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Marc S. Goldman, Robert E. Anderson, and Fredric B. Meyer

R epair of complex aneurysms may be difficult due to the location of the lesion, an atheromatous calcified base, the presence of intramural thrombus, or the location of perforator vessels. In these situations, temporary occlusion of the parent vessel is often advantageous. 8, 10, 13, 20, 35, 36 When vessel occlusion is utilized, the risk of ischemic sequelae may be lessened by the use of cerebroprotective measures. The role of intermittent reperfusion during this period of vessel occlusion is controversial. To date, no objective clinical studies have

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B. A. Bell, Lindsay Symon, and Neil M. Branston

reperfusion of ischemic brain by induced hypertension has produced clinical 40, 41 and experimental 24 evidence of improvement in blood flow and tissue function, without exacerbating edema. There is therefore a dilemma in deciding whether to attempt to restore flow to ischemic brain as soon as possible after the insult. The effect of immediate restoration of flow has been explored in these experiments, and the degree of reperfusion and its effect on ischemic edema has been quantified. Materials and Methods Forty-one baboons ( Papio anubis or cynocephalus ) with an

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Jun Chen, Philip R. Weinstein, and Steven H. Graham

R estoration of cerebral blood flow after prolonged and severe ischemia may cause damage to the blood-brain barrier (BBB), exacerbate brain edema, and cause intracerebral hemorrhage. 2, 6, 11, 21, 22, 39 Thus, reperfusion injury is a potentially hazardous complication of surgical revascularization, temporary intraoperative cerebrovascular occlusion, or thrombolytic therapy for acute stroke. Recent experimental evidence suggests that arachidonic acid and its oxidative metabolites (eicosanoids) may be important mediators of ischemic injury. 26, 28, 45

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Carlos A. David, Ricardo Prado, and W. Dalton Dietrich

. Considerable experimental evidence exists establishing that repetitive episodes of global cerebral ischemia enhance the extent of neuronal injury when compared with an equivalent single period of ischemia. 1, 10, 12, 13, 30, 31 However, little experimental data are available on repetitive episodes of focal ischemia. Furthermore, most studies have used protocols that do not simulate the temporal profiles that are likely to occur during surgery. Considerable disagreement continues to exist regarding the use of brief periods of reperfusion during temporary clipping versus a

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Yoshihiro Kinoshita and William W. Monafo

were particularly interested in determining whether there was clinical evidence of a so-called “reperfusion” injury in this model, as is known to occur in several other tissues, notably cardiac muscle, brain, and intestine. 9–11, 13, 15, 21, 38 Materials and Methods Male Sprague-Dawley rats, each weighing between 300 and 420 gm, were used for this study. As described below, the common iliac artery was temporarily occluded at the level of the superior vesical artery and the femoral artery was occluded between its circumflex iliac and superficial epigastric

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Brian A. Iuliano, Robert E. Anderson, and Fredric B. Meyer

T emporary occlusion during aneurysm surgery is sometimes necessary because of aneurysm location, an atheromatous calcified base, the presence of intramural thrombus, or the anatomy of perforator vessels. 12, 40, 41 Methods to provide protection to the brain during this temporary vascular occlusion remain controversial. 11, 25 One potential technique is the use of intermittent reperfusion based on possible beneficial effects brought about through restoration of necessary metabolic substrates, waste removal, and mitigation of the development of an environment

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Steven L. Gogela, Yair M. Gozal, Bin Zhang, Thomas A. Tomsick, Andrew J. Ringer, Joseph P. Broderick, Pooja Khatri, and Todd A. Abruzzo

criteria may also have blunted results from these studies. Nonetheless, subset analysis from IMS-III did show that good clinical outcomes after endovascular intervention strongly depended on the time interval between stroke onset and successful restoration of cerebral perfusion; specifically, longer times to reperfusion resulted in worse clinical outcomes. For example, examination of the IMS-III trial showed that every 30-minute delay in reperfusion reduced the likelihood of a good clinical outcome by 12% (adjusted analysis) to 15% (unadjusted). 15 Therefore, technical

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Aclan Doğgan, A. Muralikrishna Rao, Mustafa K. Başkaya, V. L. Raghavendra Rao, Jane Rastl, David Donaldson, and Robert J. Dempsey

clinical mechanism of cerebral ischemia. Although there are several studies indicating the effectiveness of ifenprodil administration after permanent focal cerebral ischemia has occurred, results derived by using a model of temporary focal cerebral ischemia and reperfusion have not been reported. The purpose of the present study was to determine the effect of ifenprodil therapy on postischemic brain edema, blood-brain barrier (BBB) breakdown, and infarction size after reperfusion by using a transient MCA occlusion model in rats. Materials and Methods In this study

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Ralph Rahme, Sharon D. Yeatts, Todd A. Abruzzo, Lincoln Jimenez, Liqiong Fan, Thomas A. Tomsick, Andrew J. Ringer, Anthony J. Furlan, Joseph P. Broderick, and Pooja Khatri

, endovascular reperfusion was attempted exclusively via pharmacological means, it is expected that the results of this analysis may not be necessarily applicable to patients undergoing mechanical thrombolysis. Methods The PROACT II study was an open-label randomized controlled trial conducted in 54 centers in the US and Canada. 5 One hundred eighty patients between 18 and 85 years of age, with a National Institutes of Health Stroke Scale (NIHSS) score of ≥ 4 and an angiographically proven M 1 or M 2 MCA occlusion, were randomized in a 2:1 ratio to either 9 mg IA

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Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, and Bertrand Lapergue

M echanical thrombectomy (MT) has been validated through 6 international randomized controlled trials in patients with acute ischemic stroke caused by occlusion of the arteries of the proximal anterior circulation. 2 , 12 However, patients with basilar artery occlusion (BAO) were excluded from 5 of these trials, and only a few such patients were included in the THRACE (THRobectomie des Artères CErebrales) trial. 2 In patients with BAO, prognosis remains severe with a high mortality rate, especially in the absence of early reperfusion. 27 Pending the results