AANS Beyond 2021: Scientific Papers Collection-Clinical Trials update: Vascular

Video Transcription
Video Summary
Dr. Sepi Amin-Hanjani, a professor at the University of Illinois of Chicago, discusses recent advancements in vascular surgery in this video. The video covers various topics, including trials updates in the vascular arena, acute ischemic stroke, the use of neuroprotectants in thrombectomy patients, the need for bridging therapy in thrombectomy patients, mobile stroke units and their impact on outcomes, decompressive hemicraniectomy for large hemispheric stroke, carotid endarterectomy and carotid stenting for asymptomatic carotid disease, arteriovenous malformations (AVMs) intervention, dural AV fistula, and aneurysms and subarachnoid hemorrhage.<br /><br />Dr. Amin-Hanjani highlights the key findings from different trials, emphasizing the efficacy and benefits of certain treatments. For acute ischemic stroke, studies have shown the efficacy of mechanical thrombectomy for large vessel occlusion, even in delayed time windows. The use of neuroprotectants in thrombectomy patients may have a positive impact, particularly in patients who do not receive alteplase. Studies have also explored the necessity of bridging therapy in thrombectomy patients, with some showing non-inferiority of thrombectomy alone. Mobile stroke units have demonstrated improved outcomes and lower disability rates. Decompressive hemicraniectomy has shown decreased mortality and increased favorable outcomes, but outcomes differ with age and timing. The ACST2 study compares carotid endarterectomy and carotid stenting for asymptomatic carotid disease, suggesting both procedures are equivalent in terms of periprocedural outcomes. In vascular malformations, the ARUBA trial shows higher risks of morbidity with intervention, but its design has been criticized. The RESPECT-CVT trial found a low incidence of dural fistulas after treatment of cerebral venous thrombosis. In aneurysms and subarachnoid hemorrhage, studies have compared clipping and coiling for MCA aneurysms, showing similar clinical outcomes but better treatment efficacy with clipping. The ultra early trial did not find improvements in outcomes or reduced rehemorrhage rates with tranexamic acid administration after subarachnoid hemorrhage.<br /><br />Overall, the video provides a comprehensive overview of recent trials and advancements in vascular surgery, informing the audience about the latest developments and their impact on patient outcomes.
Keywords
vascular surgery
trials updates
acute ischemic stroke
neuroprotectants
thrombectomy patients
mobile stroke units