Interesting analysis from Annals of Internal Medicine. The decision to start anticoagulation in atrial fibrillation, using CHADSVASC score is not so clear cut. See tables below.
Shah, S., Eckman, M., Aspberg, S., Go, A. and Singer, D. (2018). Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation. Annals of Internal Medicine.
5 Major Studies on Treatment of VA Stenosis:
- CAVATAS (1997) = Carotid and Vertebral Artery Transluminal Angioplasty Study
- SAMMPRIS (2011) = Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis
- VISSIT (2012) = Vitesse Intracranial Stent Study for Ischemic Therapy
- VAST (2013) = Vertebral Artery Stenting Trial
- VIST (2015) = Vertebral Artery Ischaemia Stenting Trial
*year = end of recruitment.
Key features of the trials comparing stenting with medical treatment which included vertebral stenosis
- DAPT x 90d
- BP reduction <140mm Hg
- Angio +/- stenting
- low perioperative complications with extracranial stenting
- higher risk of stroke with intracranial VA stenosis
- stenting = medical management for extracranial stenosis
- medical management better for intracranial stenosis
Powerpoint File for figure above
Drazyk, A. and Markus, H. (2017). Recent advances in the management of symptomatic vertebral artery stenosis. Current Opinion in Neurology, p.1.
Single Brain Metastases:
Multiple Brain Metastases:
SRS vs surgery:
Hatiboglu, M., Akdur, K. and Sawaya, R. (2018). Neurosurgical management of patients with brain metastasis. Neurosurgical Review.