Ehtisham Mahmud, M.D., division chief of cardiovascular medicine, director of...
This channel includes news and new technology innovations for stroke. It includes both diagnosis and treatment of stroke, stroke imaging, pharmaceuticals and interventional stroke technologies. Stroke comes in two forms, which have different therapies.
1. Ischemic stoke is a blockage of an artery in the brain, preventing blood flow and is offen referred to as a "brain attack" because it is a similar casue as a heart attack. This type of stroke is often treated with anti-coagulants, including use of tissue plasminogen activator (tPA). Interventional mechanical thrombectomy can also be used to remove the clot.
2. Hemorrhagic stroke is caused when there is bleeding due to a ruptured blood vessel in the brain caused by a brain aneurysm burst or a weakened blood vessels. These strokes are less common, but exact diagnosis is important, because use of tPA in these patients can have catastrophic consequences. Treatments include interventional embolization and surgical clipping of target vessels.
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can potentiate all 3 sides of Virchow’s Triad of coagulopathy, including endothelial dysfunction, blood flow stasis and hypercoagulability. Angiotensin-converting enzyme-2 (ACE-2)–dependent viral entry and the virus-induced inflammatory response can lead to endothelial dysfunction. Additional figure included in the JACC article.
Thrombus formation in the aortic arch in a 46-year-old COVID patients in the ICU. Three trials are underway to find which anticoagulant strategy is best to treat moderate and critically ill patients where COVID-causes venous thrombo-embolism (VTE) is a major cause of complications. Image courtesy of Margarita Revzin et al.
An example of a body composition analysis of an abdominal CT slice with the subcutaneous fat in green, skeletal muscle red and visceral fat in yellow. This was automatically identified and analyzed via a deep learning algorithm to assess the risk for heart attack and stroke in more than 12,000 patients.
Medical imaging artificial intelligence (AI) vendor Avicenna.AI today announced its FDA-cleared CINA Head triage AI solution will be offered by cloud-based imaging platform Arterys. Supporting the treatment of stroke and neurovascular emergencies, CINA Head detects intracranial hemorrhages (ICHs) and large vessel occlusions (LVOs) from CT-scan imaging.
Examples of pulmonary embolism clots caused by COVID-19 seen on a chest CT. From the journal Radiology
A carotid artery atherosclerotic plaque blockage at the bifurcation seen here can cause strokes. The stenting these lesions is a less invasive way of treating than open vessel surgery. The SVS has issued guidelines to help guide credentialing for the carotid stent procedure. Image from Vital Images.
This is Figure 2 from the article in Radiology: Acute encephalopathy. A 60 year-old-man without history of seizures presenting with convulsion. (A-B) Multifocal areas of FLAIR hyperintensity in the right cerebellum (arrows in A), left anterior cingular cortex and superior frontal gyrus (arrows in B). (C-D) Restricted diffusion in the left anterior cingulate cortex, superior frontal and middle temporal gyrus (arrows in D) and right cerebellum (arrows in E), consistent with cerebellar diaschisis. F) No hemosiderin deposits in gradient echo sequences.