Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Review Meta AnalysisCerebral microbleeds and the risk of intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: systematic review and meta-analysis.
Intracerebral haemorrhage (ICH) remains the most devastating yet unpredictable complication of intravenous thrombolysis for acute ischaemic stroke. We performed a systematic review and meta-analysis, to assess whether the presence of cerebral microbleeds (CMBs) on prethrombolysis MRI scans is associated with an increased risk of ICH. ⋯ The available evidence does not demonstrate a statistically significant increased risk of symptomatic ICH after thrombolysis for ischaemic stroke in patients with CMBs. However, in view of the methodological limitations of the studies included, the clinical relevance of any potential hazard associated with CMBs remains uncertain. Further studies are warranted to evaluate whether the risk of ICH might outweigh the benefit of thrombolysis, especially in patients with multiple lobar CMBs suggestive of cerebral amyloid angiopathy.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
ReviewStent usage in the treatment of intracranial aneurysms: past, present and future.
As endovascular approaches to intracranial aneurysm (IA) treatment continue to evolve, the use of intracranial stents has advanced from an infrequent adjunct to potential curative monotherapy. Early results of endovascular therapy for IAs have clearly underscored large aneurysm size, low coil packing density and wide aneurysm neck as factors limiting successful long term obliteration. ⋯ As evidence of their utility as flow diversion devices and as catalysts for aneurysm neck remodeling surfaced, their potential as standalone therapy was realised and is currently under close scrutiny. Here we review the evolution of stents in the treatment of IAs, from balloon expandable stents, to self-expanding stents, to the exciting advances in monotherapeutic flow diverting stents, amalgamating occlusion rates and reviewing complication rates.