1
|
Di Giorgio A, Mazzapicchi A, Rochira C, Azzarelli S, Scardaci F, Tomasello DS, Argentino V, Amico F. Successful Percutaneous Rescue Treatment of Acute Carotid Stent Thrombosis Utilizing a Modified Embolic Protection Device. Vasc Endovascular Surg 2024:15385744241290006. [PMID: 39361451 DOI: 10.1177/15385744241290006] [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: 10/05/2024]
Abstract
Acute Carotid Stent Thrombosis (ACST) is a rare complication of Carotid Artery Stenting (CAS) with a potentially fatal outcome. We report a case of ACST occurring five minutes after the end of a successful CAS procedure that was promptly treated by carotid stent-in-stent implantation using a new percutaneous strategy based on the creation of a modified embolic protection device. Following the procedure, we did not observe brain lesions suggestive of acute cerebral ischemic events at the CT scan performed at 48 hours, as well as no neurological deficits in the following days.
Collapse
Affiliation(s)
- Alessandro Di Giorgio
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| | - Alessandro Mazzapicchi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "Sant'Orsola", University of Bologna, Bologna, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Salvatore Azzarelli
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| | - Francesco Scardaci
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| | - Davide Salvatore Tomasello
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| | - Vincenzo Argentino
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| | - Francesco Amico
- Division of Cardiology, Catheterization Laboratory and Cardiovascular Intensive Care Unit, Cannizzaro Hospital, Catania, Italy
| |
Collapse
|
2
|
Liu R, Gao M, Zhao X. Evaluation of collateral circulation in patients with internal carotid artery occlusion: A clinical and ultrasonographic multicenter study. Vasc Med 2024:1358863X241264759. [PMID: 39245861 DOI: 10.1177/1358863x241264759] [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: 09/10/2024]
Abstract
BACKGROUND Internal carotid artery (ICA) occlusion is the major cause of ischemic stroke. The effect of collateral vessels on cerebral hemodynamics in ICA occlusion remains unclear. This study investigated the correlation between collateral vessels and the peak systolic velocity of the middle cerebral artery (MCA) in patients with ICA occlusion. METHODS The relevant collateral vessels included the anterior communicating (ACoA), posterior communicating (PCoA), and internal-external carotid (IECCA) arteries, respectively. Patients with unilateral ICA occlusion (n = 251) underwent transcranial Doppler imaging to detect the peak systolic velocity (PSV) of the MCA and other intracranial arteries. The clinical symptoms were assessed using the National Institutes of Health Stroke Scale (NIHSS). RESULTS Patients with ACoA collaterals had significantly higher PSVMCA scores and significantly lower NIHSS scores than those without ACoA collaterals (p < 0.001). Patients without any notable collaterals and those with only IECCA had the lowest PSVMCA and highest NIHSS scores. The PSVMCA and NIHSS scores were negatively correlated (r = -0.566, p < 0.001). CONCLUSION Collateral circulation patency in unilateral ICA occlusion was closely associated with clinical symptoms, and patients with ACoA collaterals may have favorable outcomes. (ClinicalTrials.gov Identifier: NCT02397655).
Collapse
Affiliation(s)
- Ran Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Diagnostic Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Mingjie Gao
- Department of Ultrasound, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xinyu Zhao
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Diagnostic Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Kargiotis O, Psychogios K, Safouris A, Spiliopoulos S, Karapanayiotides T, Bakola E, Mantatzis M, Dardiotis E, Ellul J, Giannopoulos S, Magoufis G, Tsivgoulis G. Diagnosis and treatment of acute isolated proximal internal carotid artery occlusions: a narrative review. Ther Adv Neurol Disord 2022; 15:17562864221136335. [PMID: 36437850 PMCID: PMC9685148 DOI: 10.1177/17562864221136335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/16/2022] [Indexed: 07/27/2023] Open
Abstract
The clinical manifestations of proximal (extracranial) internal carotid artery occlusions (pICAOs) may range from asymptomatic to acute, large, and devastating ischemic strokes. The etiology and pathophysiology of the occlusion, intracranial collateral status and patient's premorbid status are among the factors determining the clinical presentation and outcome of pICAOs. Rapid and accurate diagnosis is crucial and may be assisted by the combination of carotid and transcranial duplex sonography, or a computed tomography/magnetic resonance angiography (CTA/MRA). It should be noted that with either imaging modalities, the discrimination of a pseudo-occlusion of the extracranial internal carotid artery (ICA) from a true pICAO may not be straightforward. In the absence of randomized data, the management of acute, symptomatic pICAOs remains individualized and relies largely on expert opinion. Administration of intravenous thrombolysis is reasonable and probably beneficial in the settings of acute ischemic stroke with early presentation. Unfortunately, rates of recanalization are rather low and acute interventional reperfusion therapies emerge as a potentially powerful therapeutic option for patients with persistent and severe symptoms. However, none of the pivotal clinical trials on mechanical thrombectomy for acute ischemic stroke randomized patients with isolated extracranial large vessel occlusions. On the contrary, several lines of evidence from non-randomized studies have shown that acute carotid endarterectomy, or endovascular thrombectomy/stenting of the ICA are feasible and safe, and pοtentially beneficial. The heterogeneity in the pathophysiology and clinical presentation of acute pICAOs renders patient selection for an acute interventional treatment a complicated decision-making process. The present narrative review will outline the pathophysiology, clinical presentation, diagnostic challenges, and possible treatment options for pICAOs.
Collapse
Affiliation(s)
| | | | - Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, Piraeus,
Greece
- Second Department of Neurology, National and
Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University
General Hospital, Athens, Greece
- Aktios Rehabilitation Center, Koropi,
Greece
| | - Stavros Spiliopoulos
- Second Department of Radiology, Interventional
Radiology Unit, ‘Attikon’ University General Hospital, Athens, Greece
| | - Theodore Karapanayiotides
- Second Department of Neurology, School of
Medicine, Faculty of Health Sciences, AHEPA University General Hospital,
Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and
Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University
General Hospital, Athens, Greece
| | - Michail Mantatzis
- Department of Radiology, Interventional
Neuroradiology Unit, AHEPA University General Hospital, Aristotle University
of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital
of Larissa, School of Medicine, University of Thessaly, Larissa,
Greece
| | - John Ellul
- Department of Neurology, University General
Hospital of Patras, Patras, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, National and
Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University
General Hospital, Athens, Greece
| | | | | |
Collapse
|
4
|
Wei W, Yi X, Ruan J, Duan X, Luo H, Lv Z. Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis. BMC Neurol 2019; 19:151. [PMID: 31277587 PMCID: PMC6612158 DOI: 10.1186/s12883-019-1380-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/26/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. METHODS One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. RESULTS On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. CONCLUSIONS Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.
Collapse
Affiliation(s)
- Wei Wei
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Jianghai Ruan
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Xiaodong Duan
- Department of Rehabilitation medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Hua Luo
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Zhiyu Lv
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| |
Collapse
|
5
|
Pelizzari L, Laganà MM, Jakimovski D, Bergsland N, Hagemeier J, Baselli G, Zivadinov R. Neck Vessel Cross-Sectional Area Measured with MRI: Scan-Rescan Reproducibility for Longitudinal Evaluations. J Neuroimaging 2017; 28:48-56. [PMID: 29205670 DOI: 10.1111/jon.12488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/19/2017] [Accepted: 11/07/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE The cross-sectional area (CSA) of common carotid arteries-internal carotid arteries (CCA-ICAs), vertebral arteries (VAs), and internal jugular veins (IJVs) is influenced by aging. However, the neck vessel CSA can be affected by other factors as well, including subject positioning, hydration, and respiration, especially in longitudinal studies. This study aimed to assess scan-rescan reproducibility of CCA-ICAs, VAs, and IJVs CSA measurements in order to evaluate their feasibility for longitudinal CSA assessments, and to apply the segmentation method on a longitudinal pilot dataset. METHODS Two set of 2-dimensional neck magnetic resonance angiography (MRA) images were acquired on a 3-T scanner from two separate datasets: 9 healthy individuals (HIs) were scanned 5 days apart (scan-rescan dataset) and 12 HIs were acquired 5 years apart (baseline-follow-up dataset). CCA-ICAs, VAs, and IJVs were segmented along the whole vessel length between C3 and C7 intervertebral spaces. Repeated measure analysis of covariance, adjusted for cervical level and sample, and Wilcoxon signed-rank sum test were used to assess the scan-rescan and baseline-follow-up CSA differences. Intraclass correlation coefficient (ICC) was also computed to evaluate scan-rescan reliability. RESULTS No significant CSA differences were found for the scan-rescan and baseline-follow-up CSA comparisons, using the whole vessel length or single cervical level measurements. ICC analysis showed good degree of scan-rescan reproducibility (considering whole vessel measures: ICC > .9, P-value < .001 for CCA-ICAs, ICC > .6, P-value < .001 for VAs, and ICC > .7, P-value < .001 for IJVs). CONCLUSIONS Scan-rescan reproducibility of CCA-ICAs, VAs, and IJVs CSA measurements is high, making longitudinal studies feasible.
Collapse
Affiliation(s)
- Laura Pelizzari
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Translational Imaging Center at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
| |
Collapse
|
6
|
Moulakakis KG, Kakisis J, Tsivgoulis G, Zymvragoudakis V, Spiliopoulos S, Lazaris A, Sfyroeras GS, Mylonas SN, Vasdekis SN, Geroulakos G, Brountzos EN. Acute Early Carotid Stent Thrombosis: A Case Series. Ann Vasc Surg 2017; 45:69-78. [PMID: 28483628 DOI: 10.1016/j.avsg.2017.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute early carotid stent thrombosis (AcuteCST) is a rare complication after carotid artery stenting (CAS). The purpose of this retrospective study was to investigate the incidence, causes, and optimal management of AcuteCST. METHODS Medical records of all patients undergoing CAS between 2008 and 2016 were retrospectively reviewed. The time of thrombosis, grade of stenosis, lesion side, preprocedural and postprocedural anticoagulants, causes, symptoms, treatment, recanalization, and outcome were reviewed. RESULTS Overall, 674 patients were treated with CAS. Four cases of AcuteCST were identified (0.59%). In the first patient, the stent thrombosis was attributed to dissection caused by filter deployment within a distal internal carotid artery with 360° coiling. Notably, in 3 of the 4 cases of thrombosis a second overlapping stent had been deployed. In total, 41 patients of the cohort under investigation underwent overlapping stent deployment. The use of a second overlapping stent as a bail-out procedure due to dissection or malposition or due to long lesions was correlated with increased rate of thrombosis (3/41 [7.3%] vs. 1/633 [0.002%]). In 2 patients, carotid stents were thrombosed within 2 hr of the procedure. Endovascular thrombus aspiration and subsequent eversion carotid endarterectomy with stent explantation in the first patient and intrathrombus urokinase administration with thromboaspiration and additional stent placement in the second patient were followed. In the other 2 patients having their carotid stents thrombosed 3 and 4 days after the procedure, treatment with low weight molecular heparin and antiplatelet regimens was followed. CONCLUSIONS The use of overlapping stents in the carotid artery is a predisposing factor for AcuteCST. Prognostic factors of this potentially devastating complication are the initial clinical presentation expressing the grade of ischemic brain damage, the accurate and timely recognition of the thrombosis, and the prompt restoration of oxygenated blood flow into the viable tissue at risk of infarction.
Collapse
Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - John Kakisis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasilis Zymvragoudakis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stavros Spiliopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Giorgos S Sfyroeras
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Spyridon N Mylonas
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Spyridon N Vasdekis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Elias N Brountzos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| |
Collapse
|
7
|
Nishijima Y, Akamatsu Y, Yang SY, Lee CC, Baran U, Song S, Wang RK, Tominaga T, Liu J. Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice. Stroke 2016; 47:3014-3021. [PMID: 27834741 DOI: 10.1161/strokeaha.116.014882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status, it is unclear whether and to what extent type 2 diabetes mellitus affects cerebral collateral flow regulation during hypoperfusion. METHODS We examined the spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal middle cerebral artery and anterior cerebral artery branches over 2 weeks after unilateral common carotid artery occlusion (CCAO) using optical coherent tomography in db/+ and db/db mice. We also assessed the temporal adaptation of the circle of Willis after CCAO by measuring circle of Willis vessel diameters. RESULTS After unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared with db/+ mice, which coincided with a reduced dilation of distal anterior cerebral artery branches, leading to reduced flow not only in pial vessels but also in penetrating arterioles bordering the distal middle cerebral artery and anterior cerebral artery. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the circle of Willis, in addition to a delayed post-CCAO adaptive response by 1 to 2 weeks, compared with db/+ mice. CONCLUSIONS Type 2 diabetes mellitus is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or transient ischemic attack.
Collapse
Affiliation(s)
- Yasuo Nishijima
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Yosuke Akamatsu
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Shih Yen Yang
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Chih Cheng Lee
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Utku Baran
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Shaozhen Song
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Ruikang K Wang
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Teiji Tominaga
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Jialing Liu
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.).
| |
Collapse
|
8
|
Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, Antonopoulos CN, Brountzos EN, Vasdekis SN. Acute Carotid Stent Thrombosis. Vasc Endovascular Surg 2016; 50:511-521. [DOI: 10.1177/1538574416665986] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute carotid stent thrombosis (ACST) is a rare complication that can lead to dramatic and catastrophic consequences. A rapid diagnosis and prompt recanalization of the internal carotid artery are needed to minimize the ischemic insult and the reperfusion injury. We reviewed the current literature on this devastating complication of CAS with the intention of investigating the potential causative factors and to define the appropriate management. According to our study discontinuation of antiplatelet therapy, resistance to antiplatelet agents and inherent or acquired thrombotic disorders are the main causes of thrombosis. Technical intraprocedural parameters such as dissection, atheroma prolapse, kinking of the distal part of internal carotid artery and embolic protection device occlusion can also result in early carotid stent thrombosis. Rapid reperfusion ensures an improved neurological outcome and a better prognosis in the short and long term. Thrombolysis, mechanical thrombectomy or thromboaspiration in combination with drug or thrombolytic therapy, surgical therapy and re-angioplasty are treatment options that have been used with encouraging results. In conclusion, optimal perioperative antiplatelet treatment as well as technical considerations regarding the carotid artery stenting plays a determinant role.
Collapse
Affiliation(s)
- Konstantinos G. Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Mylonas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Giorgos S. Sfyroeras
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Constantine N. Antonopoulos
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Elias N. Brountzos
- Department of Radiology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Vasdekis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| |
Collapse
|
9
|
Schneider J, Sick B, Luft AR, Wegener S. Ultrasound and Clinical Predictors of Recurrent Ischemia in Symptomatic Internal Carotid Artery Occlusion. Stroke 2015; 46:3274-6. [DOI: 10.1161/strokeaha.115.011269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Occlusion of the internal carotid artery puts patients at risk of recurrent ischemic events because of hemodynamic compromise. Our goal was to characterize clinical and duplex parameters indicating patients at risk of recurrent ischemia.
Methods—
We retrospectively identified patients with symptomatic internal carotid artery occlusion. Clinical characteristics and ultrasound parameters, including collateral networks, were analyzed. Predictors for recurrent ipsilateral ischemia were investigated by Cox regression analysis.
Results—
Of 68 patients, at least 1 recurrent ischemic event within the same vascular territory was observed in 14 patients (20.6%) within 2 to 92 days (median, 29.5 days). The median follow-up period was 6 months. Diabetes mellitus and previous transient ischemic attack were associated with recurrence, as was activation of the maximum number of collateral pathways on transcranial ultrasound (28.6% versus 5.6%;
P
=0.03). Furthermore, flow in the posterior cerebral arteries was higher in patients with recurrence in ipsilateral and contralateral posterior cerebral artery P2 segments (76 IQR 37.5 versus 59, IQR 22.5 cm/s and 68, IQR 35.6 versus 52, IQR 21 cm/s;
P
<0.01 and 0.02).
Conclusions—
Flow increases in both posterior cerebral artery P2 segments suggest intensified compensatory efforts when other collaterals are insufficient. Together with the presence of diabetes mellitus and a history of transient ischemic attack, this duplex parameter indicates that patients with internal carotid artery are at particular risk of recurrent ischemia.
Collapse
Affiliation(s)
- Juliane Schneider
- From the Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich and University of Zurich (J.S., A.R.L., S.W.) and Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention (B.S.), University of Zurich, Switzerland; and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Beate Sick
- From the Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich and University of Zurich (J.S., A.R.L., S.W.) and Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention (B.S.), University of Zurich, Switzerland; and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Andreas R. Luft
- From the Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich and University of Zurich (J.S., A.R.L., S.W.) and Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention (B.S.), University of Zurich, Switzerland; and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Susanne Wegener
- From the Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich and University of Zurich (J.S., A.R.L., S.W.) and Department of Biostatistics, Institute of Epidemiology, Biostatistics and Prevention (B.S.), University of Zurich, Switzerland; and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| |
Collapse
|