Muhammad A. Taqi

Endovascular therapy in the acute management of ischemic stroke has become more common with technologic advances, such as easier navigation into the intracranial circulation and improved treatment efficacy with the advent of revascularization devices. This select review outlines milestones in the application of endovascular therapy in acute ischemic stroke (AIS) and offers some insight into important factors influencing the future directions of endovascular AIS treatment. In particular, we discuss the evolution of endovascular devices for AIS and how ingenuity continues to offer novel treatments. With these advances, the future of endovascular AIS treatment is promising.

Background: The dissecting posterior cerebral artery (PCA) aneurysms are very rare. These aneurysms pose significant treatment challenge and need careful evaluation to formulate an optimal treatment plan in case of ruptured or un-ruptured presentations. Methods: Retrospective review of a prospectively collected data. Results: Seven patients with dissecting aneurysms of the PCA were identified. Six out of seven presented with subarachnoid hemorrhage (SAH) and one with ischemic stroke. Three out of seven were treated with endovascular coil embolization without sacrifice of the parent artery and the rest had parent artery occlusion (PAO) with coil embolization. None of the patients developed new neurological deficits post-procedure. Aneurysm re-occurred in two patients that were treated without PAO. Conclusion: Endovascular treatment of the dissecting PCA aneurysm is safe and feasible. It can be performed with or without PAO. Recurrence is more common without PAO and close follow-up is warranted.

Stroke in crack–cocaine abusers is increasingly recognized. We aimed to identify significant differences in stroke risk factors, characteristics, and outcomes between hospitalized stroke patients with and without crack–cocaine abuse. This was a retrospective study that compared stroke patients with crack–cocaine abuse (cases) to stroke patients without crack–cocaine (controls). We identified 93 crack–cocaine cases and 93 controls admitted between January 2004 and May 2006 to one teaching hospital. There were significant differences between crack–cocaine cases and controls in age (48.7 years vs. 55 years) (P = 0.0001), male gender (65.6% vs. 40.9%) (odds ratios, OR = 1.64, 95% CI 1.22–2.21), arterial hypertension (61.1% vs. 83.9%) (OR = 0.30, 95% CI 0.15–0.60), hypercholesterolemia (18.7% vs. 68.5%) (OR = 0.10, 95% CI 0.05–0.21), diabetes (20.9% vs. 41.9%) (OR = 0.36, 95% CI 0.19–0.70), cigarette smoking (70.6% vs. 29%) (OR = 5.86, 95% CI 3.07–11.20), ischemic stroke (61.3% vs. 79.6%) (OR = 0.40, 95% CI 0.21–0.78), and intracerebral hemorrhage (33.3% vs. 17.2%) (OR = 3.03, 95% CI 1.53–6.00). Also, there were significant differences in National Institutes of Health Stroke Scale scores (3.3 vs. 7) (P < 0.0001), and MRS scores (1.8 vs. 2.5) (P = 0.0022) at hospital discharge. Using univariable and multivariable logistic regression, we found that crack–cocaine abusers had 2.28 higher odds of having a favorable functional outcome (MRS score ≤ 2) at hospital discharge, after adjusting for stroke risk factors and characteristics. Our study suggests that crack–cocaine abusers with stroke had fewer traditional risk factors, and more favorable functional outcome as compared to non-crack–cocaine abusers.