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Related Concept Videos

Atherosclerosis III: Management01:26

Atherosclerosis III: Management

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Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
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Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Atherosclerosis IV: Nursing Management01:23

Atherosclerosis IV: Nursing Management

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Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
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Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

Atherosclerosis II: Clinical Manifestations and Diagnostic Tests

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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Intracranial atherosclerosis update for neurointerventionalists.

Michael J Alexander1, Wengui Yu2

  • 1Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA michael.alexander@cshs.org.

Journal of Neurointerventional Surgery
|June 9, 2023
PubMed
Summary

Intracranial atherosclerotic disease (ICAD) management evolves. While aggressive medical management is preferred, endovascular options like stenting offer benefits for select patients who fail medical therapy, reducing stroke risk.

Keywords:
AtherosclerosisInterventionStenosisStentStroke

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Neurology

Background:

  • Intracranial atherosclerotic disease (ICAD) management is advancing with improved imaging and endovascular techniques.
  • Endovascular therapy use for symptomatic ICAD has increased significantly in the USA.
  • The SAMMPRIS trial established aggressive medical management (AMM) as superior to initial stenting.

Purpose of the Study:

  • To update neurointerventionalists on evolving ICAD management strategies.
  • To provide evidence-based guidance for counseling patients on risks and benefits of treatments.
  • To review recent advancements in medical and endovascular treatment for ICAD.

Main Methods:

  • Review of recent studies and landmark trials in ICAD management.
  • Analysis of endovascular therapy outcomes, including stenting and angioplasty.
  • Evaluation of rescue therapy in large vessel occlusion (LVO) thrombectomy.

Main Results:

  • Despite AMM superiority, stroke risk remains high in some patients.
  • Intracranial stenting shows reduced periprocedural complications in recent studies.
  • Stenting may benefit patients with hemodynamic compromise or embolic stroke after medical treatment failure.
  • Drug-coated balloons and stents may decrease in-stent restenosis.
  • Rescue stenting in LVO thrombectomy for ICAD shows promising results.

Conclusions:

  • Patients with ICAD who fail medical management may benefit from intracranial stenting.
  • Emerging endovascular techniques offer new options for complex ICAD cases.
  • Continued research is needed to optimize treatment strategies for ICAD.