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Arjun V. Pendharkar, Sabrina L. Levy, Allen L. Ho, Eric S. Sussman, Michelle Y. Cheng, and Gary K. Steinberg

S troke is the leading cause of long-term disability in the United States, 67 with a projected prevalence of 3.4 million by 2030 67 and an annual cost of approximately $34 billion. 67 Treatment options include intravenous tissue plasminogen activator and endovascular thrombolysis but are limited to ischemic stroke and a narrow administration window. From a basic science perspective, numerous experimental therapies have shown success in the laboratory, yet none have successfully reached the clinic. 107 Neuroprotective strategies, including glutamate

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Raphael Guzman, Raymond Choi, Atul Gera, Alejandro De Los Angeles, Robert H. Andres, and Gary K. Steinberg

S troke remains the number 1 cause of disability and the 3rd leading cause of death among Americans each year. The incidence of stroke in the US is 730,000 new or recurrent cases of stroke/year with an estimated 6,000,000 stroke survivors. According to the National Institutes of Health, the estimated direct and indirect costs related to stroke for 2007 total $62.7 billion. Despite the significant socioeconomic burden attributed to stroke, there are no therapeutic approaches currently available besides thrombolytic treatments, which have a narrow time

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Leonid I. Groysman, Benjamin A. Emanuel, May A. Kim-Tenser, Gene Y. Sung, and William J. Mack

date, hypothermia is the only treatment modality proven to have neuroprotective effects in clinical trials of global cerebral ischemia such as cardiac arrest 1 , 17 , 22 and newborn hypoxic encephalopathy. 40 These findings have generated enthusiasm for the use of hypothermia as a neuroprotectant in focal ischemic stroke. Successful implementation, however, 40 thus far has been marred by clinical trials with small sample size, prolonged time to intervention, and concern for potential side effects. In the following article we explore the current development of

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Howard Yonas, Holly A. Smith, Susan R. Durham, Susan L. Pentheny, and David W. Johnson

stroke had been defined by PET studies. 22, 24 Because maximum vasodilatation accompanies severely compromised cerebral hemodynamics, CBF response to a vasodilatory challenge has been examined as a more accessible means of identifying patients with compromised vascular reserves. Whether a vasodilatory challenge is induced by inhaling a gas mixture containing 3% to 5% CO 2 2, 9, 16, 20, 25 or is chemically induced with the intravenous injection of acetazolamide, 4, 29, 31, 32 the resultant regional OEF-flow response has proven useful for identifying individuals with

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Nickalus R. Khan, Brittany D. Fraser, Vincent Nguyen, Kenneth Moore, Scott Boop, Brandy N. Vaughn, and Paul Klimo Jr.

Grade III, intracranial hemorrhage requiring neurosurgical intervention or resulting in death as a direct result of AHT. Using our AHT database, we first reviewed the imaging reports of all children to identify those with a definite or suspected a CVA. The diagnosis of CVA or a stroke-like finding is well established on MRI as an area of brain parenchyma that is hyperintense on DWI and correspondingly hypointense on the ADC map. For those cases in which CT was the only imaging modality, a stroke was diagnosed as a hypodense region that was not considered to be

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Chirag G. Patil, Elisa F. Long, and Maarten G. Lansberg

E ndovascular mechanical thrombectomy for acute ischemic stroke is being increasingly performed by neurosurgeons and neurointerventionalists. Mechanical thrombectomy devices reopen large cerebral vessels and represent an alternative treatment to the standard medical therapy with antiplatelet agents in patients with large-vessel ischemic stroke who are not eligible for thrombolytic therapy, or in whom thrombolytic therapy has failed. The Merci retriever system (Concentric Medical) and more recently, the Penumbra system (Penumbra Inc.) have been granted 510

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Rohaid Ali, Ian D. Connolly, Amy Li, Omar A. Choudhri, Arjun V. Pendharkar, and Gary K. Steinberg

plans for a post-WWII planet. Within 20 years of this conference, all of these men had died. Source:,_Roosevelt,_Stalin)_(B%26W).jpg . Public domain. Within 20 years after this historic agreement, all 3 major participants had died of a stroke. 15 , 26 , 43 The first of these deadly strokes—that of Roosevelt—would prove to be among the most consequential in human history, as subsequent interactions between the succeeding Truman administration and Stalin's Soviet Union were

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Nickalus R. Khan, Kenneth Moore, Jaafar Basma, David S. Hersh, Asim F. Choudhri, Brandy Vaughn, and Paul Klimo Jr.

exclusive to adult patients. 1 , 3 , 4 , 11 , 22 A cerebrovascular accident (CVA), also referred to as an ischemic stroke, is a perioperative complication of particular interest. A stroke can cause neurological deficits, seizures, or medical complications, resulting in increased hospital length of stay, increased need for rehabilitative services, and overall higher healthcare costs. McCutcheon et al. identified a 30-day rate of 8.6% of “major neurologic complications” (defined in the adult NSQIP dataset as “coma or stroke”) after clipping of an unruptured aneurysm. 18

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Michael Karsy, Andrea Brock, Jian Guan, Phillip Taussky, M. Yashar S. Kalani, and Min S. Park

C erebrovascular ischemia, or stroke, affects up to 800,000 US individuals yearly and is a leading cause of disability, costing $34 billion per year in health care expenses, disability, and lost productivity. 109 Although there have been significant advances in intravenous tissue plasminogen activator (TPA) and mechanical thrombectomy approaches, there remains a significant need for additional neuroprotective and neuroregenerative therapies. 74 , 109 , 136 Neuroprotection involves strategies to interrupt the cascade of cell injury leading to infarction

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Mark N. Rubin and Bart M. Demaerschalk

C erebrovascular disease, including acute ischemic stroke, remains a major public health problem in the US 33 and throughout the world. 5 There has been a concerted effort to apply evidence-based practices to stroke care to improve primary and secondary prevention as well as poststroke outcomes. One facet of this effort includes the development and accreditation of acute stroke–ready hospitals, and primary and comprehensive stroke centers, which have been demonstrated to improve stroke care. 21 , 27 The prompt and guideline-based administration of an