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Lin M, Hu L, Shen S, Liu J, Liu Y, Xu Y, Chen H, Sugimoto K, Li J, Kamitsukasa I, Hiwasa T, Wang H, Xu A. Atherosclerosis-related biomarker PABPC1 predicts pan-cancer events. Stroke Vasc Neurol 2024; 9:108-125. [PMID: 37311641 PMCID: PMC11103157 DOI: 10.1136/svn-2022-002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Atherosclerosis (AS) and tumours are the leading causes of death worldwide and share common risk factors, detection methods and molecular markers. Therefore, searching for serum markers shared by AS and tumours is beneficial to the early diagnosis of patients. METHODS The sera of 23 patients with AS-related transient ischaemic attack were screened by serological identification of antigens through recombinant cDNA expression cloning (SEREX), and cDNA clones were identified. Pathway function enrichment analysis was performed on cDNA clones to identify their biological pathways and determine whether they were related to AS or tumours. Subsequently, gene-gene and protein-protein interactions were performed and AS-associated markers would be discovered. The expression of AS biomarkers in human normal organs and pan-cancer tumour tissues were explored. Then, immune infiltration level and tumour mutation burden of various immune cells were evaluated. Survival curves analysis could show the expression of AS markers in pan-cancer. RESULTS AS-related sera were screened by SEREX, and 83 cDNA clones with high homology were obtained. Through functional enrichment analysis, it was found that their functions were closely related to AS and tumour functions. After multiple biological information interaction screening and the external cohort validating, poly(A) binding protein cytoplasmic 1 (PABPC1) was found to be a potential AS biomarker. To assess whether PABPC1 was related to pan-cancer, its expression in different tumour pathological stages and ages was screened. Since AS-associated proteins were closely related to cancer immune infiltration, we investigated and found that PABPC1 had the same role in pan-cancer. Finally, analysis of Kaplan-Meier survival curves revealed that high PABPC1 expression in pan-cancer was associated with high risk of death. CONCLUSIONS Through the findings of SEREX and bioinformatics pan-cancer analysis, we concluded that PABPC1 might serve as a potential biomarker for the prediction and diagnosis of AS and pan-cancer.
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Affiliation(s)
- Miao Lin
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Liubing Hu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- The Biomedical Translational Research Institute,Faculty of Medical Science, Jinan University, Guangzhou, China
| | - Si Shen
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jiyue Liu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yanyan Liu
- The Biomedical Translational Research Institute,Faculty of Medical Science, Jinan University, Guangzhou, China
| | - Yixian Xu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Honglin Chen
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Kazuo Sugimoto
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jianshuang Li
- The Biomedical Translational Research Institute,Faculty of Medical Science, Jinan University, Guangzhou, China
| | - Ikuo Kamitsukasa
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
- Department of Neurology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hao Wang
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Anding Xu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Fiehler J, Shelesko A. New online tools to speed-up training of neurointerventionalists: an example in Central Asia. J Neurointerv Surg 2024; 16:111-112. [PMID: 38216333 DOI: 10.1136/jnis-2023-021401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Andrey Shelesko
- Department of Interventional Radiology, Bukhara Medical University Hospital, Bukhara, Uzbekistan
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Grunwald IQ, Mathias K, Bertog S, Snyder KV, Sievert H, Siddiqui A, Musialek P, Hornung M, Papanagiotou P, Comelli S, Pillai S, Routledge H, Nizankowski RT, Ewart I, Fassbender K, Kühn AL, Alvarez CA, Alekyan B, Skrypnik D, Politi M, Tekieli L, Haldis T, Gaikwad S, Houston JG, Donald-Simpson H, Guyler P, Petrov I, Roffe C, Abelson M, Hargroves D, Mani S, Podlasek A, Witkowski A, Sievert K, Pawlowski K, Dziadkiewicz A, Hopkins NL. World Federation for Interventional Stroke Treatment (WIST) Multispecialty Training Guidelines for Endovascular Stroke Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:67-72. [PMID: 37012107 DOI: 10.1016/j.carrev.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Today, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT. AIM To provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes. MATERIAL AND METHODS The World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency - rather than time-based - guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated. RESULTS The WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. CONCLUSIONS WIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SUMMARY The World Federation for Interventional Stroke Treatment (WIST) establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in endovascular treatment (EVT). WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. WIST multispecialty guidelines outline competency and quality standards for physicians and centers to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SIMULTANEOUS PUBLICATION The WIST 2023 Guidelines are published simultaneously in Europe (Adv Interv Cardiol 2023).
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Affiliation(s)
- Iris Q Grunwald
- Department of Radiology, NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - Klaus Mathias
- Asklepios Clinik St. Georg-Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - Stefan Bertog
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Marius Hornung
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Panagiotes Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany; First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Simone Comelli
- S. C. Neuroradiologia ed Interventistica Vascolare, Ospedale S. Michele, Cagliari, Italy
| | | | - Helen Routledge
- Worcestershire Royal Hospital, Cardiology Department, Worcester, United Kingdom
| | - Rafal T Nizankowski
- Accreditation Council, National Centre for Health Quality Assessment, Krakow, Poland
| | - Ian Ewart
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Anna L Kühn
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Carlos A Alvarez
- Hospital Italiano Regional Del Sur, Hospital Privado Del Sur and Hospital Regional Español, Bahia Blanca, Argentina
| | | | - Dmitry Skrypnik
- I.V. Davidovsky City Hospital, Moscow State University and Dentistry, Moscow, Russia
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | | | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, Neurosciences Center, Ansari Nagar, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - John Graeme Houston
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Helen Donald-Simpson
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Paul Guyler
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Ivo Petrov
- Department of Cardiology and Angiology, Acibadem City Clinic-Cardiovascular Center, Sofia, Bulgaria
| | - Christine Roffe
- University Hospital of North Midlands, Keele University, Stoke-on-Trent, UK
| | - Mark Abelson
- Vergelegen MediClinic, Somerset West, University of Cape Town, South Africa
| | - David Hargroves
- East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | | | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Adam Witkowski
- Deptartment of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Kolja Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Krzysztof Pawlowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, Wejherowo, Poland
| | - Nelson L Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
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Watanabe T, Kobara S, Amisaki R, Yamamoto K. Primary percutaneous coronary intervention for cardio-cerebral infarction: a case report. Front Cardiovasc Med 2023; 10:1165735. [PMID: 37583581 PMCID: PMC10424438 DOI: 10.3389/fcvm.2023.1165735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are the leading causes of death globally. Cardio-cerebral infarction (CCI) is the rare occurrence of AMI and AIS, either simultaneously or one after the other. Treatment recommendations are not clear in case of the occurrence of AMI and AIS simultaneously, especially the strategy of primary percutaneous coronary intervention (PCI). Case presentation We report consecutive seven case series of patients with CCI who underwent primary PCI in our institute. Comorbidities, strategy of primary PCI, and outcomes were investigated. All patients presented with the chief complaints associated with stroke. Atrial fibrillation (AF) was complicated in five of CCI patients, and four of AF patients were not anticoagulated. The major causes of stroke were cardiogenic and/or hemodynamic in this case series. All patients showed total occlusion in the culprit lesion, and six patients had other diseased vessels. Thrombus aspiration was mainly chosen as the reperfusion strategy in PCI. However, only two patients were diagnosed as definitive coronary embolism, and stenting was needed in six patients due to severe atherosclerotic lesion in culprit coronary artery. Final thrombolysis in myocardial infarction (TIMI) 3 flow was achieved only in four patients. Hemorrhagic complications occurred in three patients. Two patients died during in-hospital stay, and most had to be transferred for rehabilitation. Conclusions CCI was a rare but fatal condition in patients who underwent primary PCI. Although CCI was associated with concomitant atrial fibrillation, organic coronary stenosis requiring stenting for revascularization was present in almost all the cases. Given the complexity of coronary artery lesions and high in-hospital mortality, further investigations are needed to determine the optimal treatment strategy.
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Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University,Yonago,Japan
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Dervishi M, Al-Natour M, Thomas JP, Harth K. Multidisciplinary Approach to Venous Disease: Enhancing Patient Care and Trainee Education Through Collaboration. Tech Vasc Interv Radiol 2023; 26:100902. [PMID: 37865452 DOI: 10.1016/j.tvir.2023.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a sequela of the long-term effects of chronic venous insufficiency, deep vein thrombosis (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the quality of life of a considerable proportion of the adult population. Untreated and progressive lower extremity venous disease can lead to venous ulceration and other complications. Additionally, poorly recognized and poorly understood venous conditions of the abdomen and pelvis leave many patients "orphaned" in health-care systems that lack expertise in complex venous conditions. Addressing the burden and breadth of venous disease requires comprehensive management approaches, early diagnosis, appropriate treatment interventions, and provider and patient education. Multidisciplinary collaborations and further research are essential to enhance our understanding, develop innovative therapies, and improve patient outcomes in the field of venous disease. In this paper, we highlight the importance of multidisciplinary collaboration and our journey to building an institutional venous team, as well as lessons learned.
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Affiliation(s)
- Mario Dervishi
- Division of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland OH
| | - Mohamed Al-Natour
- Division of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland OH
| | - Jones P Thomas
- Vascular Surgery, INTEGRIS Cardiovascular Physicians, Oklahoma City, OK
| | - Karem Harth
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland OH.
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Zhang L, Shu Y, Han C, Liu J. Correlation Between Family Functioning and Health Beliefs in Patients with Stroke in Beijing, China. J Multidiscip Healthc 2023; 16:1067-1074. [PMID: 37096237 PMCID: PMC10122470 DOI: 10.2147/jmdh.s394396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/14/2023] [Indexed: 04/26/2023] Open
Abstract
Objective To explore the relationship between family functioning and health beliefs in patients with stroke. Methods A total of 253 patients with stroke were selected from Beijing Luhe Hospital, Capital Medical University from May 2021 to November 2021. All patients were of Chinese nationality, and 240 valid questionnaires were obtained. The Family Assessment Device and Champion's Health Belief Model Scale were used to collect patients' family functioning and health beliefs information, and correlation analysis was used to analyse it. Results The total score for family functioning in patients with stroke was 130.5 (22). The highest mean score was 2.46 for behaviour control, and the lowest score was 2.00 for total function. The items were ranked from high to low in this order: behaviour control, emotional response, role, communication, emotional intervention, problem solving and total function. The total score of the patients' health beliefs was 116 (33), The items were ranked from high to low in this order: were self-efficacy, health motivation, perceived benefit, susceptibility, severity and perceived impairment. The scores for family functioning were negatively correlated with the total scores for health beliefs (P < 0.05). Discussion Stroke can reduce the self-care ability of the patients and aggravate the burden of family care. This can lead to abnormal function roles for patients and their families, emotional reactions in patients with stroke and weaker levels of family functioning. Conclusion The health beliefs scores of patients with stroke were at the middle level, and family functioning was at the general level. There was a negative correlation between the family functioning score and the total score for health beliefs in patients with stroke.
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Affiliation(s)
- Lingli Zhang
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - YaoYa Shu
- Department of Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Chunjie Han
- Department of Rehabilitation Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jihong Liu
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Jihong Liu, Department of Neurology, Beijing Luhe Hospital, Capital Medical University, No. 82 of Xin Hua South Road, Tongzhou District, Beijing, 101149, People’s Republic of China, Tel +86 10-69543901-1041, Fax +86 10 69531069, Email
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Widimsky P, Snyder K, Sulzenko J, Hopkins LN, Stetkarova I. Acute ischaemic stroke: recent advances in reperfusion treatment. Eur Heart J 2022; 44:1205-1215. [PMID: 36477996 PMCID: PMC10079392 DOI: 10.1093/eurheartj/ehac684] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
During the last 5–7 years, tremendous progress was achieved in the reperfusion treatment of acute ischaemic stroke during its first few hours from symptom onset. This review summarizes the latest evidence from randomized clinical trials and prospective registries with a focus on endovascular treatment using stent retrievers, aspiration catheters, thrombolytics, and (in selected patients) carotid stenting. Novel approaches in prehospital (mobile interventional stroke teams) and early hospital (direct transfer to angiography) management are described, and future perspectives (‘all-in-one’ laboratories with angiography and computed tomography integrated) are discussed. There is reasonable chance for patients with moderate-to-severe acute ischaemic stroke to survive without permanent sequelae when the large-vessel occlusion is removed by means of modern pharmaco-mechanic approach. Catheter thrombectomy is now the golden standard of acute stroke treatment. The role of cardiologists in stroke is expanding from diagnostic help (to reveal the cause of stroke) to acute therapy in those regions where such up-to-date Class I. A treatment is not yet available.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Jakub Sulzenko
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Leo Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Ivana Stetkarova
- Department of Neurology at the Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
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Widimský P, Kucera D. Stroke thrombectomy (± thrombolysis), and not thrombolysis alone, should be the gold standard for stroke treatment. EUROINTERVENTION 2022; 17:e1367-e1368. [PMID: 35354552 PMCID: PMC9896380 DOI: 10.4244/eij-e-22-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Petr Widimský
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00 Praha 10, Czech Republic
| | - Dusan Kucera
- Cardiocenter, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Wita K, Kułach A, Wilkosz K, Wybraniec M, Wojakowski W, Kuczmik W, Lelek M, Tomalski W, Ochała A, Uchwat U, Lasek-Bal A. Mechanical Thrombectomy in Acute Ischemic Stroke-The Role of Interventional Cardiologists: A Prospective Single-Center Study. JACC Cardiovasc Interv 2022; 15:550-558. [PMID: 35151607 DOI: 10.1016/j.jcin.2021.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality. BACKGROUND MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy. METHODS In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52). RESULTS Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar. CONCLUSIONS Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure.
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Affiliation(s)
- Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Kułach
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Katarzyna Wilkosz
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wacław Kuczmik
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Michał Lelek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Andrzej Ochała
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Urszula Uchwat
- Department of Neurology, Upper Silesian Medical Center, Katowice, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Pracoń R, Zieliński K, Bangalore S, Konka M, Kruk M, Kępka C, Trochimiuk P, Dębski M, Przyłuski J, Kaczmarska E, Dzielińska Z, Kurowski A, Witkowski A, Demkow M. Residual stroke risk after left atrial appendage closure in patients with prior oral anticoagulation failure. Int J Cardiol 2022; 354:17-21. [PMID: 35219744 DOI: 10.1016/j.ijcard.2022.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2022] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and oral anticoagulation (OAC) failure may benefit from left atrial appendage closure (LAAC), however, the evidence is scarce. We report outcomes of LAAC in patients with OAC failure compared to those with classic indications of OAC contraindications. METHODS Prospective registry of LAAC with Amplatzer or WATCHMAN device followed by dual antiplatelet therapy (DAPT) was analyzed (05.2014-11.2019). The study group included patients with OAC failure defined as stroke/TIA/PE/LAA thrombus (n = 39) during OAC, whereas the control group consisted of patients with OAC contraindications (n = 156). Structured follow-up at 3, 6, and 12 months was done. RESULTS The study group compared to controls was younger [73 (IQR, 62-77) vs 74 (IQR, 68-81) years, P = 0.046], with higher CHA2DS2-VASc [5.0 (IQR, 3.0-6.0) vs 4.0 (IQR, 3.0-5.0), P = 0.001)], lower HAS-BLED [2.0 (IQR, 1.0-3.0) vs 3.0 (IQR, 2.0-3.0), P = 0.006] and similar proportion of WATCHMAN implantations (43.6% vs 44.2%, P = 1.000). The reduction from CHA2DS2-VASc predicted to observed annual stroke/TIA/PE rate was markedly smaller in the study vs control group (14% vs 77%) with 10.3% vs 1.9% stroke/TIA/PE respectively (P = 0.031). The reduction from HAS-BLED predicted to observed annual major nonprocedural bleeding rate was higher (100% vs 7.4%) with 0.0% vs 5.1% major bleedings respectively (P = 0.361). The device-related thrombosis remained similar (13.2% vs 11.3%, P = 0.778). CONCLUSIONS Patients after LAAC for OAC failure and unremarkable prior bleeding history presented with high residual stroke and low bleeding risks. Therefore concomitant long-term OAC or prolonged DAPT should strongly be considered in this population.
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Affiliation(s)
- Radosław Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Kamil Zieliński
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland.
| | | | - Marek Konka
- Congenital Cardiac Defects Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Cezary Kępka
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Trochimiuk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Dębski
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Jakub Przyłuski
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Edyta Kaczmarska
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Zofia Dzielińska
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Kurowski
- Anesthesiology Department, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Interventional Cardiology and Angiology Department, National Institute of Cardiology, Warsaw, Poland
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
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11
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Routledge H, Sharp AS, Kovac J, Westwood M, Keeble TR, Bathula R, Eteiba H, Grunwald IQ, Curzen N. Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group. Interv Cardiol 2022; 17:e07. [PMID: 35774864 PMCID: PMC9214600 DOI: 10.15420/icr.2021.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022] Open
Abstract
There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.
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Affiliation(s)
| | - Andrew Sp Sharp
- University Hospital of Wales Cardiff, Wales, UK.,University of Exeter Exeter, UK
| | - Jan Kovac
- University Hospitals of Leicester NHS Trust Leicester, UK
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin University Chelmsford, Essex, UK
| | - Raj Bathula
- London North West University Healthcare NHS Trust London, UK
| | - Hany Eteiba
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital Glasgow, Scotland, UK
| | - Iris Q Grunwald
- University of Dundee Dundee, Scotland, UK.,Cardiovascular Center Frankfurt Frankfurt, Germany
| | - Nick Curzen
- Faculty of Medicine, University of Southampton Southampton, UK.,Cardiothoracic Unit, University Hospital Southampton Southampton, UK
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12
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Lip GYH, Lane DA, Lenarczyk R, Boriani G, Doehner W, Benjamin LA, Fisher M, Lowe D, Sacco RL, Schnabel R, Watkins C, Ntaios G, Potpara T. OUP accepted manuscript. Eur Heart J 2022; 43:2442-2460. [PMID: 35552401 PMCID: PMC9259378 DOI: 10.1093/eurheartj/ehac245] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
The management of patients with stroke is often multidisciplinary, involving various specialties and healthcare professionals. Given the common shared risk factors for stroke and cardiovascular disease, input may also be required from the cardiovascular teams, as well as patient caregivers and next-of-kin. Ultimately, the patient is central to all this, requiring a coordinated and uniform approach to the priorities of post-stroke management, which can be consistently implemented by different multidisciplinary healthcare professionals, as part of the patient ‘journey’ or ‘patient pathway,’ supported by appropriate education and tele-medicine approaches. All these aspects would ultimately aid delivery of care and improve patient (and caregiver) engagement and empowerment. Given the need to address the multidisciplinary approach to holistic or integrated care of patients with heart disease and stroke, the European Society of Cardiology Council on Stroke convened a Task Force, with the remit to propose a consensus on Integrated care management for optimizing the management of stroke and associated heart disease. The present position paper summarizes the available evidence and proposes consensus statements that may help to define evidence gaps and simple practical approaches to assist in everyday clinical practice. A post-stroke ABC pathway is proposed, as a more holistic approach to integrated stroke care, would include three pillars of management:
A: Appropriate Antithrombotic therapy. B: Better functional and psychological status. C: Cardiovascular risk factors and Comorbidity optimization (including lifestyle changes).
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Affiliation(s)
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Radosław Lenarczyk
- Division of Medical Sciences in Zabrze, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, The Medical University of Silesia, Silesian Center of Heart Diseases, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT) and Department of Internal Medicine and Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK) partner site Berlin and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Laura A Benjamin
- Laboratory of Molecular and Cell Biology, University College London National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Marc Fisher
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Deborah Lowe
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral CH49 5PE, UK
| | - Ralph L Sacco
- UM Clinical & Translational Science Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Renate Schnabel
- University Heart & Vascular Center Hamburg Eppendorf, German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston PR1 2HE, UK
| | - George Ntaios
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
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13
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Interdisciplinary management of acute ischaemic stroke - current evidence on training requirements for endovascular stroke treatment. Position Paper from the ESC Council on Stroke and the European Association for Percutaneous Cardiovascular Interventions with the support of the European Board of Neurointervention: A step forward. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:245-250. [PMID: 34819960 PMCID: PMC8596728 DOI: 10.5114/aic.2021.109832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023] Open
Abstract
Stroke, a vascular disease of the brain, is the #1 cause of disability and a major cause of death worldwide. Stroke has a major negative impact on the life of stroke-affected individuals, their families and the society. A significant proportion of stroke victims indicate that would have preferred death over their after-stroke quality of life. Mechanical thrombectomy (MT), opening the occluded artery using mechanical aspiration or a thrombus-entrapment device, is a guideline-mandated (class I, level of evidence A) treatment modality in patients with large vessel occlusion stroke. MT clinical benefit magnitude indicates that a universal access to this treatment strategy should be the standard of care. Today there is a substantial geographic variation in MT deliverability, with large-scale disparities in MT implementation. In many countries effective access to MT remains severely limited. In addition, many of the MT-treated patients are treated too late for a good functional outcome because of logistic delays that include transportations to remotely located, scarce, comprehensive stroke centres. Position Paper from the European Society of Cardiology Council on Stroke and European Association for Percutaneous Cardiovascular Interventions on interdisciplinary management of acute ischaemic stroke, developed with the support of the European Board of Neurointervention fills an important gap in systematically enabling interventional cardiologists to support stroke intervention in the geographic areas of unmet needs in particular. We review strengths and weaknesses of the document, and suggest directions for the next steps that are swiftly needed to deliver MT to stroke patients more effectively.
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14
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Nardai S, Vorobcsuk A, Nagy F, Vajda Z. Successful endovascular treatment of simultaneous acute ischaemic stroke and hyperacute ST-elevation myocardial infarction: the first case report of a single-operator cardio-cerebral intervention. Eur Heart J Case Rep 2021; 5:ytab419. [PMID: 34746640 PMCID: PMC8567068 DOI: 10.1093/ehjcr/ytab419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published endovascular treatment of synchronous heart and brain infarctions delivered by a single operator with excellent clinical outcome.
Case summary
A 67-year-old female patient was directly transported to the emergency room of a comprehensive stroke centre with acute onset global aphasia and right hemiplegia. The onset to admission time exceeded the 4.5-h time window of systemic thrombolysis. Head computed tomography (CT) excluded extensive early extensive brain damage, CT angiography documented left middle cerebral artery occlusion and mechanical thrombectomy was indicated. Extensive anterior ST elevation was detected on the transport monitor while waiting for in-hospital transfer. The two simultaneously evolving pathologies were handled in a single endovascular procedure that took less than 60 min by a dual-trained interventional cardiologist/neurointerventional surgeon. The patient recovered without any major cardiac or neurologic sequela.
Discussion
Interventional cardiologists, professionally trained through a neurointerventional fellowship programme to perform endovascular stroke interventions according to the latest multi-society position paper, could not only complement stroke teams lacking manpower, but their unique experience could also help the patients suffering from the most devastating forms of cardio-cerebral infarctions.
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Affiliation(s)
- Sándor Nardai
- Semmelweis University, Heart and Vascular Center, Városmajor Street 68, Budapest 1122, Hungary
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
- Corresponding author. Tel: +36 206632722,
| | - András Vorobcsuk
- Department of Cardiology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Zsolt Vajda
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
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15
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Piayda K, Grunwald I, Sievert K, Bertog S, Sievert H. Acute stroke intervention for acute embolic procedural strokes performed by cardiologists. Catheter Cardiovasc Interv 2021; 98:E963-E967. [PMID: 34156744 DOI: 10.1002/ccd.29820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/25/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
Acute ischemic stroke is a feared complication during cardiovascular procedures associated with high morbidity and mortality if not immediately recognized and treated. We conducted a review of cases at our center where patients experienced an acute, procedure-related ischemic stroke and underwent immediate endovascular stroke treatment by the interventional cardiologists trained in acute endovascular stroke intervention. Baseline demographics, procedural and follow-up data were collected. Three patients were identified in whom the percutaneous procedure (peripheral arterial intervention, transapical NeoChord [NeoChord Inc, Minnesota, USA] implantation and transcatheter aortic valve implantation, respectively) was complicated by an acute embolic ischemic stroke. In all cases, cerebral vessel re-canalization was technically successful with thrombolysis in cerebral infarction (TICI) IIB/III flow. Follow-up computed tomography scans showed no infarct demarcation, oedema or intracranial hemorrhage. One patient survived with no neurological symptoms at 6-month follow-up whereas the two other patients died of unrelated intensive care complications and decompensated heart failure. We conclude that endovascular stroke treatment during cardiovascular interventions can be performed by interventional cardiologists with appropriate training. It offers the unique opportunity to treat cerebral embolization in a time-efficient manner, potentially improving morbidity and mortality of affected patients.
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Affiliation(s)
- Kerstin Piayda
- CardioVascularCenter (CVC) Frankfurt, Frankfurt, Germany.,Division of Cardiology, Vascular Medicine and Pulmonology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Iris Grunwald
- CardioVascularCenter (CVC) Frankfurt, Frankfurt, Germany.,Divison of Neuroscience, University of Dundee, Dundee, UK
| | - Kolja Sievert
- CardioVascularCenter (CVC) Frankfurt, Frankfurt, Germany
| | - Stefan Bertog
- CardioVascularCenter (CVC) Frankfurt, Frankfurt, Germany.,Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Horst Sievert
- CardioVascularCenter (CVC) Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, East Anglia, UK
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16
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Crea F. Management of ischaemic stroke, prognostic impact of procedural myocardial injury, and antiplatelet treatment: the many facets of interventional cardiology. Eur Heart J 2021; 42:289-291. [PMID: 33625517 DOI: 10.1093/eurheartj/ehab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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