAHA.123.042385","DOIUrl":"10.1161/STROKEAHA.123.042385","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-05DOI: 10.1161/STROKEAHA.124.047228
Gregory W Albers, Jeremy J Heit, Maarten G Lansberg, Manabu Inoue, Xiaochuan Huo, Vivek S Yedavalli, Pierre Seners, Margy McCullough-Hicks, Carlo W Cereda, Jenny P Tsai, Eva A Mistry, Arindam R Chatterjee, Colin P Derdeyn, Pooja Khatri, J M Olivot, Michael D Hill, Jeffrey L Saver, Marc Fisher
{"title":"Exploring the Limits of Endovascular Therapy for Large Core Patients: Where Do We Need More Data?","authors":"Gregory W Albers, Jeremy J Heit, Maarten G Lansberg, Manabu Inoue, Xiaochuan Huo, Vivek S Yedavalli, Pierre Seners, Margy McCullough-Hicks, Carlo W Cereda, Jenny P Tsai, Eva A Mistry, Arindam R Chatterjee, Colin P Derdeyn, Pooja Khatri, J M Olivot, Michael D Hill, Jeffrey L Saver, Marc Fisher","doi":"10.1161/STROKEAHA.124.047228","DOIUrl":"10.1161/STROKEAHA.124.047228","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1161/STROKEAHA.124.046218
Ana Paula Beck da Silva Etges, Carisi Anne Polanczyk, Junaid Nabi
{"title":"Revitalizing Stroke Care: The LEADER Strategy for Sustainable Transformation in Health Care Delivery.","authors":"Ana Paula Beck da Silva Etges, Carisi Anne Polanczyk, Junaid Nabi","doi":"10.1161/STROKEAHA.124.046218","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.046218","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号