Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, May 1, 2022

Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis

When your doctor suggests this have them guarantee no complications.

Problems to consider:

You might want to ask your doctor about this?

New ischemic brain lesions on diffusion-weighted MRI after treatment were found in 51% of cases after stenting.  Link here

 

1.  Talk to your doctor about why you would want to put inflexible metal stents in flexible arteries.

2. You might want to prevent stent placement complications per European Society of Cardiology

A - Minor complications

  • Carotid artery spasm

  • Sustained hypotension / bradycardia

  • Carotid artery dissection

  • Contrast encephalopathy (very rare)

  • Minor embolic neurological events (TIAs)

B - Major complications

  • Major embolic stroke

  • Intracranial hemorrhage

  • Hyperperfusion syndrome

  • Carotid perforation (very rare)

  • Acute stent thrombosis (very rare)

  • Complications at the site of the vascular access


Tandem lesion (or tandem occlusion) is a term used in cerebrovascular imaging and intervention to refer to the simultaneous presence of high-grade stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches, usually the middle cerebral artery1.

  The latest here:

Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis
  1. Francesco Diana1,
  2. Michele Romoli2,
  3. Giada Toccaceli3,
  4. Aymeric Rouchaud4,5,
  5. Charbel Mounayer4,5,
  6. Daniele Giuseppe Romano1,
  7. Francesco Di Salle6,
  8. Paolo Missori7,
  9. Andrea Zini8,
  10. Diana Aguiar de Sousa9,
  11. Simone Peschillo10,11
  1. Correspondence to Dr Francesco Diana, Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona', 84131 Salerno, Campania, Italy; francesco.diana.md@gmail.com

Abstract

Background Emergent carotid artery stenting (eCAS) is performed during mechanical thrombectomy for acute ischemic stroke due to tandem occlusion. However, the optimal management strategy in this setting is still unclear.

Objective To carry out a systematic review and meta-analysis to investigate the safety and efficacy of eCAS in patients with tandem occlusion.

Methods Systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from January 1, 2004 to March 7, 2022 for studies evaluating eCAS and no-stenting approach in patients with stroke with tandem occlusion. Primary endpoint was the 90-day modified Rankin Scale score 0–2; secondary outcomes were (1) symptomatic intracerebral hemorrhage (sICH), (2) recurrent stroke, (3) successful recanalization (Thrombolysis in Cerebral Infarction score 2b–3), (4) embolization in new territories, and (5) restenosis rate. Meta-analysis was performed using the Mantel-Haenszel method and random-effects modeling.

Results Forty-six studies reached synthesis. eCAS was associated with higher good functional outcome compared with the no-stenting approach (OR=1.52, 95% CI 1.19 to 1.95), despite a significantly increased risk of sICH (OR=1.97, 95% CI 1.23 to 3.15), and higher successful recanalization rate (OR=1.91, 95% CI 1.29 to 2.85). Restenosis rate was lower in the eCAS group than in the no-stenting group (2% vs 9%, p=0.001). Recanalization rate was higher in retrograde than antegrade eCAS (OR=0.51, 95% CI 0.28 to 0.93). Intraprocedural antiplatelets during eCAS were associated with higher rate of good functional outcome (60% vs 46%, p=0.016) and lower rate of sICH (7% vs 11%; p=0.08) compared with glycoprotein IIb/IIIa inhibitors.

Conclusions In observational studies, eCAS seems to be associated with higher good functional outcome than no-stenting in patients with acute ischemic stroke due to tandem occlusion, despite the higher risk of sICH. Dedicated trials are needed to confirm these results.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

http://dx.doi.org/10.1136/neurintsurg-2022-018683

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