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Related Concept Videos

Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

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A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
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Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
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Ischemic Stroke ll: Pathophysiology01:15

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An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Transcervical access in acute ischemic stroke.

Ashutosh P Jadhav1, Marc Ribo2, Ramesh Grandhi3

  • 1Department of Neurology, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Journal of Neurointerventional Surgery
|November 9, 2013
PubMed
Summary
This summary is machine-generated.

Transcervical access offers rapid recanalization for acute ischemic stroke patients with large vessel occlusive disease. This approach overcomes transfemoral challenges in tortuous anatomy, improving treatment outcomes.

Keywords:
AngiographyStrokeTechniqueThrombectomy

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Vascular Surgery

Background:

  • Large vessel occlusive disease (LVOD) necessitates rapid recanalization for favorable prognosis.
  • Standard transfemoral endovascular approaches face challenges in tortuous vasculature.
  • Alternative access routes are crucial for effective acute stroke intervention.

Observation:

  • A retrospective review identified 7 patients undergoing acute endovascular reperfusion via transcervical approach.
  • Patients presented with severe stroke (NIHSS 8-27).
  • Significant time was previously spent on transfemoral attempts (20-90 min) before switching to transcervical access.

Findings:

  • Transcervical access enabled rapid recanalization (7-49 min post-access) in all cases.
  • High-quality reperfusion (TICI 2b/3) was achieved in 87.5% of patients with left MCA occlusions.
  • One case of neck hematoma occurred, managed with intubation. All patients survived at 2-month follow-up (mRS 0-4), except one with a large infarct.

Implications:

  • Direct transcervical access is a viable and effective strategy for acute ischemic stroke reperfusion.
  • This method facilitates faster and higher-quality recanalization compared to transfemoral attempts in complex cases.
  • Future research should optimize hemostasis and identify ideal candidates for direct carotid access in acute stroke management.