CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.
One way to classify acute ischemic stroke is by the anatomy of vessel occlusion. Initial randomized trials of endovascular thrombectomy focused on large-vessel occlusions.1-5 These proximal occlusions of the intracranial carotid artery or the stem of the middle cerebral artery (MCA) represent the most severe form of anterior...
A 65-year-old woman with cardiovascular risk factors presented with a 14-hour history of painless, worsening, blurry vision in the right eye (visual acuity, 20/400). Funduscopy showed diffuse retinal hemorrhages and venous dilatation.
Among patients with stroke due to medium-vessel occlusion, thrombectomy led to functional independence at 90 days (in 58.6% of patients, vs. 46.6% with medical management) but also to a higher risk of intracranial hemorrhage.
In the catheterization laboratory, the most consequential decisions are frequently not about whether to treat, but rather about how far to extend treatment. Nowhere is that tension more apparent than in high-risk percutaneous coronary intervention (PCI). In these cases, the margin between a good outcome and a catastrophic one is...