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Amy A. Ishkanian, Margy E. McCullough-Hicks, Geoffrey Appelboom, Matthew A. Piazza, Brian Y. Hwang, Samuel S. Bruce, Lindsay M. Hannan, E. Sander Connolly, Sean D. Lavine and Philip M. Meyers

numbers of patients (%) unless otherwise indicated; means are expressed ± SD, medians with IQR in parentheses. Abbreviations: INR = international normalized ratio; PT = prothrombin time; PTT = partial thromboplastin time. † Statistically significant difference. Review Forms of IAT and Existing Study Findings Intraarterial therapy has become widely used to treat ischemic strokes and comprises a number of pharmaceutical or mechanical techniques used to enter the intracranial arteries and eradicate a blood clot to restore blood flow to the brain. Patients in

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Imad S. Khan, Mitchell Odom, Moneeb Ehtesham, Daniel Colvin, C. Chad Quarles, BethAnn McLaughlin and Robert J. Singer

an important role in the direct disruption of the BBB by breaking down collagen Type 4, an integral part of the laminin forming the BBB and increasing the risk of hemorrhagic transformation. 12 , 33 , 35 MMP-9 knockout mice show significantly smaller infarct volumes and decreased BBB disruption than wild-type mice after stroke. 1 Based on these findings we chose MMP-9 as a viable therapeutic target for intraarterial therapy. Our data suggest that intraarterial NCTD decreased the expression of MMP-9, provided robust cell preservation, increased BBB integrity, and

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Harry Cloft

A cute ischemic stroke is a complex entity with many forms and many corresponding treatments that must be tailored to the individual patient. Consensus guidelines from the American Heart Association and American Stroke Association regarding acute ischemic stroke mention intraarterial therapy as one of many tools in the armamentarium for ischemic stroke. 1 The rapid evolution of intraarterial therapy for ischemic stroke has led to speculation regarding the availability of a sufficient number of operators to treat patients in the United States (US). 14 , 15

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Christopher S. Eddleman, Michael C. Hurley, Andrew M. Naidech, H. Hunt Batjer and Bernard R. Bendok

become viable options in the treatment of cerebral vasospasm. The rationale for intraarterial therapy includes the fact that morbidity and mortality have not changed in recent years despite optimized noninvasive medical care. Furthermore, the aggressive endovascular treatment of cerebral vasospasm appears to improve neurological outcomes without putting the patient at significant risk of complications that can accompany prolonged triple-H therapy. Eskridge et al. 10 have suggested the following criteria to determine the need for endovascular therapy for cerebral

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Nohra Chalouhi, Stavropoula Tjoumakaris, Robert M. Starke, David Hasan, Nimrita Sidhu, Saurabh Singhal, Shannon Hann, L. Fernando Gonzalez, Robert Rosenwasser and Pascal Jabbour

recanalization. 7 , 10 , 19 , 22 Endovascular stroke intervention is particularly indicated for patients with large-vessel occlusions, 14 for whom revascularization rates with intravenous rtPA alone are suboptimal, and range from 10% in internal carotid artery occlusion to less than 30% for middle cerebral artery occlusion. 23 Indeed, subgroup analysis of the recently published Interventional Management of Stroke III (IMS III) trial showed a significant benefit with intraarterial therapy in patients with large vessel occlusions, 3 suggesting that endovascular

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Brian V. Nahed, Manuel Ferreira Jr., Matthew R. Naunheim, Kristopher T. Kahle, Mark R. Proctor and Edward R. Smith

radiological features suggestive of vasospasm in a 7 month old with postinfectious SAH, but imaging results were inconclusive and intraarterial therapy was not instituted. There is a strong correlation between vasospasm onset and the amount of subarachnoid blood in the basal cisterns. Pasqualin and associates 19 reported that 51% of adult patients with aneurysms and a thick cisternal blood layer on CT develop vasospasm, whereas only 2% of patients with a thin or absent cisternal blood layer suffered similar complications. Interestingly, the authors noted that thick

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Maxim Mokin, Alexander A. Khalessi, J Mocco, Giuseppe Lanzino, Travis M. Dumont, Ricardo A. Hanel, Demetrius K. Lopes, Richard D. Fessler II, Andrew J. Ringer, Bernard R. Bendok, Erol Veznedaroglu, Adnan H. Siddiqui, L. Nelson Hopkins and Elad I. Levy

-Vessel Occlusion as a Target for Endovascular Therapy Enthusiasm for endovascular catheter-assisted interventions for acute stroke was in part triggered by observations of limited recanalization rates achieved with systemic thrombolysis in patients with large-vessel occlusion. In trials of intraarterial therapies conducted in the 1990s, investigators relied on clinical evaluation alone for screening of cases in which large-vessel occlusion was suspected, because noninvasive imaging modalities (such as CTA or magnetic MR angiography [MRA]) were not widely available. Even at

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Eric M. Deshaies, Amit Singla, Mark R. Villwock, David J. Padalino, Sameer Sharma and Amar Swarnkar

, NIH Stroke Scale (NIHSS) score at admission, intravenous (IV) administration of recombinant tissue plasminogen activator (rt-PA), clot location, ASPECTS (Alberta Stroke Program Early CT Score), 5 method of intraarterial thrombectomy, time from symptom onset until revascularization, and complications related to intraarterial therapy (procedural complications included intraparenchymal or subarachnoid hemorrhage; periprocedural complications included hemorrhagic transformation as evidenced on subsequent CT scans). An independent observer reviewed the posttreatment

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Shervin R. Dashti, Aaron Spalding, Rob J. Kadner, Tom Yao, Arooshi Kumar, David A. Sun and Renato LaRocca

rationale for further study. To maintain therapeutic efficacy of the drug at the lower dose, however, its ability to penetrate the brain must be improved. There are two ways to increase drug penetration into the brain: intraarterial route of administration and blood-brain barrier disruption. Intraarterial Delivery Intraarterial therapy decreases volume dilution of the drug in the circulation and reduces first-pass degradation through proteolytic catabolism. 10 Superselective intraarterial injection of 99m Tc–hexamethylpropyleneamine oxime (Ceretec) into human

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Philip M. Meyers, H. Christian Schumacher, Michael J. Alexander, Colin P. Derdeyn, Anthony J. Furlan, Randall T. Higashida, Christopher J. Moran, Robert W. Tarr, Donald V. Heck, Joshua A. Hirsch, Mary E. Jensen, Italo Linfante, Cameron G. McDougall, Gary M. Nesbit, Peter A. Rasmussen, Thomas A. Tomsick, Lawrence R. Wechsler, John A. Wilson and Osama O. Zaidat

); and mentored experience in intraarterial stroke therapy (including a minimum of 10 cases mentored by a credentialed fellowship-trained neurointerventionalist credentialed in intraarterial stroke therapy) prior to being credentialed to perform intraarterial therapy. It is anticipated that by 2012 stroke centers that are providing intraarterial stroke therapy will be staffed with exclusively fellowship-trained neurointerventionalists and/or practitioners who have met the above prerequisite guidelines and have demonstrated credentialed experience in intraarterial