AANS Beyond 2021: Full Collection-Clinical Trials Update: Vascular

Video Transcription
Video Summary
In the video, Dr. Sepi Amin-Hanjani from the University of Illinois at Chicago discusses recent advances in vascular surgery. She focuses on trials updates in the vascular arena, specifically in acute ischemic stroke, vascular malformations, aneurysms, subarachnoid hemorrhage, and stroke prevention. <br />In acute ischemic stroke, Dr. Amin-Hanjani talks about the Aurora study, which shows that mechanical thrombectomy in the delayed time window of 6-24 hours after symptom onset improves outcomes. The ESCAPE-NA1 study explores the potential benefit of a neuroprotectant in combination with thrombectomy, showing that patients who did not receive alteplase had a higher odds of a better functional outcome. She also discusses several studies that examine the necessity of bridging therapy (thrombolysis) in patients undergoing mechanical thrombectomy, with data suggesting that bridging therapy may not be necessary.<br />Moving on to stroke prevention, the ACST2 study compares carotid endarterectomy and carotid stenting for asymptomatic carotid disease, finding that both procedures have a low risk of perioperative events and are fairly equivalent in terms of outcomes. In vascular malformations, Dr. Amin-Hanjani mentions the ARUBA trial, which concludes that intervention for arteriovenous malformations (AVMs) carries a higher risk of morbidity compared to medical treatment alone, though the validity of the trial is questioned. She also discusses a trial on dural arteriovenous fistulas, suggesting that routine follow-up after treatment of cerebral venous thrombosis may not be necessary due to the low incidence of developing dural fistulas.<br />In aneurysms and subarachnoid hemorrhage, Dr. Amin-Hanjani highlights a study that specifically focuses on middle cerebral artery (MCA) aneurysms, showing that both clipping and coiling have similar functional outcomes, but clipping leads to better occlusion of the aneurysm. Lastly, she mentions the ultra early trial, which explores the use of tranexamic acid to reduce re-bleeding after subarachnoid hemorrhage, but finds that it does not improve clinical outcomes or re-hemorrhage rates.<br />Overall, Dr. Amin-Hanjani provides a summary of recent trials in vascular surgery, highlighting important findings and conclusions in each area.
Keywords
vascular surgery
acute ischemic stroke
vascular malformations
aneurysms
subarachnoid hemorrhage
stroke prevention