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Kalmar PJ, Tarkanyi G, Nagy CB, Csecsei P, Lenzser G, Bosnyak E, Karadi ZN, Annus A, Szegedi I, Buki A, Szapary L. Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects. Life (Basel) 2021; 11:458. [PMID: 34065422 PMCID: PMC8160775 DOI: 10.3390/life11050458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15-20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management. METHODS We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients' data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes. RESULTS A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, p = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, p < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, p = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, p = 0.382) and 90-day mortality (23.5% vs. 13.8%, p = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, p = 0.043) in patients with ACS. In the overall population age (p = 0.013), atrial fibrillation (AF) (p = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline (p = 0.029), and successful recanalization (p = 0.023) were associated with favorable outcome. CONCLUSION Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.
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Affiliation(s)
- Peter Janos Kalmar
- Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary; (P.J.K.); (G.T.); (E.B.); (Z.N.K.)
| | - Gabor Tarkanyi
- Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary; (P.J.K.); (G.T.); (E.B.); (Z.N.K.)
| | - Csaba Balazs Nagy
- Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary; (C.B.N.); (P.C.); (G.L.); (A.B.)
| | - Peter Csecsei
- Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary; (C.B.N.); (P.C.); (G.L.); (A.B.)
| | - Gabor Lenzser
- Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary; (C.B.N.); (P.C.); (G.L.); (A.B.)
| | - Edit Bosnyak
- Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary; (P.J.K.); (G.T.); (E.B.); (Z.N.K.)
| | - Zsofia Nozomi Karadi
- Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary; (P.J.K.); (G.T.); (E.B.); (Z.N.K.)
| | - Adam Annus
- Department of Neurology, University of Szeged, 6725 Szeged, Hungary;
| | - Istvan Szegedi
- Department of Neurology, University of Debrecen, 4032 Debrecen, Hungary;
| | - Andras Buki
- Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary; (C.B.N.); (P.C.); (G.L.); (A.B.)
| | - Laszlo Szapary
- Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary; (P.J.K.); (G.T.); (E.B.); (Z.N.K.)
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Papanagiotou P, Haussen DC, Turjman F, Labreuche J, Piotin M, Kastrup A, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Nogueira RG, Boutchakova M, Siddiqui A, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Spiotta A, Labeyrie MA, Biondi A, Mazighi M, Richard S, Anxionnat R, Bracard S, Gory B, Grossberg JA, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada MM, Consoli A, Rodesch G, Houdart E, Turner R, Turk A, Chaudry I, Labeyrie PE, Riva R, Lockau J, Blanc R, Redjem H, Behme D, Shallwani H, Christopher M, Derelle AL, Tonnelet R, Liao L, Amaz C. Carotid Stenting With Antithrombotic Agents and Intracranial Thrombectomy Leads to the Highest Recanalization Rate in Patients With Acute Stroke With Tandem Lesions. JACC Cardiovasc Interv 2018; 11:1290-1299. [DOI: 10.1016/j.jcin.2018.05.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
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The Role of Circular RNAs in Cerebral Ischemic Diseases: Ischemic Stroke and Cerebral Ischemia/Reperfusion Injury. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1087:309-325. [PMID: 30259377 DOI: 10.1007/978-981-13-1426-1_25] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cerebral ischemic diseases including ischemic stroke and cerebral ischemia reperfusion injury can result in serious dysfunction of the brain, which leads to extremely high mortality and disability. There are no effective therapeutics for cerebral ischemic diseases to date. Circular RNAs are a kind of newly investigated noncoding RNAs. It is reported that circular RNAs are enriched in multiple organs, especially abundant in the brain, which indicates that circular RNAs may be involved in cerebral physiological and pathological processes. In this chapter, we will firstly review the pathophysiology, underlying mechanisms, and current treatments of cerebral ischemic diseases including ischemic stroke and cerebral ischemia/reperfusion injury. Secondly, the characteristics and function of circular RNAs will be outlined, and then we are going to introduce the roles circular RNAs play in human diseases. Finally, we will summarize the function of circular RNAs in cerebral ischemic diseases.
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Kalçık M, Yesin M, Bayam E, Gürsoy MO, Güner A, Gündüz S, Özkan M. Management of an acute ischemic stroke during thrombolytic treatment in a pregnant patient with prosthetic valve thrombosis. Interv Med Appl Sci 2017; 9:150-153. [PMID: 29201439 PMCID: PMC5700703 DOI: 10.1556/1646.9.2017.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Prosthetic valve thrombosis (PVT) is a life-threatening complication in pregnant women with mechanical prosthetic heart valves. Thrombolytic therapy (TT) has evolved as an effective treatment alternative to surgery, which is associated with very high maternal and fetal mortality and morbidity in these patients. Acute ischemic stroke may rarely occur during TT for PVT. Here, we present a pregnant patient who was complicated with cerebral thromboembolism during TT for PVT and successfully managed with continuation of TT.
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Affiliation(s)
- Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Emrah Bayam
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | | | - Ahmet Güner
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.,Division of Health Sciences, Ardahan University, Ardahan, Turkey
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Sharma AB, Lule EB, Razak A, Hussain SI, Sharma S, Deeprasertkul P, Thakur RK. Neurointerventional Therapies for Stroke in Atrial Fibrillation: Illustrated Cases. Card Electrophysiol Clin 2014; 6:169-180. [PMID: 27063831 DOI: 10.1016/j.ccep.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Approximately 800,000 strokes occur in the United States every year, resulting in 200,000 deaths. Strokes may be ischemic (80%) or hemorrhagic (20%). Strokes caused by atrial fibrillation (AF) are thromboembolic, and AF is the leading cause of ischemic stroke. Rapid distinction between these forms of strokes is critical because approaches to treatment are different. The goal for acute ischemic stroke is reperfusion of ischemic brain tissue, whereas the treatment of hemorrhagic stroke is supportive therapy and correction of the underlying conditions. The treatment of acute ischemic strokes is similar to treatment of acute myocardial infarction, which requires timely reperfusion for optimal results.
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Affiliation(s)
- Amit B Sharma
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Enoch B Lule
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Anmar Razak
- Department of Neurology and Ophthalmology, Michigan State University, Lansing, MI, USA
| | - Syed I Hussain
- Department of Neurology and Ophthalmology, Michigan State University, Lansing, MI, USA
| | - Shalini Sharma
- Department of Radiology, Michigan State University, Lansing, MI, USA
| | - Peerawut Deeprasertkul
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA.
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Cloft H. Editorial: Workforce needs for endovascular acute ischemic stroke therapy: myth or reality? Neurosurg Focus 2014; 36:E8. [DOI: 10.3171/2013.9.focus13372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The acute ischemic strokes amenable to intraarterial therapy probably number no more than 20,000 per year in the United States. The future demand for intraarterial reperfusion techniques may change, but the fraction of patients who require intraarterial thrombolysis is currently rather low, and the number of neurointerventionists is adequate. Each hospital caring for patients with acute stroke will need to determine its own demand for intraarterial therapy and employ an adequate supply of qualified neurointerventionists available to meet demand. Comprehensive stroke centers are now being designated and hopefully will foster a rational, regionalized approach to the delivery of endovascular therapies for stroke.
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Widimsky P, Coram R, Abou-Chebl A. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences. Eur Heart J 2013; 35:147-55. [PMID: 24096325 PMCID: PMC3890694 DOI: 10.1093/eurheartj/eht409] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis-but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, starting acute stroke interventional programme requires a lot of learning, discipline, and humility. Randomized trials comparing different reperfusion strategies provided similar results in acute ischaemic stroke as in STEMI. Thus, it might be expected that also a future randomized trial comparing direct (primary) catheter-based thrombectomy vs. i.v. thrombolysis could show superiority of the mechanical intervention if it would be initiated without delay. Such randomized trial is needed to define the role of mechanical intervention alone in acute stroke treatment.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague, Ruska 87, 100 00 Prague 10, Czech Republic
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Widimský P, Kožnar B, Vaško P, Peisker T, Štětkářová I. Acute myocardial infarction and acute stroke: what are the differences? Focus on reperfusion therapy. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Roth C, Reith W, Walter S, Behnke S, Kettner M, Viera J, Yilmaz U, Alexandrou M, Politi M, Kostopoulos P, Körner H, Krick C, Haass A, Fassbender K, Papanagiotou P. Mechanical recanalization with flow restoration in acute ischemic stroke: the ReFlow (mechanical recanalization with flow restoration in acute ischemic stroke) study. JACC Cardiovasc Interv 2013; 6:386-91. [PMID: 23523460 DOI: 10.1016/j.jcin.2012.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/09/2012] [Accepted: 11/21/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to assess the feasibility and safety of a recently described technique of mechanical recanalization with the help of a stent-like device. BACKGROUND In the special group of acute stroke patients with an intracranial large vessel occlusion, intravenous tissue-type plasminogen activator on its own leads to a good clinical outcome (mRS ≤ 2) in only 15% to 25% of cases. The aforementioned technique of mechanical recanalization showed very promising clinical results. METHODS Forty patients presenting within 6 h from stroke symptom onset were enrolled. Mechanical recanalization was performed using a Solitaire FR revascularization device. The primary endpoint of the study was the clinical outcome rated with the help of the modified Rankin Scale (mRS) after 90 days. RESULTS Twenty-four patients (60%) showed a good clinical outcome (mRS ≤ 2) at 90 days. One symptomatic hemorrhage was detected on follow-up computed tomography. The death rate was 12.5% (5 patients). Successful recanalization (Thrombolysis In Cerebral Infarction score ≥ 2b) of the target vessel was achieved in 95% of the patients with a mean of 1.8 runs with the device. CONCLUSIONS The ReFlow (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke) study shows that mechanical recanalization with flow restoration is highly effective in stroke patients with a large intracranial vessel occlusion presenting within 4.5 h after symptom onset. (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke [ReFlow]; NCT01210729).
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Affiliation(s)
- Christian Roth
- Clinic for Diagnostic and Interventional Neuroradiology, Saarland University Hospital, Homburg, Germany
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A simple risk score for early ischemic stroke mortality derived from National Institutes of Health Stroke Scale: a discriminant analysis. Clin Neurol Neurosurg 2012; 115:1036-9. [PMID: 23219218 DOI: 10.1016/j.clineuro.2012.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 08/27/2012] [Accepted: 10/28/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the current study was to design a new simpler form of National Institutes of Health Stroke Scale (NIHSS) for use in emergency settings, and compare its predictive ability with original NIHSS score for mortality. METHODS A total of 152 consecutive patients with first ever ischemic stroke admitted to a university affiliated hospital were recruited. NIHSS score on admission was estimated and the predictive ability of NIHSS items for mortality at 28 days was evaluated by logistic regression. Stepwise discriminant analysis was performed on NIHSS items to obtain a discriminant function with the best discriminative ability for mortality. Further, receiver operating characteristics (ROC) curves were depicted to compare the new determined discriminant function with the original NIHSS score. RESULTS Cumulative rate of mortality was 11.8% for 28-day follow-up period. Among NIHSS items, scores of visual field, limb ataxia and extinction neglect were not associated with mortality (P>0.05). On the contrary, level of consciousness-commands, language and gaze were determined as independent indicators of mortality (P<0.05), and their coefficients on discriminant function were equal to 0.65, 0.44 and 0.30, respectively. In addition, area under the ROC curve of the calculated discriminant function was not statistically different from NIHSS score (P>0.05). CONCLUSIONS The suggested discriminant function, comprising NIHSS items of level of consciousness-commands, language and gaze, can predict 28-day mortality after ischemic stroke in a similar way to the original NIHSS score and can provide a baseline for stroke severity in emergency settings.
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Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices. Biomed Microdevices 2012; 14:511-32. [PMID: 22331446 DOI: 10.1007/s10544-011-9627-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiovascular diseases are the leading cause of death worldwide; they are mainly due to vascular obstructions which, in turn, are mainly caused by thrombi and atherosclerotic plaques. Although a variety of removal strategies has been developed for the considered obstructions, none of them is free from limitations and conclusive. The present paper analyzes the physical mechanisms underlying state-of-art removal strategies and classifies them into chemical, mechanical, laser and hybrid (namely chemo-mechanical and mechano-chemical) approaches, while also reviewing corresponding commercial/research tools/devices and procedures. Furthermore, challenges and opportunities for interventional micro/nanodevices are highlighted. In this spirit, the present review should support engineers, researchers active in the micro/nanotechnology field, as well as medical doctors in the development of innovative biomedical solutions for treating vascular obstructions. Data were collected by using the ISI Web of Knowledge portal, buyer's guides and FDA databases; devices not reported on scientific publications, as well as commercial devices no more for sale were discarded. Nearly 70% of the references were published since 2006, 55% since 2008; these percentages respectively raise to 85% and 65% as regards the section specifically reviewing state-of-art removal tools/devices and procedures.
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Abstract
The level of health care spending in the United States and other developed nations is rising at a disturbingly rapid rate. However, in the United States, these increases are not justified by superior performance. Rather, most other wealthy countries' inhabitants live longer and suffer from fewer medical problems than the average American. This paper demonstrates the continued abundance of opportunities for substantially reducing health care costs without decreasing the quality of care. In particular, it emphasizes the need to reduce the practice of defensive medicine and to enlarge the cadre of non-specialist physicians who educate future doctors. Such cost-saving opportunities are not rare phenomena but are widely available and offer the United States opportunities to move toward the markedly lower cost levels that have been achieved in other countries.
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Demaria AN, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall J, Hlatky M, Lew WYW, Lima JAC, Maisel AS, Narayan SM, Nissen S, Sahn DJ, Tsimikas S. Highlights of the Year in JACC 2011. J Am Coll Cardiol 2012; 59:503-37. [PMID: 22281255 DOI: 10.1016/j.jacc.2011.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony N Demaria
- University of California-San Diego, San Diego, California 92122, USA.
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