Long-term cardiac rhythm monitoring has become a central component of the diagnostic evaluation of patients with ischemic stroke in whom atrial fibrillation (AF) is suspected but not initially detected. Implantable loop recorders (ILRs) substantially increase AF detection compared with conventional short-term monitoring, particularly when surveillance is extended over months to years. However, increased detection has not consistently translated into fewer strokes, underscoring important limitations in current paradigms. Growing evidence supports atrial cardiopathy as the underlying substrate predisposing to thromboembolism, with AF representing a variable electrical manifestation rather than the primary disease itself. Electrocardiographic and echocardiographic markers of atrial cardiopathy, including abnormal P-wave indices, left atrial enlargement, and impaired atrial function, help identify patients most likely to benefit from prolonged monitoring. This review examines the role of ILRs in post-stroke patients through the lens of atrial cardiopathy, emphasizing biologic plausibility, patient selection, and disciplined interpretation of monitoring results to optimize clinical relevance and avoid uncritical escalation of therapy.
Chronic carotid occlusion (CCO) carries a significant risk of ischemic stroke, particularly in patients with impaired cerebrovascular reserve. Extracranial-intracranial (EC-IC) bypass emerged as a popular treatment strategy with high technical success rates. However, multiple large randomized trials, including the Carotid Occlusion Surgery Study (COSS), failed to demonstrate a statistically significant benefit, mainly due to perioperative stroke risk and limitations in patient selection. Surgical revascularization declined as a result. We aim through this review to re-examine the role of flow augmentation in CCO in light of modern advances in cerebral perfusion imaging. Contemporary modalities-including computed tomography perfusion and emerging magnetic resonance techniques-allow better identification of patients with hemodynamic compromise who may be at highest risk despite medical therapy. Future studies incorporating refined imaging criteria may better define the subset of patients most likely to benefit from selective revascularization.
Acute ischemic stroke remains a leading cause of death and disability; despite time-dependent reperfusion therapies, delays in recognition, imaging interpretation, triage, and specialist access still limit timely treatment. This narrative review outlines how artificial intelligence (AI) may reduce bottlenecks across the stroke pathway. Prehospital tools include dispatcher decision support, consumer wearables, mobile assessment apps, and portable diagnostics may improve early detection and destination selection. In-hospital, AI increasingly assists neuroimaging and workflow, including intracranial hemorrhage detection, automated ASPECTS scoring, large vessel occlusion identification, and perfusion-based estimation of tissue salvageability, often shortening notification and process times. We also discuss AI-enabled risk stratification, systems-of-care coordination, and emerging uses of generative AI for documentation and communication. Key limitations include domain shift, incomplete external validation, bias and equity risks, limited explainability, alert fatigue, integration challenges, and evolving regulatory accountability. Future priorities include multimodal models, prospective implementation-focused trials, and deployment-ready solutions for diverse real-world settings.
Cerebrovascular disease remains a leading cause of global mortality. While endovascular therapies like mechanical thrombectomy and aneurysm coiling have revolutionized management, manual techniques are limited by operator fatigue, tremor, and occupational radiation exposure. This review examines the current state of robotics in neuroendovascular surgery. FDA-approved systems demonstrate safety and technical feasibility, achieving high success rates (94-100%) in aneurysm coiling and carotid stenting while significantly reducing operator radiation exposure (60-80%). In ischemic stroke, preclinical and recent clinical milestones, including the first fully remote, in-human diagnostic angiogram and transcontinental thrombectomy simulations, validate the feasibility of long-distance tele-interventions. Robotics in cerebrovascular management is rapidly evolving from a novel adjunct to clinical reality. Although challenges regarding cost, haptic feedback, and training persist, next-generation platforms integrating artificial intelligence and magnetic navigation hold the potential to overcome these barriers, establishing remote telerobotic networks to expand access to time-critical stroke care.
Cerebral aneurysms represent a heterogeneous group of vascular lesions whose clinical behavior ranges from incidental, asymptomatic findings to catastrophic aneurysmal subarachnoid hemorrhage. Despite major advances in neuroimaging, microsurgical technique, and endovascular technology, the management of both ruptured and unruptured cerebral aneurysms remains complex and highly individualized. This review examines current concepts in aneurysm pathobiology, natural history, risk stratification, and contemporary treatment strategies, emphasizing durable clinical principles that transcend evolving technology. Particular attention is given to the balance between conservative surveillance and intervention in unruptured aneurysms, as well as the time-critical priorities, complications, and neurocritical care considerations in ruptured aneurysms. The relative roles of microsurgical and endovascular therapies are discussed through the lens of long-term durability, retreatment risk, and patientspecific anatomy. Ultimately, optimal outcomes depend less on any single technique than on disciplined clinical judgment, longitudinal thinking, and true interdisciplinary collaboration within experienced neurovascular centers.
As we pass the five-year mark since the COVID-19 pandemic hit, the prevalence of persistent (and often disabling) symptoms from the SARS-CoV-2 virus is estimated to be on par with the prevalence of heart disease. Yet, these Long COVID symptoms can masquerade as other conditions and/or normal aging, so it is believed that Long COVID is under-diagnosed and, as a result, under-treated. Although there is not yet a true cure for Long COVID, many patients benefit substantially from rehabilitation strategies, medications, and social support resources that are available in Missouri. The purpose of this article is to review the definition and epidemiology of Long COVID, provide practical guidance for Long COVID assessment and management especially in the primary care setting, and increase awareness of regional resources for people in Missouri who are living with Long COVID and for the clinicians who are caring for them.
