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Ryu JC, Lee SH, Kwon B, Song Y, Lee DH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis. J Clin Neurosci 2024; 125:1-6. [PMID: 38728814 DOI: 10.1016/j.jocn.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Carotid artery stenting (CAS) has been the standard treatment for carotid stenosis because it is less invasive; however, the risk of periprocedural thromboembolism is high. We investigated the predictors for silent brain infarcts (SBIs), focusing on embolic protection in CAS. METHODS This study was single-center retrospective study, and we obtained baseline demographics and clinical, laboratory, and periprocedural variables of patients who underwent CAS. Also, methods used for embolic protection (no EPD, distal EPD, or proximal balloon guiding catheter) during CAS were obtained. Distal normal vessel diameter was defined as the diameter of cervical internal carotid artery where the artery wall becomes parallel. Diffusion-weighted imaging was performed before and after procedure to detect SBIs. The primary outcome was stented territory SBIs, and the secondary outcomes were any territories SBIs and stented territory SBIs in cases with EPD. RESULTS A total of 196 CAS procedures with mean age 69.1 ± 9.9 years were included. After CAS, stented territory SBIs occurred in 53 (27.0 %) cases and any territories SBIs in 60 (30.6 %) cases. Univariable analyses revealed that distal normal vessel diameter (odds ratio = 1.71, 95 % confidence interval = 1.20-2.43, P = 0.003) was associated with the occurrence of stented territory SBIs after CAS. After adjusting for potential variables, larger distal normal vessel diameter (1.61 [1.10-2.36], P = 0.014) increased the occurrence of SBIs after CAS. Consistent results were obtained when the outcome was any territories SBIs or stented territory SBIs in cases with EPD. CONCLUSIONS Distal normal vessel diameter was a predictor for the occurrence of SBI after CAS. The passable pore size of EPDs may vary depending on vessel diameter, and may impact the occurrence of SBIs.
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Affiliation(s)
- Jae-Chan Ryu
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Boseong Kwon
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yunsun Song
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Deok Hee Lee
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wha Kang
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun U Kwon
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Jun Young Chang
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Yamashita S, Kohta M, Hosoda K, Tanaka J, Matsuo K, Kimura H, Tanaka K, Fujita A, Sasayama T. Absence of the Anterior Communicating Artery on Selective MRA is Associated with New Ischemic Lesions on MRI after Carotid Revascularization. AJNR Am J Neuroradiol 2022; 43:1124-1130. [PMID: 35835591 PMCID: PMC9575412 DOI: 10.3174/ajnr.a7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE ICA-selective MRA using a pencil beam presaturation pulse can accurately visualize anterior communicating artery flow. We evaluated the impact of anterior communicating artery flow on the perioperative hemodynamic status and new ischemic lesions after carotid revascularization. MATERIALS AND METHODS Eighty-three patients with carotid artery stenosis were included. We assessed anterior communicating artery flow using ICA-selective MRA. The preoperative hemodynamic status was measured using SPECT. We also measured the change in regional cerebral oxygen saturation after temporary ICA occlusion. New ischemic lesions were evaluated by DWI on the day after treatment. RESULTS Anterior communicating artery flow was detected in 61 patients, but it was not detected in 22 patients. Preoperative cerebrovascular reactivity was significantly higher in patients with (versus without) anterior communicating artery flow with a mean peak systolic velocity of ≥200 cm/s (39.6% [SD, 23.8%] versus 25.2% [SD, 16.4%]; P = .030). The decrease in mean regional cerebral oxygen saturation was significantly greater in patients without (versus with) anterior communicating artery flow (8.5% [SD, 5.6%] versus 3.7% [SD, 3.8%]; P = .002). New ischemic lesions after the procedure were observed in 23 patients. The multivariate logistic regression analysis revealed that anterior communicating artery flow (OR, 0.07; 95% CI, 0.012-0.45; P = .005) was associated with new ischemic lesions. CONCLUSIONS The absence of anterior communicating artery flow influenced the perioperative hemodynamic status in patients with carotid stenosis and was associated with an increased incidence of new ischemic lesions after carotid revascularization.
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Affiliation(s)
- S Yamashita
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - M Kohta
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Hosoda
- Department of Neurosurgery (K.H.), Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - J Tanaka
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Matsuo
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Kimura
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Tanaka
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - A Fujita
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Sasayama
- From the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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Ger Akarsu F, Aykaç Ö, Özcan Özdemir A. Identifying 'fast progressors' likely to benefit from mechanical thrombectomy. J Clin Neurosci 2022; 103:4-8. [PMID: 35785615 DOI: 10.1016/j.jocn.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although the effect of mechanical thrombectomy in large vessel occlusions has been clearly demonstrated, there are different opinions about the treatment of patients with low ASPECT scores. We conducted this research to explore the utility of mechanical thrombectomy for the fast progressor patients. METHODS We evaluated 394 patients with large vessel occlusion (LVO) who applied to our center between 2012 and 2020 retrospectively. Patients with posterior system stroke and who admitted 6 h after the onset of symptoms, were not included in the study. The remaining 256 patients were divided into two groups as computed tomography angiography source image Alberta stroke program early computer tomography score (CTA-SI ASPECT) ≤ 6 and > 6. Modified rankin scale (mRS) 0-2 defined as good clinical outcome. Thrombolysis in cerebral infarction (TICI) score 2c-3 was accepted as successful recanalization. RESULTS The mean age of the patients in the fast-progressive group (23.4%; n = 60) was 66.3 ± 11.6 years, whereas the mean age of the CTA-SI ASPECTS > 6 group (76.6%; n = 196) was 62.4 ± 12.8 years (p = 0.034) A statistically significant difference was found between the groups regarding 90-day mRS (p < 0.001). Whereas 61.7% of the patients with a CTA-SI ASPECTS > 6 had a 90-day mRS 0-2, this rate was 28.3% for patients with a CTA-SI ASPECTS ≤ 6. CONCLUSION According to our study, approximately 1/3 of patients with ASPECTS ≤ 6 benefit from mechanical thrombectomy. In this patient group, age emerged as a determinant of good clinical outcome.
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Affiliation(s)
- Fatma Ger Akarsu
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey.
| | - Özlem Aykaç
- Department of Neurology, Eskisehir Osmangazi University, Eskişehir, Turkey
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Feng Y, Bai X, Zhang X, Wang T, Lu X, Yang K, Ling F, Ma Y, Jiao L. Risk factors for new ischemic cerebral lesions after carotid artery stenting: A systematic review and meta-analysis. Ann Vasc Surg 2021; 77:296-305. [PMID: 34437972 DOI: 10.1016/j.avsg.2021.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND New ischemic cerebral lesions (NICL) are commonly occur after carotid artery stenting (CAS) with an incidence rate ranging from 18-58% and are detected by diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI). Numerous studies have reported that NICL could increase the risk of future cerebrovascular events and cognitive impairment. This systematic review and meta-analysis aimed to identify risk factors for NICL after CAS. METHODS Relevant literature reporting risk factors for NICL after CAS were searched. Randomized controlled trials, case-control studies, or cohort studies were included in accordance with the pre-specified eligibility criteria. The risk of bias was assessed using the Cochrane Collaboration criteria and the quality of evidence was assessed with the corresponding scale. Data were analyzed using the RevMan V. 5.3 analysis software. RESULTS The final analyses included a total of 21 studies and 1907 participants, including 764 NICL-positives and 1143 NICL-negatives. Determinants for NICL-positivity were age (mean deviation (MD): 2.60; 95% confidence interval (CI): [1.53-3.68]), symptomatic carotid lesions (odds ratio (OR): 1.77; 95% CI: [1.39-2.25]) and smoking (OR: 0.74; 95% CI: [0.58-0.94]). For symptomatic patients, risk factors for NICL-positive included diabetes mellitus (OR: 1.76; 95% CI: [1.09-2.82]), but smoking (OR: 0.54; 95% CI: [0.31-0.93]) was a protective factor. Risk factors for centers with high NICL incidence were age (MD: 2.05; 95% CI: [0.93-3.17]) and symptomatic carotid lesions (OR: 1.77; 95% CI: [1.29-2.45]). CONCLUSIONS Older age and symptomatic carotid lesions are associated with an increased risk of post-CAS NICL whereas smoking is associated with a decreased risk. Risk factors for NICL in symptomatic patients is diabetes mellitus, while those for patients at centers with high incidence are age and symptomatic carotid lesions. Systematic review registration: CRD42019121129.
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Affiliation(s)
- Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China; Department of Interventional Neuroradiology, Capital Medical University, Beijing, China.
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Ito H, Uchida M, Takasuna H, Takumi I, Yuichiro T. Analysis of postprocedural microembolic infarctions and global oxygen extraction fraction during balloon-protected carotid artery stenting: Preliminary study. Surg Neurol Int 2021; 12:87. [PMID: 33767891 PMCID: PMC7982096 DOI: 10.25259/sni_919_2020] [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] [Received: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Atherosclerotic carotid stenosis with impaired cerebral perfusion is a risk factor for cerebral ischemia. In major carotid stenoocclusive diseases, increased oxygen extraction fraction (OEF) is associated with ischemic stroke. Balloon-protected carotid artery stenting (CAS) is valuable for high-grade carotid stenosis. However, while balloon-protected CAS can effectively reduce the occurrence of ischemic complications by blocking carotid flow, cerebral hypoperfusion may result in simultaneous cerebral ischemia. We sought to evaluate whether increased OEF during balloon-protected CAS can predict postprocedural microembolic infarction (MI). Methods: Eighty-four patients who underwent balloon-protected CAS were enrolled. Initial, intraprocedural, and postprocedural OEFs were calculated from the cerebral arteriovenous oxygen differences obtained from blood sampled just before the temporary occlusion and reperfusion of the internal carotid artery during and after the procedure. MIs were evaluated by diffusion-weighted imaging (DWI). Patients were classified into two groups based on the presence or absence of new MIs, and the relationship between the OEF and postprocedural MIs was analyzed. Results: New DWI-positive lesions were found in 37 cases (44.0%). Age, signal intensity ratio (SIR) of carotid plaque on T1-weighted black blood magnetic resonance imaging, and intraprocedural OEF were significantly higher in the DWI-positive group. The high SIR and intraprocedural OEF were significantly associated with the development of postprocedural MIs in multivariate analysis. MIs were correlated with the increase in OEF. Conclusion: Increased intraprocedural OEF, obtained by blood sampling during balloon-protected CAS, could predict the incidence of postprocedural MIs. Patients with carotid stenosis could be hemodynamically compromised by carotid flow blockage during balloon-protected CAS.
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Affiliation(s)
- Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Masashi Uchida
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Tanaka Yuichiro
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
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Age and the risk of new ischemic lesions on diffusion weighted imaging after carotid artery stenting: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 195:105881. [PMID: 32416326 DOI: 10.1016/j.clineuro.2020.105881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/21/2022]
Abstract
To perform a systematic review and meta-analysis to show the association between age and the risk of new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) after carotid artery stenting in patients with carotid artery stenosis. We searched PubMed and EMBASE from their dates of inception to March 14, 2019 for eligible studies. Standardized mean difference (SMD) and pooled odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the association between age and new DWI lesions. Sensitivity analysis was performed to detect the possible source of heterogeneity. Twenty-three studies enrolling 2127 patients were included. The incidence of new DWI lesions was 62% in older patients and 41% in younger patient (OR 2.44, 95%CI 1.57-3.79; p < 0.0001). The patients with new DWI lesions were older than those without (SMD 0.24, 95% CI 0.08-0.39; p = 0.003). The risk of new DWI lesions increased by 1.07 per added year (95%CI 1.04-1.11, p < 0.0001). The results remained stable in sensitivity analyses and after adjusting for publication bias. It was concluded that older age was at higher risk of new DWI lesions after stenting in patients with carotid artery stenosis.
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Xu X, Feng Y, Bai X, Ma Y, Wang Y, Chen Y, Yang B, Ling F, Zhang X, Jiao L. Risk factors for silent new ischemic cerebral lesions following carotid artery stenting. Neuroradiology 2020; 62:1177-1184. [DOI: 10.1007/s00234-020-02447-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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Feng Y, Li L, Bai X, Wang T, Chen Y, Zhang X, Ling F, Jiao L. Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e030025. [PMID: 31446417 PMCID: PMC6719763 DOI: 10.1136/bmjopen-2019-030025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION New ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS. METHODS AND ANALYSIS All relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case-control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2 statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION There is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42019121129.
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Affiliation(s)
- Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Rots ML, Meershoek AJ, Bonati LH, den Ruijter HM, de Borst GJ. Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 58:163-174. [DOI: 10.1016/j.ejvs.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 12/16/2022]
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Kim JG, Lee D, Choi JC, Song Y, Lee DH, Suh DC. DWI-pc-ASPECT score in basilar artery occlusion: is 6 points or less always indicative of a bad outcome? Interv Neuroradiol 2019; 25:371-379. [PMID: 30803336 DOI: 10.1177/1591019919827505] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging - posterior circulation-Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less. METHODS We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy. Clinical and imaging data on patients with DWI-pc-ASPECTS of 6 or less who underwent endovascular reperfusion therapy for acute basilar arterial occlusion were collected for this study. A good clinical outcome was defined as a modified Rankin scale of 2 or less at 90 days. RESULTS Forty-five acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less were included. Among them, 11 (24.4%) patients had a good clinical outcome at 90 days. Patients with a good clinical outcome had less severe neurological symptoms at presentation (National Institutes of Health Stroke Scale (NIHSS) 19.0 (12.0-25.0) vs. 8.0 (6.0-11.5); P = 0.003) and were younger (72.5 years (57.0-80.0 years) vs. 63.0 years (55.5-69.0 years), P = 0.096) than those with a poor clinical outcome. The symptomatic intracranial haemorrhage rate was significantly higher in the poor clinical outcome group (13 (38.2%)) than in the good clinical outcome group (0 (0.0%)) (P = 0.045). In particular, in patients aged over 70 years, a favourable outcome was low (18 (52.9%) vs. 1 (9.1%); P = 0.027) even after successful recanalisation. In a multivariate model, a low initial NIHSS score (odds ratio 1.21; 95% confidence interval 1.07-1.44; P = 0.0093) and age over 70 years (odds ratio 15.27; 95% confidence interval 1.85-379.79; P = 0.0321) were independent predictors of poor clinical outcome. CONCLUSIONS Even with DWI-pc-ASPECTS of 6 or less, good clinical outcome can be achieved after endovascular reperfusion therapy. Relatively mild initial symptoms and younger age can predict a better outcome in acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less.
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Affiliation(s)
- Joong-Goo Kim
- 1 Department of Neurology, Jeju National University, Jeju, Korea
| | - Dongwhane Lee
- 2 Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jay Chol Choi
- 1 Department of Neurology, Jeju National University, Jeju, Korea
| | - Yunsun Song
- 2 Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Hee Lee
- 2 Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Suh
- 2 Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Cullati S, Kliegel M, Widmer E. Development of reserves over the life course and onset of vulnerability in later life. Nat Hum Behav 2018; 2:551-558. [PMID: 31209322 DOI: 10.1038/s41562-018-0395-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 05/14/2018] [Accepted: 06/19/2018] [Indexed: 01/20/2023]
Abstract
This Review develops a theoretical framework for the development and onset of vulnerability in later life based on the concept of reserves. We stress the advantages of using the concept of reserves in interdisciplinary life-course studies, compared with related concepts such as resources and capital. We enrich the definition of vulnerability as a lack of reserves and a reduced capacity of an individual to restore reserves. Two dimensions of reserves, originating from lifespan psychology and gerontology, are of particular importance: their constitution and sustainability by behaviours and interaction with the environment (the 'use it or lose it' paradigm) and the presence of thresholds, below which functioning becomes highly challenging. This heuristic approach reveals the potential for a conceptualization of reserves and is exemplified in an empirical illustration. Further interdisciplinary research based on the concept is needed.
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Affiliation(s)
- Stéphane Cullati
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland. .,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland. .,Institute of Sociological Research, University of Geneva, Geneva, Switzerland.
| | - Matthias Kliegel
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Eric Widmer
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland.,Institute of Sociological Research, University of Geneva, Geneva, Switzerland
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Commentary on ‘Operative Factors Associated with the Development of New Brain Lesions During Awake Carotid Endarterectomy’. Eur J Vasc Endovasc Surg 2016; 51:174. [DOI: 10.1016/j.ejvs.2015.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 11/20/2022]
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To CY, Rajamand S, Mehra R, Falatko S, Badr Y, Richards B, Qahwash O, Fessler RD. Outcome of mechanical thrombectomy in the very elderly for the treatment of acute ischemic stroke: the real world experience. Acta Radiol Open 2015; 4:2058460115599423. [PMID: 26445678 PMCID: PMC4580118 DOI: 10.1177/2058460115599423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/15/2015] [Indexed: 01/19/2023] Open
Abstract
Background Although initial studies of neuroendovascular intervention did not review benefit over intravenous thrombolytics (iv r-tPA), recent studies have suggested otherwise. Elderly patients (age ≥80 years) are typically excluded from clinical trials. Purpose To examine the utility of mechanical thrombectomy based on patient outcomes. Material and Methods All stroke-alert activations at our health system from January 2011 to June 2014 were examined. All patients aged ≥80 years who had undergone mechanical thrombectomy were identified. Clinical characteristics included physiologic imaging findings, use of intravenous thrombolytics, baseline and postoperative National Institute of Health Stroke Scale (NIHSS), thrombolysis in cerebral infarction scores (TICI), and discharge destination. Results Mean NIHSS on presentation was 18.2 (range, 6–31), and 13.3 (range, 3–30) post thrombectomy. Three (16.6%) patients received iv r-tPA, two (11.1%) had symptomatic intracranial hemorrhage. Eight (44.4%) died, eight (44.4%) were discharged to nursing homes, and two (11.7%) were discharged to inpatient rehab and subsequently home. Favorable outcome was achieved in five (27.7%) patients. Fourteen (77.7%) patients had physiologic imaging prior to intervention. Three (75%) of four patients who did not have physiologic imaging prior to thrombectomy died. Thirteen (66.6%) patients had TICI 3 recanalization. Conclusion Our study showed that although there remains a role of mechanical thrombectomy in the treatment of acute ischemic stroke in very elderly patients, it is associated with significant higher morbidity and mortality compared to younger patients, but should remain a very viable treatment option when quality of life is the most important consideration.
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Affiliation(s)
- Chiu Yuen To
- Providence Hospital and Medical Center, Southfield, MI, USA
| | - Sina Rajamand
- Providence Hospital and Medical Center, Southfield, MI, USA
| | - Ratnesh Mehra
- Providence Hospital and Medical Center, Southfield, MI, USA
| | | | - Yaser Badr
- Badr Medical Corperation, Los Angeles, CA, USA
| | - Boyd Richards
- Providence Hospital and Medical Center, Southfield, MI, USA
| | - Omar Qahwash
- St. John Hospital and Medical Center, Detroit, MI, USA
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14
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Liu M, Zhou L. Cerebrovascular reserve may be a more accurate predictor of stroke than degree of ICA or MCA stenosis. Med Sci Monit 2014; 20:2082-7. [PMID: 25351338 PMCID: PMC4222448 DOI: 10.12659/msm.892377] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background It is currently unclear whether the degree of stenosis or the cerebrovascular reserve (CVR) is a better predictor of ischemic stroke. Material/Methods In this study, CVR was measured by perfusion computed tomography with inhalation of 5% CO2 in 37 symptomatic patients with internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis or occlusion. Patients were divided into groups according to the degree of stenosis: ≥70% stenosis (stenosis group 1) or <70% stenosis (stenosis group 2); and according to CVR: ≥10% CVR (CVR group 1) or <10% CVR (CVR group 2). All patients were given medical treatment. Results During a mean follow-up period of 56.9 months (range 24–73 months), recurrent ipsilateral ischemic stroke occurred in 7 patients. Ischemic stroke occurred in 0 of 19 patients in CVR group 1 (annual risk 0%), 7 of 18 patients in CVR group 2 (annual risk 7.7%), 3 of 18 patients in stenosis group 1 (annual risk 3.3%), and 4 of 19 patients in stenosis group 2 (annual risk 4.7%). Comparisons using Pearson’s chi-square test showed a significant difference in the rate of ischemic stroke between CVR group 1 and CVR group 2 (odds ratio 1.700; 95% confidence interval 1.142–2.530; P=0.003), but no significant difference between stenosis group 1 and stenosis group 2 (P=0.691). Conclusions Cerebrovascular reserve may be a more accurate predictor of stroke than degree of ICA or MCA stenosis.
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Affiliation(s)
- Mingyong Liu
- Department of Neurology, Capital Medical University Chaoyang Hospital, Beijing, China (mainland)
| | - Lichun Zhou
- Department of Neurology, Capital Medical University Chaoyang Hospital, Beijing, China (mainland)
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