Vascular Neurology Notes

A great reference to keep close-at-hand by @JeremyHeitMDPHD

Large vessel occlusion stroke patients should be taken for thrombectomy within 7 hours, even if imaging doesn’t look favorable…

They are limited and are only used to assist in decision making but important to be familiar with them. Clinical Scales in Aneurysm Rupture Prediction | Stroke: Vascular and Interventional Neurology ahajournals.org/doi/full/10.11…

Workflow for patients with symptoms concerning for aSAH. ahajournals.org/doi/epdf/10.11…

13% of patients will die in the hospital of aneurysmal subarachnoid hemorrhage, and up to 26% will die before arriving at the hospital. If ≥2 first-degree relatives with cerebral aneurysms -> you have a 12% chance of having one ahajournals.org/doi/epdf/10.11…

1/ CTA. DSA. MRA. CFD. VWI. So many letters, so many ❓❓❓ & so the discussion ensues - which imaging are YOU going to use for intracranial aneurysm dx + mgt?   Luckily, Beaman et. al go thru +/- of imaging modalities - both old + new🧠   Let's begin! 👇

One caveat is that mRS is unlikely to be a great assessment tool for isolated PCA infarcts. A trial should assess visual fields.

Interesting results comparing medical management to med + thrombectomy for isolated PCA strokes. Notes: -Multicenter observational -Higher symptomatic ICH and END in thrombectomy patients -mRS not better for thrombectomy patients RCT may be warranted ahajournals.org/doi/10.1161/ST…

Important arterial connections at the skull base. Be careful with embolizations of the middle meningeal artery that may cause facial paralysis or hearing loss. ahajournals.org/doi/full/10.11…

It appears that clots should be removed even when the core infarct is large, 2 new studies in NEJM: #thrombectomy for all nejm.org/doi/full/10.10… nejm.org/doi/full/10.10…

Sturge-Weber Syndrome patients may present to the hospital with stroke like episodes that often fully resolve over a period of days, weeks, or months. MRI rarely shows diffusion restriction, but impaired venous drainage is common on perfusion imaging. pubmed.ncbi.nlm.nih.gov/36263782/

A new method for ischemic stroke treatment? “Molecularly self‐fueled nano-penetrator for nonpharmaceutical treatment of thrombosis and ischemic stroke” nature.com/articles/s4146…

The thalamostriate vein does not drain the thalamus

Thrombectomy beyond 24 hours from last known well? This study demonstrated worse outcomes overall (as one might expect), but similar hemorrhages/complications compared to the 6–24 hours group. Study by @ashabanmd et al. jnis.bmj.com/content/early/…

Are you at the SVIN conference in LA?! @svinsociety great opportunity to meet leaders/friends in the field

Which component of Wallenberg Syndrome is the most disabling? Tough disease for such a small infarct... Most occur with V4 segment occlusion, remainder with PICA occlusion or lateral medullary arteries.

The U.S. neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). jnis.bmj.com/content/early/…

New CASSISS study from China compares medical management to medicine + Wingspan stenting in patients with ICAD. ->No significant difference ->Relatively low stroke rates in both groups (see SAMMPRIS) ->Question remains:why do some patients still fail? jamanetwork.com/journals/jama/…

Cinematic rendering reconstruction of intracranial arteries showing right paraclinoid aneurysm Read More: ajronline.org/doi/10.2214/AJ…

The era of TNK begins! 0.25 mg/kg thelancet.com/journals/lance…

“The M1 segment of the middle cerebral artery precedes by a few hundred million years the appearance of the M2 segment.” -Lasjaunias, Berenstein, and Ter Brugge