Smit Patel, MD, MPH

Paclitaxel Drug-Coated Balloon Angioplasty for Medically Refractory Intracranial Atherosclerotic Disease: A US Single-Center Experience With the AGENT Balloon ahajrnls.org/4t21ZV4

Just Published Intra-Distal Access Catheter Deployment of the Surpass Evolve Device: A Novel Technique to Prevent Advancement of the Delivery Wire: A Case Report and Literature Review doi.org/10.5797/jnet.c… #Neuroendovascular

Carotid Artery Stenting Outcomes in Comprehensive Stroke Hospitals (CASSH): A Prospective Multicenter Study ahajrnls.org/48kocpS

Tenzingplasty 💪 🎉 "All treated segments had improved narrowing, with 78 (95.1%) having residual narrowing <50%. No procedural complications occurred." jnis.bmj.com/content/18/5/1…

🧠 ESTENOSIS CAROTÍDEA ASINTOMÁTICA: ¿Cuándo revascularizar en 2026? 1️⃣ El riesgo de ictus ipsilateral en estenosis ≥70% bajo terapia médica intensiva es ~1.5%/año (CREST-2, NEJM 2026) — mayor de lo estimado por estudios observacionales previos (0.5–1.0%/año). 2️⃣ CREST-2 (n=2485): Stenting redujo el evento primario vs. terapia médica sola (2.8 vs. 6.0%; NNT=31). CEA no alcanzó significancia estadística (3.7 vs. 5.3%). Ambas técnicas mostraron tasas perioperatorias similares (~1.3–1.5%). 3️⃣ La revascularización en estenosis 70–99% asintomática se sugiere SOLO si: expectativa de vida ≥5 años + riesgo perioperatorio de ACV/muerte <1.5% (umbral actualizado post-CREST-2). Estenosis 50–69%: terapia médica intensiva sin intervención. 4️⃣ Marcadores de alto riesgo que individualizan la decisión: émbolos silentes en TCD, infarto silente ipsilateral en neuroimagen, hemorragia intraplaca en RM (HR 7.9), placa ecolucentе, área negra yuxtacanal >10mm² (stroke rate 5%/año). 5️⃣ La terapia médica intensiva es la base universal: estatinas (LDL <70mg/dL), antiagregación, control PA <130mmHg, cesación tabáquica y actividad física. Sin esto, ninguna revascularización optimiza su beneficio real. 🏥 Clínica Ricardo Palma — Centro Avanzado de Stroke | Lima, Perú ✍🏽 Dr. Manuel A. Moquillaza Valle | Neurólogo Vascular e Intervencionista | CMP 54060 / RNE 25595 #IctusIsquémico #EstenisisCarotídea #NeurologíaVascular #CREST2 #StrokePrevention

In high-risk atrial fibrillation with cerebral amyloid angiopathy, anticoagulation was associated with lower ischemic stroke and mortality without increased risk of intracranial hemorrhage or major bleeding. By @HAlvinChenNeuro link.springer.com/article/10.100…

🚨 DISTALS trial results out! @Rapid__Medical Tigeretriever13 showing efficacious recanalization with reduction in perfusion delay on CTP 👍 💪 ✨ rapid-medical.com/distals-results

In the phase 3 OCEANIC-STROKE trial involving patients with noncardioembolic ischemic stroke or high-risk TIA, asundexian added to antiplatelet therapy led to a lower risk of ischemic stroke without increasing major bleeding. Full trial results: nejm.org/doi/full/10.10… Editorial: Asundexian for Noncardioembolic Ischemic Stroke nejm.org/doi/full/10.10…

Adjusting Antiplatelet Therapy Using P2Y12 Reaction Units in Endovascular Treatment of Unruptured Intracranial Aneurysms ahajrnls.org/4tFzjC3

More evidence to show that waiting for 7 days after stroke to stent a proximal carotid lesion is NOT necessary "Delaying the ICAS according to current FDA recommendations may not be necessary when ICAS is indicated." jnis.bmj.com/content/18/4/9…

Useful information for neurointensivists and neurohospitalists. When working up autoimmune CNS inflammatory syndromes, the Kappa Free Light Chain Index can distinguish MOGAD (very low to undetectable), NMOSD (moderately elevated), and MS (extremely elevated). KFLCI is calculated as the ratio of CSF versus plasma levels, with elevated values indicating intrathecal B-cell mediated antobody sysnthesis, a key feature of MS. neurology.org/doi/10.1212/WN…

Don't miss "Comparative Effectiveness of Surgical, Endovascular, and Conservative Strategies for Unruptured Intracranial Aneurysms" in the newest issue of S:VIN. ahajrnls.org/4sx8Czg

Endovascular vs Medical Treatment of Basilar Artery Occlusion @JAMANeuro “At 3 years, the clinical benefit of EVT in patients with acute BAO was durable, with substantially better functional outcomes and reduced mortality compared with medical management. These results reinforce EVT as the standard of care for BAO and support broader implementation and timely access to thrombectomy services.” #curingcoma jamanetwork.com/journals/jaman…

CTA-based #PlaqueRADS helps stratify nonstenotic carotid plaques in #ESUS. New paper in @GreenJournal neurology.org/doi/10.1212/WN…

The new AHA lipid guidelines are out, recommending a target LDL < 55 mg/dL in very high risk patients (e.g. symptomatic ICAD or ECAD). This can be achieved by high dose statin, or adding ezetemibe, PCSK9 inhibitors, or other treatments to high dose statin. ahajournals.org/doi/10.1161/CI…

🧠💉 In TNK-treated LVO stroke patients eligible for EVT, thrombus migration occurred in 36% and made EVT impossible in 26% vs 4% without migration. Thrombus migration significantly reduced rates of complete reperfusion but did not affect functional outcomes. Read more here: bit.ly/4lpk658 @jildazz

This is a 15 years old male. What can be seen here?

Ischemic stroke, defined as a central nervous system injury caused by loss of blood flow, is most often due to arterial thromboembolism. Evaluation should include relevant blood tests and cardiovascular and cardiac investigations (seen in table). Learn more: nej.md/3OFpJ2C

Tenecteplase versus standard medical treatment for basilar artery occlusion within 24 h (TRACE-5). thelancet.com/journals/lance…

#EMBOLISE2 Observation cohort showed that we need to keep our SDH patients on AC/AP. High baseline rates of comorbidity mean they suffer if we stop their meds. #ISC26