Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Magid, David; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Schreiner, Pamela J; Sorlie, Paul D; Stein, Joel; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2013 Update A Report From the American Heart Association

Rosamond, Paul D. Sorlie, Randall S. Stafford, Tanya N. Turan, Melanie B. Turner, Nathan D. Dariush Mozaffarian, Michael E. Mussolino, Graham Nichol, Nina P. Paynter, Wayne D. Ariane Marelli, David B. Matchar, Mary M. McDermott, James B. Meigs, Claudia S. Moy, Lackland, Judith H. Lichtman, Lynda D. Lisabeth, Diane M. Makuc, Gregory M. Marcus, John A. Heit, P. Michael Ho, Virginia J. Howard, Brett M. Kissela, Steven J. Kittner, Daniel T. Caroline S. Fox, Heather J. Fullerton, Cathleen Gillespie, Kurt J. Greenlund, Susan M. Hailpern, Todd M. Brown, Mercedes R. Carnethon, Shifan Dai, Giovanni de Simone, Earl S. Ford, Véronique L. Roger, Alan S. Go, Donald M. Lloyd-Jones, Robert J. Adams, Jarett D. Berry, Association 2011 Update : A Report From the American Heart −− Heart Disease and Stroke Statistics

Heart Disease and Stroke Statistics—2011 Update A Report From the American Heart Association

Dear Sir, We wish to bring to your attention the neuroradiological findings in a 40-year-old woman who presented with a sentinel headache. Neuroimaging revealed a hemorrhagic cavernous malformation in the body of the corpus callosum and an anterior communicating artery (ACoA) aneurysm (Fig. 1a and b). Aneurysmal subarachnoid hemorrhage was excluded on the basis of computed tomography and lumbar puncture. The aneurysm measured 1.2 cm on a catheterbased angiogram; an early carotid bifurcation at the level of the ophthalmic artery (OA) origin and a horizontal course of the right A1 segment (the only A1) were also noted (Fig. 2a and b). Given the higher risk of rupture of the aneurysm, the patient underwent coil embolization of the aneurysm. The patient did well, but significant aneurysm recurrence was documented on the follow-up angiogram. She underwent microsurgical clipping through a right-sided transsylvian approach. Intraoperatively, the right A1 was seen to originate from the carotid artery at the level of the OA, coursing beneath the optic nerve to supply the ACoA aneurysm (Fig. 3). Intraoperative indocyanine green fluorescence angiography (Fig. 4) and postoperative conventional angiography revealed total aneurysm occlusion. To our knowledge, the present report is the first case of an infraoptic anterior cerebral artery (ACA) in association with a cavernous malformation. This is also the first reported case of multimodal treatment of an infraoptic ACoA aneurysm variant. The origin of an infraoptic ACA remains speculative. Enlargement of the prechiasmal arterial plexus, persistence and enlargement of an anastomotic loop between the primitive dorsal and ventral OAs and persistence of a fetal anastomosis between the primitive maxillary artery, and the ACA have all been implicated [1–3]. The aberrant anastomosis often leads to agenesis of ipsilateral and contralateral A1 segments [4]. Infraoptic ACAs are classified according to local vascular anatomy [5]. The type I configuration has a normal ACoA complex with an additional infraoptic vessel P. Kan : P. Yashar :A. J. Chamczuk : E. I. Levy : L. N. Hopkins : A. H. Siddiqui (*) Department of Neurosurgery, University at Buffalo, State University of New York, 3 Gates Circle, Buffalo, NY 14209, USA e-mail: asiddiqui@ubns.com

Letter to the editor: Multimodal treatment of co-existent callosal cavernous malformation and anterior communicating artery aneurysm associated with an infraoptic anterior cerebral artery.

Blazing the Frontiers of Stroke Therapy.

Flow diversion: exciting new technology in its infancy.

The purpose of Clinical Problem Solving manuscripts is to present management challenges in an attempt to give practicing neurosurgeons insight into how field leaders address these dilemmas. This illustration is accompanied by a brief review of the literature on the topic. We describe the case of a patient who presented with recurrent headaches resulting from a nondominant hemisphere parietal arteriovenous malformation. Challenges in prognosis, treatment, and complication management are discussed.

To glue or not to glue? That is the question!!!

Cervical carotid stenosis is a major cause of stroke and disability. Although carotid endarterectomy is an established and effective treatment for some patients with carotid artery stenosis, angioplasty and stenting has emerged in recent years as a viable alternative, particularly for patients who may be less suited for surgery. This article reviews patient selection for the two alternative approaches. The authors review the findings of the major clinical trials of carotid endarterectomy, summarize the development of carotid angioplasty and stenting, and identify patient characteristics that may guide selection of surgical or endovascular treatment.

L. Nelson Hopkins

Papers

Letter to the editor: Multimodal treatment of co-existent callosal cavernous malformation and anterior communicating artery aneurysm associated with an infraoptic anterior cerebral artery.

Blazing the Frontiers of Stroke Therapy.

Flow diversion: exciting new technology in its infancy.

To glue or not to glue? That is the question!!!

Patient Selection for Revascularization in Cervical Carotid Artery Disease: Angioplasty and Stenting vs. Endarterectomy