#CAD causes ~ 10-20% of #strokes
Atherosclerosis occurs most frequently at carotid #bifurcation, an area of low vessel-wall shear stress and oscillatory/turbulent blood flow
Welcome to this mini review!
#WeekendLecture #CAD
Endothelial dysfunction
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Inflammatory response to Lp retention in arterial wall
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Accelerated accumulation of Lp in subendothelial matrix
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Macrophages
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VSCM migrate/proliferate to fibroblast-like cells👉 production of EC matrix atm.amegroups.com/article/view/7…
#WeekendLecture #CAD
Stroke Mechanisms
✅#artery_to_artery embolization: retinal (amaurosis fugax) or cerebral circulation
✅#thrombosis in situ
✅#Flow reduction in high grade stenosis: #watershed infarcts, repetitive and brief TIAs (ie limb shaking)
#WeekendLecture #CAD
The most important information gained from imaging test is % of #stenosis
The measurement method used in the North American Symptomatic Carotid Endarterectomy Trial #NASCET is used most widely
The #ECST used different criteria
#WeekendLecture #CAD #NASCET👉#CEA for preventing stroke in symptomatic patients w/ TIAs/minor strokes
✅ARR 17% for ipsilateral stroke in high-grade 70–99% stenosis
👉ARR 7.8% if 50-69%
No benefit for stenosis <50% #ECST & #VACS provided similar results
#WeekendLecture #CAD
☝️It is very important to recognize that patients with symptomatic CAD should not only be evaluated for CEA/CAS.
✅Medical management has improved to a large extent in:
👉Antiplatelets
👉Lipid management
👉Other RFs: HTN,DM, smoking link.springer.com/article/10.100…
#ISC22 Highlights #Rescue-BT EVT with or w/o #tirofiban in LVO stroke
GPIIb/IIIa-R inhibitor could ⏬reocclusion after MT
55🏥in🇨🇳AIS<24hr, no IVT, ASPECT≥6
950pts
🚶mRS at 90d: 3 vs 3
🩸sICH: 9.7 vs 6.4%, NS
⚫️Death: 18.1 vs 16.9%
Treatment effect modification in LAA subgroup
It’s no secret that #EVT for AIS has been a complete game changer for the field resulting in dramatic reduction in death & disability
Join us to explore the #history of EVT in collaboration with @SVINJournal, to celebrate the inaugural issue
Many thanks to @Mahmoudneuro, #RaulNogueira and @DiogoHaussen whose review entitled:
👉“Tx Advancements in the Endovascular Management of Stroke” celebrates the advances in #ETV
1st #Fun fact: Interventional treatment of AIS dates all the way back to 1950s‼️
Sussman & Fitch reported 3 cases of IA infusion of fibrinolytics
Didn’t work 😫. Probably because they were performed in a non-hyperacute fashion
But this laid the foundation for years of refinement
👉⬆️T1/2 allows single bolus dosing and⬆️clot exposure to TNK
👉Higher affinity to fibrin-rich clots & + potent/faster clot #lysis vs alteplase
👉 < consumption of fibrinogen/plasminogen/ a2- antiplasmin👉⬇️systemic fibrinolytic effect👉⏬risk for bleeding
#WeekendLecture #TNK
First analysis in stroke patients was a #dose-scalation safety study
There was no #symptomatic ICHs in dosis of 0.1-0.2-0.4mg/kg, and 15% (2 of 13) in 0.5mg/kg
No differences in clinical outcomes bit.ly/3DNHamV
#Genetics is involved in several #stroke related conditions, such as small vessel disease #SVD, aneurysms, dissections, cavernomas, and intracranial #hemorrhages
✅1,5% of cerebral #SVD are #monogenic disorders
✅AR, AD or X-linked
☝🏼Absence of family history doesn't rule out diagnosis because of
👉de novo mutation
👉reduced expression or
👉incomplete penetrance
✅ahajournals.org/doi/10.1161/ST…
✅early onset stroke without vascular RFs
✅systemic features and neuroimaging of an specific monogenic disorder
✅consanguinity
✅negative work up for other causes of SVD
☝️#Stroke clinicians are routinely asked by patients and families regarding prognosis.
🧠The cognitive process underlying prognostication is #complex, poorly understood, and sometime #biased by personal experiences
#Fact: Clinicians, even those with expertise in stroke, perform poorly in predicting clinical outcomes
In this case-based study, overall accuracy for predicting death or disability at discharge was <20%😩 #JURaSSIC n.neurology.org/content/81/5/4…