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Chang X, Ruan X, Ding J, Ma P, Yang G, Zhang R, Li Y, Na K, Xu H, Mu L, Zhang X, Tang Z. The efficacy of STA-MCA double anastomosis comparing to single anastomosis in chronic internal carotid artery occlusion patients. Clin Neurol Neurosurg 2023; 233:107947. [PMID: 37611351 DOI: 10.1016/j.clineuro.2023.107947] [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: 07/09/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To investigate the efficacy of STA-MCA double-anastomosis and single-anastomosis in patients with cerebral hypoperfusion caused by chronic internal carotid artery occlusion(CICAO). METHODS In this retrospective study, data were collected from 19 patients with CICAO who underwent STA-MCA anastomosis at our hospital between January 2016 and January 2022, and they were divided into single anastomosis group and double anastomosis group according to the surgical method. The study collected general clinical data from both groups, including age, sex, lipid levels, blood pressure, glucose levels, smoking and alcohol consumption. Additionally, pre- and postoperative neurological function, cerebral hemodynamic parameters, and postoperative ischemic events were also recorded. By combining our study findings with the existing literature, a comparative analysis of the efficacy of single- and double-anastomosis in patients with CICAO was conducted. RESULTS Prior to surgical treatment,there were no statistically significant differences in cerebral hemodynamic parameters, including rob (0.65 ± 0.09 VS. 0.62 ± 0.04), rut (1.73 ± 0.40 VS. 1.99 ± 0.53), and rTMax (2.02 ± 0.49 VS. 1.72 ± 0.46), as well as neurofunctional scores, including modified Rankin Scale (MRS) (2.8 ± 1.03 VS. 2.4 ± 0.88) and National Institutes of Health Stroke Scale (NIHSS) (9.1 ± 5.08 VS. 8.3 ± 4.09) between the two groups. After operation, rCBF (single: 0.65 ± 0.09 VS.0.84 ± 0.08, p = 0.007; double: 0.62 ± 0.04 VS.1.08 ± 0.20, p = 0.001) were significantly increased in both groups, but the rMTT (1.99 ± 0.53 VS.1.27 ± 0.42, p = 0.0447) and rTMax (1.72 ± 0.46 VS.1.16 ± 0.16, p = 0.038) showed significant differences postoperatively only in the double-anastomosis group. The MRS (single: 1.8 ± 1.23, double: 1.7 ± 0.9) in both groups and the NIHSS (7.2 ± 5.11) in single-anastomosis group were not improved after surgery, while the NIHSS (8.3 ± 4.09 VS.4.4 ± 3.08, p = 0.037) in double-anastomosis group was improve significantly. In summary, the double-anastomosis group showed better improvement in rCBF and NIHSS scores compared to the single-anastomosis group.(ΔrCBF: 0.19±0.09 VS. 0.45±0.18, p=0.02, ΔNIHSS: 1.9±0.56 VS. 4±1.73, p=0.002). The cases were followed up for 20.3 ± 18.6 months, and there were no ischemic events in either group during the follow-up period. CONCLUSION STA-MCA revascularization can improve CBF in patients with hypoperfusion caused by CICAO, and prevent the reoccurrence of ischemic stroke effectively. Compared with single-anastomosis, double-anastomosis can provide more CBF and improve neurologic dysfunction.
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Affiliation(s)
- Xuying Chang
- Kunming Medical University, Kunming, Yunnan, China
| | | | - Jiangbo Ding
- Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People,s Hospital of Honghe Prefecture), Mengzi, Yunnan,China
| | - Peiyu Ma
- Department of surgery, The Second People's Hospita of Honghe Prefecture, Jianshui, Yunnan, China
| | - Guangwu Yang
- Kunming Medical University, Kunming, Yunnan, China
| | - Ruoyu Zhang
- Kunming Medical University, Kunming, Yunnan, China
| | - Yuhan Li
- Kunming Medical University, Kunming, Yunnan, China
| | - Kunpeng Na
- Kunming Medical University, Kunming, Yunnan, China
| | - Hang Xu
- Department of Pain,The First People's Hospital of Zhaotong, Zhaotong, Yunnan, China
| | - Linjie Mu
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xingkui Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhiwei Tang
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Ni H, Zhou C, Hang Y, Jia ZY, Cao YZ, Shi HB, Liu S, Zhao LB. Endovascular treatment for acute ischaemic stroke caused by isolated internal carotid artery occlusion: treatment strategies, outcomes, and prognostic factors. Clin Radiol 2023; 78:451-458. [PMID: 36932006 DOI: 10.1016/j.crad.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
AIM To describe the experience of endovascular treatment (EVT) of acute ischaemic stroke caused by isolated internal carotid artery (ICA) occlusion, with emphasis on treatment strategies, outcomes, and prognostic factors. MATERIALS AND METHODS A retrospective examination was performed of 66 consecutive patients with acute moderate-to-severe stroke who underwent EVT for isolated ICA occlusion from July 2016 to June 2021. The modified thrombolysis in cerebral ischaemia (mTICI) score was used to evaluate reperfusion outcomes. A multivariate analysis was performed to identify risk factors associated with poor 90-day outcome (modified Rankin Scale [mRS] 3-6). RESULTS The National Institutes of Health Stroke Scale (NIHSS) median score of the 66 patients at admission was 15. Twelve patients (18.2%) showed thrombus migration to the M1 segment or proximal M2 during EVT and underwent additional intracranial thrombectomy. Successful reperfusion (mTICI 2b-3) was achieved in 60 patients (90.9%) and complete reperfusion (mTICI 3) in 42 (63.6%). A poor functional outcome was seen in 27 patients (40.9%). The rate of 90-day mortality was 9.1% (6/66). Higher NIHSS scores and a lower Alberta Stroke Program Early CT Score (ASPECTS) were independently associated with poor outcomes. Complete reperfusion was the only treatment factor with a significant predictive value (adjusted odds ratio [OR] 0.03; 95% CI = 0.01 to 0.25; p=0.001). CONCLUSION Endovascular therapy is safe and effective in patients with acute ischaemic stroke due to isolated ICA occlusion. Prevention of thrombus migration and complete reperfusion should be the aim of EVT.
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Affiliation(s)
- H Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - C Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Y Hang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Z-Y Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Y-Z Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H-B Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - S Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - L-B Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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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.
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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
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Wu J, Fang C, Wei L, Liu Y, Xu H, Wang X, Yuan L, Wu X, Xu Y, Zhang A. Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment. Front Surg 2022; 9:971066. [PMID: 36425889 PMCID: PMC9679017 DOI: 10.3389/fsurg.2022.971066] [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: 06/16/2022] [Accepted: 10/18/2022] [Indexed: 10/11/2023] Open
Abstract
Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a devastating stroke or die. It is important to note that CICAO causes cerebrovascular accidents. Currently, the external carotid-internal carotid (EC-IC) bypass technique is used to treat CICAO. However, many clinical studies showed that EC-IC bypass was not beneficial for many patients with CICAO. Meanwhile, endovascular intervention treatment options for CICAO are evolving, and an increasing number of patients are undergoing endovascular intervention therapy. Accordingly, a review comparing both techniques is warranted. For this review, we searched PubMed and collected relevant case study reports comparing endovascular interventional therapy and internal and external cervical bypass surgeries to provide strategies for clinical treatment.
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Affiliation(s)
- Junnan Wu
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Chaoyou Fang
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingying Wei
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Yibo Liu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Houshi Xu
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Ling Yuan
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoya Wu
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Yuanzhi Xu
- Department of Neurosurgery, Huashan Hospital, School of Medicine, Fudan University, Shanghai, China
| | - Anke Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
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Deniz C, Altunan B, Aykaç Ö, Özdemir AÖ. Coexistence of external carotid artery embolus and internal carotid artery occlusion in acute ischemic stroke: An indicator of cardioembolic etiology? J Stroke Cerebrovasc Dis 2022; 31:106630. [PMID: 35816785 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106630] [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: 02/23/2022] [Revised: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aims to evaluate whether the presence of an external carotid artery embolism accompanying internal carotid artery occlusion may contribute to identifying the etiology of internal carotid artery occlusion in the early period. MATERIAL AND METHODS The presence of external carotid artery embolism was evaluated in 117 patients who were adjudicated for internal carotid artery occlusion based on digital subtraction angiography images. RESULTS Embolus in the external carotid artery was detected in 8 (6.8%) of the 117 patients with internal carotid artery occlusion (7 (87.5%) patients were found to have tandem and 1 (12.5%) patient had carotid T occlusion). In all of these patients, the thrombus was of embolic origin. Evaluation of the etiology revealed cardioembolic etiology in 4 patients and dissection in 1 patient, and the cause could not be determined in the remaining 3 patients. Patients with external carotid artery embolism accompanying an internal carotid artery occlusion had significantly higher The National Institutes of Health Stroke Scale scores at admission and significantly lower recanalization success compared to those without external carotid artery embolism (p = 0.009, p = 0.01). In the comparison of prognosis, poorer prognosis was observed in those with external carotid artery embolism, although without a statistically significant difference (p = 0.07). CONCLUSIONS This study observed that the etiology was mostly embolic in patients with external carotid artery embolism accompanying an internal carotid artery occlusion, most of whom were found to have tandem embolic occlusion, and cardiac origin appeared to be the prominent etiology of stroke.
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Affiliation(s)
- Cigdem Deniz
- Department of Neurology, Tekirdag Namik Kemal University, Namik Kemal Kampus Cad No:1, Tekirdag 59030, Turkey.
| | - Bengu Altunan
- Department of Neurology, Tekirdag Namik Kemal University, Namik Kemal Kampus Cad No:1, Tekirdag 59030, Turkey
| | - Özlem Aykaç
- Department of Neurology, Osmangazi University, Eskisehir, Turkey
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Tanaka E, Nagakane Y, Yamada T, Kishitani T. Early recurrence in patients with symptomatic, non-cardioembolic, internal carotid artery occlusion. J Stroke Cerebrovasc Dis 2022; 31:106571. [PMID: 35732086 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106571] [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: 10/26/2021] [Revised: 03/28/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There are limited data on the clinical course of patients with non-cardioembolic, mostly atherosclerotic, internal carotid artery occlusion (ICAO). The purpose of this study was to elucidate the frequency and underlying pathogenesis of early recurrent ischemic stroke in symptomatic non-cardioembolic ICAO. MATERIALS AND METHODS Consecutive patients with symptomatic non-cardioembolic ICAO were retrospectively reviewed. Those who had a tandem occlusion of the proximal middle cerebral artery (MCA) or underwent endovascular thrombectomy were excluded. Early recurrent stroke was defined as deterioration of the NIHSS score by ≥1 point with new lesions on magnetic resonance (MR) diffusion-weighted imaging (DWI) in the ipsilateral territory of the ICAO within 30 days of the index stroke onset. Patients were classified into two groups on carotid ultrasonography: cervical occlusion and intracranial occlusion. The presumed pathogenesis of recurrent stroke was categorized as embolic or hemodynamic according to the topographical features of subsequent lesions on DWI. RESULTS Of 36 consecutive medically treated patients with symptomatic non-cardioembolic ICAO without tandem MCA occlusion, 23 patients had cervical occlusion, and 13 had intracranial occlusion. Early recurrent stroke occurred in 16 patients (44.4%), which happened much more with intracranial occlusion than with cervical occlusion (69.2% vs 30.4%, p<0.02). Focusing on the presumed pathogenesis, hemodynamic was more common than embolic (68.8% vs 31.2%), especially with intracranial occlusion (77.8%). CONCLUSIONS Early recurrent stroke occurs at a high frequency in symptomatic non-cardioembolic ICAO, and intracranial occlusion may be a risk factor for early recurrent stroke. The pathogenesis of recurrence is more often hemodynamic than embolic.
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Affiliation(s)
- Eijirou Tanaka
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
| | | | - Takehiro Yamada
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Toru Kishitani
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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Ter Schiphorst A, Peres R, Dargazanli C, Blanc R, Gory B, Richard S, Marnat G, Sibon I, Guillon B, Bourcier R, Denier C, Spelle L, Labreuche J, Consoli A, Lapergue B, Costalat V, Obadia M, Arquizan C. Endovascular treatment of ischemic stroke due to isolated internal carotid artery occlusion: ETIS registry data analysis. J Neurol 2022; 269:4383-4395. [PMID: 35357557 DOI: 10.1007/s00415-022-11078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO. METHODS We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value). RESULTS Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead. CONCLUSION Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
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Affiliation(s)
- Adrien Ter Schiphorst
- Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Roxane Peres
- Department of Neurology, Fondation Rothschild Hospital, Paris, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - Benoit Guillon
- Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Christian Denier
- Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Julien Labreuche
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, 59000, Lille, France
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | | | - Vincent Costalat
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
| | - Michael Obadia
- Department of Neurology, Fondation Rothschild Hospital, Paris, France
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
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Yin H, Zhang J, Zhao W, Zheng M, Song Y, Sun L, Zhang J, Han J. Drug-Coated Balloon for the Treatment of Nonacute Symptomatic Intracranial Carotid Artery Terminus Occlusion: Initial Experience and Follow-Up Outcome. Front Neurol 2022; 13:840865. [PMID: 35222260 PMCID: PMC8879511 DOI: 10.3389/fneur.2022.840865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStudies on the recanalization for occlusion of the internal carotid artery terminus are scattered. Recently, drug-coated balloon (DCB) has been increasingly applied in the intracranial artery occlusion and achieved encouraging results. However, there seems no convincing data for the nonacute symptomatic internal carotid artery terminus occlusion (sICATO).ObjectiveTo assess the feasibility and effectiveness (safety) of DCB for patients with nonacute sICATO refractory to medical therapy.ApproachThis study included 30 patients with nonacute sICATO treated with DCBs and/or remedial stenting. The rate of successful recanalization, periprocedural complications, and clinical and vascular imaging follow-up outcomes were retrospectively analyzed.ResultsDrug-coated balloon (DCB) dilatation of nonacute sICATO gives a 100% rate of successful recanalization, with a low complication rate (10.00%), good clinical outcomes (86.20%), low restenosis/reocclusion rate (3.45%), and one asymptomatic ipsilateral infarction (3.45%).ConclusionDrug-coated balloon dilation seems to be the promising treatment option for nonacute sICATO considering its safety and feasibility.
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Yan C, Wang J, Guo R, Jin W, Zhao Y, Wang R. Vascular Diameters as Predictive Factors of Recanalization Surgery Outcomes in Internal Carotid Artery Occlusion. Front Neurol 2021; 12:632063. [PMID: 34552546 PMCID: PMC8451719 DOI: 10.3389/fneur.2021.632063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Revascularization surgery sometimes can achieve recanalization in patients with internal carotid artery occlusion (ICAO). High-resolution vessel wall magnetic resonance imaging (HRVWI) is a feasible technique to give detailed characteristics of the vessel wall, which may help to identify patients that carry higher success rates and more suitable for revascularization surgery. Objective: To examine the association between HRVWI characteristics of ICAO and the success rate of revascularization surgery in ICAO patients. Methods: We conducted a retrospective analysis of 31 ICAO recanalization patients enrolled from October 2017 to May 2019. The clinical data of patients and lesions were collected and analyzed. Results: A total of 31 ICAO patients were enrolled in this study. No significant differences were found between recanalization success and recanalization failure groups with regard to occlusion length, distal end of the occluded segment, and the treatment applied. The ipsilateral-to-contralateral diameter ratios (I/C ratios) of C1 or C2 and the diameter of C7 were positively related to recanalization success. A two-factor predictive model was constructed, and the I/C ratio of C2 < 0.86 and the diameter of C7 < 1.75mm were separately assigned 1 point. The ICAO patients who scored 0, 1, or 2 points had a risk of 5.6% (1/18), 55.6% (5/9), or 100% (4/4) to fail in the recanalization. Conclusions: The I/C ratios of C1 or C2 and the diameter of C7 are predictive factors of a revascularization surgery success in ICAO patients. A risk stratification model involving C2 and C7 was constructed for future clinical applications.
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Affiliation(s)
- Chengrui Yan
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Jiaru Wang
- Department of Radiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruohan Guo
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Weitao Jin
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Yang Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, China.,Department of Neurosurgery, Peking University International Hospital, Beijing, China
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Paraskevas KI. Carotid artery stenosis and stroke: controversies in prevention and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1200. [PMID: 34430641 PMCID: PMC8350638 DOI: 10.21037/atm-21-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
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Reale G, Giovannini S, Iacovelli C, Castiglia SF, Picerno P, Zauli A, Rabuffetti M, Ferrarin M, Maccauro G, Caliandro P. Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study. SENSORS 2021; 21:s21072479. [PMID: 33918503 PMCID: PMC8038235 DOI: 10.3390/s21072479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.
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Affiliation(s)
- Giuseppe Reale
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
- Unità Operativa Complessa Neuroriabilitazione ad Alta Intensità, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy
| | - Silvia Giovannini
- Unità Operativa Complessa Medicina Fisica e Riabilitazione, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy;
- Correspondence: ; Tel.: +39-0630-155-553
| | - Chiara Iacovelli
- Unità Operativa Complessa Medicina Fisica e Riabilitazione, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy;
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Viale XXIV Maggio, 7-04100 Latina, Italy;
| | - Pietro Picerno
- SMART Engineering Solutions & Technologies Research Center, Università Telematica “e-Campus”, Via Isimbardi, 10-22060 Novedrate, Italy;
| | - Aurelia Zauli
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66-20148 Milan, Italy; (M.R.); (M.F.)
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66-20148 Milan, Italy; (M.R.); (M.F.)
| | - Giulio Maccauro
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
| | - Pietro Caliandro
- Unità Operativa Neurologia, Largo A, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli, 8-00168 Rome, Italy;
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12
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Rava RA, Snyder KV, Mokin M, Waqas M, Zhang X, Podgorsak AR, Allman AB, Senko J, Shiraz Bhurwani MM, Hoi Y, Davies JM, Levy EI, Siddiqui AH, Ionita CN. Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID. J Neurointerv Surg 2021; 13:130-135. [PMID: 32457224 DOI: 10.1136/neurintsurg-2020-015966] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND CT perfusion (CTP) infarct and penumbra estimations determine the eligibility of patients with acute ischemic stroke (AIS) for endovascular intervention. This study aimed to determine volumetric and spatial agreement of predicted RAPID, Vitrea, and Sphere CTP infarct with follow-up fluid attenuation inversion recovery (FLAIR) MRI infarct. METHODS 108 consecutive patients with AIS and large vessel occlusion were included in the study between April 2019 and January 2020 . Patients were divided into two groups: endovascular intervention (n=58) and conservative treatment (n=50). Intervention patients were treated with mechanical thrombectomy and achieved successful reperfusion (Thrombolysis in Cerebral Infarction 2b/2 c/3) while patients in the conservative treatment group did not receive mechanical thrombectomy or intravenous thrombolysis. Intervention and conservative treatment patients were included to assess infarct and penumbra estimations, respectively. It was assumed that in all patients treated conservatively, penumbra converted to infarct. CTP infarct and penumbra volumes were segmented from RAPID, Vitrea, and Sphere to assess volumetric and spatial agreement with follow-up FLAIR MRI. RESULTS Mean infarct differences (95% CIs) between each CTP software and FLAIR MRI for each cohort were: intervention cohort: RAPID=9.0±7.7 mL, Sphere=-0.2±8.7 mL, Vitrea=-7.9±8.9 mL; conservative treatment cohort: RAPID=-31.9±21.6 mL, Sphere=-26.8±17.4 mL, Vitrea=-15.3±13.7 mL. Overlap and Dice coefficients for predicted infarct were (overlap, Dice): intervention cohort: RAPID=(0.57, 0.44), Sphere=(0.68, 0.60), Vitrea=(0.70, 0.60); conservative treatment cohort: RAPID=(0.71, 0.56), Sphere=(0.73, 0.60), Vitrea=(0.72, 0.64). CONCLUSIONS Sphere proved the most accurate in patients who had intervention infarct assessment as Vitrea and RAPID overestimated and underestimated infarct, respectively. Vitrea proved the most accurate in penumbra assessment for patients treated conservatively although all software overestimated penumbra.
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Affiliation(s)
- Ryan A Rava
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Xiaoliang Zhang
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
| | - Alexander R Podgorsak
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Medical Physics, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Ariana B Allman
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Jillian Senko
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Mohammad Mahdi Shiraz Bhurwani
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Yiemeng Hoi
- Canon Medical Systems USA Inc, Tustin, California, USA
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Biomedical Informatics, University at Buffalo,The State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Ciprian N Ionita
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Medical Physics, University at Buffalo - The State University of New York, Buffalo, New York, USA
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13
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Rava RA, Snyder KV, Mokin M, Waqas M, Podgorsak AR, Allman AB, Senko J, Bhurwani MMS, Hoi Y, Davies JM, Levy EI, Siddiqui AH, Ionita CN. Enhancing performance of a computed tomography perfusion software for improved prediction of final infarct volume in acute ischemic stroke patients. Neuroradiol J 2021; 34:222-237. [PMID: 33472519 DOI: 10.1177/1971400920988668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Computed tomography perfusion (CTP) is crucial for acute ischemic stroke (AIS) patient diagnosis. To improve infarct prediction, enhanced image processing and automated parameter selection have been implemented in Vital Images' new CTP+ software. We compared CTP+ with its previous version, commercially available software (RAPID and Sphere), and follow-up diffusion-weighted imaging (DWI). Data from 191 AIS patients between March 2019 and January 2020 was retrospectively collected and allocated into endovascular intervention (n = 81) and conservative treatment (n = 110) cohorts. Intervention patients were treated for large vessel occlusion, underwent mechanical thrombectomy, and achieved successful reperfusion of thrombolysis in cerebral infarction 2b/2c/3. Conservative treatment patients suffered large or small vessel occlusion and did not receive intravenous thrombolysis or mechanical thrombectomy. Infarct and penumbra were assessed using intervention and conservative treatment patients, respectively. Infarct and penumbra volumes were segmented from CTP+ and compared with 24-h DWI along with RAPID, Sphere, and Vitrea. Mean infarct differences (95% confidence intervals) and Spearman correlation coefficients (SCCs) between DWI and each CTP software product for intervention patients are: CTP+ = (5.8 ± 5.9 ml, 0.62), RAPID = (10.0 ± 5.2 ml, 0.73), Sphere = (3.0 ± 6.0 ml, 0.56), Vitrea = (7.2 ± 4.9 ml, 0.66). For conservative treatment patients, mean infarct differences and SCCs are: CTP+ = (-8.0 ± 5.4 ml, 0.64), RAPID = (-25.6 ± 11.5 ml, 0.60), Sphere = (-25.6 ± 8.0 ml, 0.66), Vitrea = (1.3 ± 4.0 ml, 0.72). CTP+ performed similarly to RAPID and Sphere in addition to its semi-automated predecessor, Vitrea, when assessing intervention patient infarct volumes. For conservative treatment patients, CTP+ outperformed RAPID and Sphere in assessing penumbra. Semi-automated Vitrea remains the most accurate in assessing penumbra, but CTP+ provides an improved workflow from its predecessor.
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Affiliation(s)
- Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Medical Physics, University at Buffalo, USA
| | - Ariana B Allman
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Jillian Senko
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | | | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA.,Department of Bioinformatics, University at Buffalo, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA.,Department of Medical Physics, University at Buffalo, USA
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Lall A, Yavagal DR, Bornak A. Chronic total occlusion and spontaneous recanalization of the internal carotid artery: Natural history and management strategy. Vascular 2020; 29:733-741. [PMID: 33297876 DOI: 10.1177/1708538120978043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Spontaneous recanalization of a chronic total occlusion of the extra-cranial internal carotid artery is an under-reported clinical entity. This paper reviews the different etiologies of internal carotid artery occlusion, its natural course, as well as the significance and our recommendations for the management of spontaneous internal carotid artery recanalization. METHODS A review of literature on etiology, diagnosis, and treatment of internal carotid artery occlusion and recanalization was conducted. PubMed database was searched using the terms "internal carotid occlusion" and "recanalization". Articles were reviewed and studies involving the management of internal carotid artery occlusion and spontaneous recanalization were included. We subsequently developed a management algorithm for chronic total occlusion of the internal carotid artery and spontaneous recanalization of such lesions based on the available evidence. RESULTS Common etiologies of chronic total occlusion of the internal carotid artery include carotid atherosclerotic disease, cardioembolic, and carotid dissection. Progression of an asymptomatic to symptomatic occlusion is estimated at 2-8% annually. Well-compensated patients can be asymptomatic. In others, clinical symptoms range from ipsilateral or global hypoperfusion to embolic stroke in some cases of spontaneous recanalization. Spontaneous recanalization occurs in 2.3-10.3% of patients but rarely results in a cerebrovascular event. CONCLUSIONS Progression of an asymptomatic chronic total occlusion of the internal carotid artery to symptomatic is infrequent. The management algorithm of chronic total occlusion of the internal carotid artery and spontaneous recanalization of the internal carotid artery must be tailored to the patient based on symptoms, etiology of the lesion, imaging findings, surgical risk, and reliability for follow-up.
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Affiliation(s)
- Alex Lall
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
| | | | - Arash Bornak
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
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15
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Zhou J, Cai SF, Yuan XS, Pang ZY, Yu BX, Yao H, Xu JJ, Pang YJ, Guo N, Liu XP. Remodeling of occluded internal carotid artery in vessel wall magnetic resonance imaging. Int J Neurosci 2020; 132:860-867. [PMID: 33153335 DOI: 10.1080/00207454.2020.1847105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the remodeling pattern of the extracranial occluded internal carotid artery (OICA) by vessel wall magnetic resonance imaging (VWI). METHODS Thirty-nine atherosclerotic OICAs from 32 consecutive cases underwent 3-Tesla VWI to acquire pre- and post-contrast T1-weighted two-dimensional fluid-attenuated inversion recovery fast spin echo sequences. 25 symptomatic CAs exhibited ipsilateral downstream cerebral ischemia or ophthalmic artery embolism within last three months. The 14 remaining CAs were asymptomatic. Twenty-four CAs from 22 patients with atherosclerosis but no stenosis were recruited as control group. The outer wall area (OWA) was calculated based on the outer contour of the carotid artery drawn on the pre-contrast VWI. Negative remodeling was defined as a lower OWA compared to that of control group. RESULTS Clinical characteristics including age, sex and vascular risk factors showed no significant difference between the occluded and control group. However, the OWA was lower in the occluded group than in the control group (0.63 versus 0.90 cm2, p = 0.004). For all OICAs, the OWA was larger in symptomatic cases than asymptomatic cases (0.71 versus 0.49cm2, p = 0.025). Using a cutoff value of 0.44, the sensitivity and specificity of OWA for detecting symptomatic OICA were 0.88 and 0.57, respectively. Heterogeneous signal intensity and enhancement were more often observed at the proximal than the distal segment of occlusion (p < 0.001). The inter-observer agreement regarding the evaluation of VWI characteristics was desirable (κ = 0.805 ∼ 0.847). CONCLUSIONS Negative remodeling is prevalent in OICA, especially in asymptomatic cases.
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Affiliation(s)
- Jun Zhou
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shi-Feng Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xian-Shun Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zai-Ying Pang
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bing-Xin Yu
- Department of Health Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Yao
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing-Jing Xu
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yue-Jiu Pang
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ning Guo
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xue-Ping Liu
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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16
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Mayer L, Grams A, Freyschlag CF, Gummerer M, Knoflach M. Management and prognosis of acute extracranial internal carotid artery occlusion. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1268. [PMID: 33178800 PMCID: PMC7607089 DOI: 10.21037/atm-20-3169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute occlusion of the internal carotid artery is the underlying etiology in 4 to 15% of all ischemic strokes. The clinical presentation varies considerably ranging from asymptomatic occlusion to severe ischemic strokes. Substantial differences in the acute management of acute symptomatic internal carotid artery occlusions (ICAO) exists between centers. Thusly, we comprised a narrative review of the natural course of acute ICAO and of available treatment options [i.v. thrombolysis, endovascular thrombectomy and stenting, bypass between the superficial temporal and the middle cerebral arteries (MCA) and carotid endarterectomy (CEA)]. We found that very few randomized treatment trials have been performed in patients acute symptomatic ICAO. Most evidence stems from case series and observational studies. Especially in older studies the intracranial vessel status has rarely been considered. After revision of these studies we concluded that the mainstay of the acute management of acute symptomatic ICAO is i.v. thrombolysis when applied within the label and in combination with mechanical thrombectomy in case of intracranial large vessel occlusion. In cases without intracranial large vessel occlusion mechanical thrombectomy of acute ICAO is associated with a risk of distal embolization. More research on prognostic parameters is needed to better characterize the risk of decompensation of collateral flow and to better define the time-window of intervention. When mechanical thrombectomy fails or is not available, surgical approaches are an alternative in selected patients.
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Affiliation(s)
- Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Maria Gummerer
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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17
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Symptomatic isolated internal carotid artery occlusion with initial medical management: a monocentric cohort. J Neurol 2020; 268:346-355. [PMID: 32809152 DOI: 10.1007/s00415-020-10118-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Symptomatic isolated carotid artery occlusions (ICAO) can lead to disability, recurrent stroke, and mortality, but natural history and best therapeutic management remain poorly known. The objective of this study was to describe our cohort of ICAO patients with an initial medical management. METHODS We conducted a retrospective study including consecutive patients admitted to our Comprehensive Stroke Center for ICAO within 24 h after stroke onset between January 2016 and September 2018. Patients with immediate endovascular therapy (EVT) were excluded. Medical treatment was based on anticoagulation (delayed by 24 h if intravenous thrombolysis was performed). 'Rescue' EVT was considered if first-week neurological deterioration (FWND) occurred. RESULTS Fifty-six patients were included, with a median National Institutes of Health Stroke Scale (NIHSS) of 3. Eleven patients (20%) had FWND during the first week, four benefited from rescue EVT. A mismatch volume > 40 cc on initial perfusion imaging and FLAIR vascular hyperintensities were associated with FWND (p = 0.007 and p = 0.009, respectively). Thirty-eight patients (69%) had a good outcome (modified Rankin Scale mRS 0-2) at 3 months, 36 (69%) had an excellent outcome (mRS 0-1). Seventeen patients (38%) had carotid patency on 3-month control imaging. Recurrences occurred in six (13%) of the survivors (mean follow-up: 13.6 months). CONCLUSION Our results suggest that the prognosis of patients with acute ICAO was favorable with a medical strategy, albeit a substantial rate of FWND and recurrence. FWND was well predicted by a core-perfusion mismatch volume > 40 cc. Randomized controlled trials are necessary to assess the benefit of EVT in ICAO.
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18
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Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery. Ann Thorac Surg 2020; 110:448-456. [DOI: 10.1016/j.athoracsur.2020.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 11/18/2022]
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19
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Amano Y, Sano H, Fujimoto A, Kenmochi H, Sato H, Akamine S. Cortical and Internal Watershed Infarcts Might Be Key Signs for Predicting Neurological Deterioration in Patients with Internal Carotid Artery Occlusion with Mild Symptoms. Cerebrovasc Dis Extra 2020; 10:76-83. [PMID: 32726784 PMCID: PMC7443627 DOI: 10.1159/000508090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Treatment for acute ischemic stroke due to large vessel occlusion (LVO) with mild symptoms is under discussion. Although most patients have good outcomes, some patients deteriorate and have unfavorable results. Imaging findings that predict the prognosis of LVO with mild symptoms are needed to identify patients who require treatment. In this study, we focused on watershed infarctions (WSIs), because this clinical phenomenon quite sensitively reflects changes in cerebral blood flow. The purpose of this study was to assess positive rates of WSI on MRI findings in patients with internal carotid artery (ICA) occlusion, and compare WSI-positive rates between patients divided according to their clinical course. Methods We retrospectively collected data of 1,531 patients who presented with acute ischemic stroke between June 2006 and July 2019. Among them, we chose symptomatic ICA occlusion patients with a past history of atrial fibrillation who were treated conservatively. We divided these patients into two groups, those with maintenance or improvement in their NIHSS score after hospitalization, and those whose NIHSS score worsened. We compared WSI-positive rates between these two groups. Results Thirty-seven of the 1,531 patients were included in this study. Of them, total NIHSS score was maintained or improved in 8 patients (group A), 3 of whom (37.5%) had internal watershed infarctions (IWIs). In group B, consisting of patients whose NIHSS score worsened by >2 at 7 days from symptom onset, 24 (82.8%) had IWIs. Group A thus had statistically lower IWI positivity rates than group B (p = 0.02). Three patients (37.5%) in group A had cortical watershed infarctions (CWIs), while 27 patients in group B (93.1%) had CWIs. Group A thus had a significantly lower CWI positivity rate than group B (p = 0.002). Conclusion In patients with mildly symptomatic ICA occlusion, CWIs and IWIs might be key signs for predicting neurological deterioration after hospitalization.
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Affiliation(s)
- Yuki Amano
- Department of Neurosurgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroyasu Sano
- Department of Stroke Center, Seirei Mikatahara General Hospital, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hiroaki Kenmochi
- Department of Neurosurgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Haruhiko Sato
- Department of Neurosurgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Soichi Akamine
- Department of Stroke Center, Seirei Mikatahara General Hospital, Seirei Hamamatsu General Hospital, Hamamatsu, Japan,
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20
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Koge J, Matsumoto S, Nakahara I, Ishii A, Hatano T, Tanaka Y, Kondo D, Kira JI, Nagata I. Impact of thrombus migration on clinical outcomes in patients with internal carotid artery occlusions and patent middle cerebral artery. J Neurol Sci 2020; 412:116737. [PMID: 32087429 DOI: 10.1016/j.jns.2020.116737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patency of the middle cerebral artery (MCA) in acute ischemic stroke with internal carotid artery (ICA) occlusions is associated with less severe stroke and favorable outcomes. However, thrombus migration to distal intracranial vessels may lead to unfavorable outcomes. We investigated the influence of thrombus migration on clinical outcomes in patients with ICA occlusions and patent MCA. MATERIALS AND METHODS We retrospectively analyzed patients with acute ischemic stroke compromising ICA occlusions and patent MCA who were consecutively admitted to our hospital between January 2006 and March 2016. Thrombus migration was assessed (1) by analyzing the discrepancies in arterial occlusion sites between initial imaging and follow-up imaging and (2) by analyzing how occlusion sites changed during endovascular therapy. RESULTS Thirty-eight patients (mean age: 74.9 years; 23 men, 15 women, median National Institutes of Health Stroke Scale score = 7.5) with ICA occlusions and patent MCA were ultimately included. We identified 10 patients (26%) with thrombus migration (spontaneous: 3; during endovascular therapy: 7). Patients with thrombus migration had higher rates of unfavorable functional outcomes (modified Rankin Scale scores 3-6 at 90 days) than those without thrombus migration (90% vs. 39%, p < .01). Multivariate analysis showed that thrombus migration was independently related to unfavorable functional outcomes (odds ratio, 42.9; 95% confidence interval, 1.5-1211.0; p = .03). CONCLUSION Thrombus migration in cases of ICA occlusion with patent MCA is associated with poor prognosis. Careful monitoring is required under these conditions even if the initial clinical presentation is mild.
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Affiliation(s)
- Junpei Koge
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Hospital, Kyoto, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yujiro Tanaka
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Daisuke Kondo
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
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21
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Zhao J, Huangfu C, Chang Z, Grainger AT, Liu Z, Shi W. Atherogenesis in the Carotid Artery with and without Interrupted Blood Flow of Two Hyperlipidemic Mouse Strains. J Vasc Res 2019; 56:241-254. [PMID: 31536996 DOI: 10.1159/000502691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/13/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Atherosclerosis in the carotid arteries is a common cause of ischemic stroke. We examined atherogenesis in the left carotid artery with and without interrupted blood flow of C57BL/6 (B6) and C3H-Apoe-deficient (Apoe-/-) mouse strains. METHODS Blood flow was interrupted by ligating the common carotid artery near its bifurcation in one group of mice and another group was not interrupted. RESULTS Without interference with blood flow, C3H-Apoe-/- mice developed no atherosclerosis in the carotid artery, while B6-Apoe-/- mice formed advanced atherosclerotic lesions (98,019 ± 10,594 μm2/section) after 12 weeks of a Western diet. When blood flow was interrupted by ligating the common carotid artery near its bifurcation, C3H-Apoe-/- mice showed fatty streak lesions 2 weeks after ligation, and by 4 weeks fibrous lesions had formed, although they were smaller than in B6-Apoe-/- mice. Neutrophil adhesion to endothelium and infiltration in lesions was observed in ligated arteries of both strains. Treatment of B6-Apoe-/- mice with antibody against neutrophils had little effect on lesion size. CONCLUSIONS These findings demonstrate the dramatic influences of genetic backgrounds and blood flow on atherogenesis in the carotid artery of hyperlipidemic mice.
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Affiliation(s)
- Jian Zhao
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaoji Huangfu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA.,Center for Disease Control and Prevention, Western Theater Command, Lanzhou, China
| | - Zhihui Chang
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Andrew T Grainger
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia, USA
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weibin Shi
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA, .,Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia, USA,
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22
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Zhou Y, Xu C, Zhang R, Shi F, Liu C, Yan S, Ding X, Zhang M, Lou M. Longer Length of Delayed-Contrast Filling of Clot on 4-Dimensional Computed Tomographic Angiography Predicts Cardiogenic Embolism. Stroke 2019; 50:2568-2570. [PMID: 31327313 DOI: 10.1161/strokeaha.118.024411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and Purpose- We hypothesized the length of delayed-contrast filling sign (DCFS) of intraarterial clot, indicating contrast medium penetration into the thrombus, was associated with stroke etiology. Methods- We retrospectively included patients with large vessel occlusion in anterior circulation who underwent computed tomographic perfusion within 24 hours poststroke onset. We defined DCFS as contrast medium diffusion through the thrombi after the arterial peak phase on 4-dimensional computed tomographic angiography derived from computed tomographic perfusion. We measured the length of DCFS and investigated its value for predicting the stroke etiology. Results- Three hundred twenty-one patients were analyzed, and their stroke etiologies included cardiogenic embolism (CE, n=167), large artery atherosclerosis (n=64), other etiology group (n=4), and undetermined etiology (n=86). CE patients had longer length of DCFS than non-CE patients (2.3 versus 0.5 mm; P<0.001). The optimal cutoff value of DCFS length for predicting CE was 1.5 mm. The sensitivity, specificity, positive predictive value, and negative predictive value of a length of DCFS >1.5 mm for predicting CE were 83.2%, 70.8%, 75.5%, and 79.6%. Conclusions- Longer length of DCFS was associated with CE in patients with large vessel occlusion in anterior circulation, which may provide stroke etiology information.
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Affiliation(s)
- Ying Zhou
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Feina Shi
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chang Liu
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinfa Ding
- Department of Radiology (X.D., M.Z.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology (X.D., M.Z.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- From the Department of Neurology (Y.Z., C.X., R.Z., F.S., C.L., S.Y., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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23
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Stanescu I, Bulboaca A, Fodor D, Dogaru G. Functional outcome after symtomatic internal carotid artery occlusion. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Internal carotid artery occlusion accounts for 15-20% of ischemic strokes, caused by atherosclerosis or dissection. Clinical symptoms are variable, from asymptomatic cases to minor or severe strokes. Diagnosis in internal carotid artery (ICA) occlusion is based on imaging techniques. Prognosis after ICA occlusion depends on many factors: severity of neurologic deficit, spontaneous recanalization of the artery, and the occurrence of recurrent strokes. Patients with spontaneous recanalization of the occluded ICA tend to have a retained functional ability and favorable clinical outcomes. Medical treatment, recanalization techniques and intensive rehabilitation program are essential in improving functional outcome of patients with stroke produced by ICA occlusion. We present the case of a young patient diagnosed with ischemic stroke produced by internal carotid artery occlusion, with consecutive severe neurologic deficit, and an unfavorable functional outcome, as evaluated with the Modified Rankin Scale. Spontaneous recanalization of the occluded ICA was observed after 6 weeks, suggesting a carotid dissection. The patient was included in an intensive rehabilitation program, associated with best medical therapy, showing improvement of its functional status at 3 months follow up. Key words: ischemic stroke, carotid artery occlusion, carotid dissection, spontaneous recanalization, functional outcome,
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Affiliation(s)
- Ioana Stanescu
- ¹“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj- Napoca, Romania ²Rehabilitation Hospital Cluj-Napoca, Romania
| | | | - Dana Fodor
- ¹“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj- Napoca, Romania
| | - Gabriela Dogaru
- ¹“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj- Napoca, Romania ²Rehabilitation Hospital Cluj-Napoca, Romania
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24
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Kim YW, Kang DH, Kim YS, Hwang YH. Efficacy and Safety of Endovascular Treatment in Patients with Internal Carotid Artery Occlusion and Collateral Middle Cerebral Artery Flow. J Korean Neurosurg Soc 2019; 62:201-208. [PMID: 30840975 PMCID: PMC6411575 DOI: 10.3340/jkns.2018.0144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022] Open
Abstract
Objective In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT.
Methods The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient’s clinical status and results of TFCA.
Results Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group.
Conclusion In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.
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Affiliation(s)
- Yong-Won Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.,Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Hun Kang
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.,Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea.,Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.,Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.,Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Korea
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25
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Sheriff F, Hirsch J, Shelton K, D'Alessandro D, Stapleton C, Koch M, Rabinov J, Jassar A, Patel A, Leslie-Mazwi T. Large-vessel occlusion stroke after cardiothoracic surgery: Expanding time windows offer new salvage opportunities. J Thorac Cardiovasc Surg 2018; 158:186-196.e2. [PMID: 30685180 DOI: 10.1016/j.jtcvs.2018.11.106] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/09/2018] [Accepted: 11/25/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Ischemic stroke due to large-vessel occlusion (LVO) is a complication after cardiothoracic surgery (CTS). Recently published endovascular stroke trials have major implications for treating LVO strokes; we evaluated our experience in patients undergoing CTS. METHODS Our prospective institutional CTS database was reviewed between July 2013 and April 2018 for ischemic strokes. Patients with LVO were identified and their course and outcomes analyzed. RESULTS A total of 5947 patients were reviewed; 148 (2.48%) had a cerebrovascular complication; 92.5% were ischemic. Of these 10.9% had an LVO. Prolonged aortic crossclamp was associated with LVO (odds ratio, 1.012 for every minute of prolonged aortic crossclamp time; confidence interval, 1.001-1.023) and remained significant in patients with ejection fraction >45%; prolonged cardiac bypass time was only associated with LVO in patients with ejection fraction >45% (odds ratio, 1.012 for every minute of prolonged cardiac bypass time; confidence interval, 1.003-1.021). Patients fell into 2 categories: detection of neurologic deficit in the stable postoperative patient or detection of deficit on emergence from anesthesia. Seven patients met criteria for emergent revascularization, with median National Institutes of Health Stroke Scale score 15, and shorter times from last seen well to deficit detection compared with patients not meeting criteria (P = .032). Median National Institutes of Health Stroke Scale day 7 score improved to 5. There was a trend toward better modified Rankin Scale scores at 3 months in patients who underwent thrombectomy. CONCLUSIONS LVO complicates a small proportion of patients after CTS and may be more likely with prolonged aortic crossclamp and cardiac bypass times. Both early and late window endovascular stroke treatment has the potential to positively modify the complication profile of CTS. Greater awareness of this treatment option is needed.
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Affiliation(s)
- Faheem Sheriff
- Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, Mass
| | - Joshua Hirsch
- Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Kenneth Shelton
- Cardiac Critical Care, Department of Anesthesia, Massachusetts General Hospital, Boston, Mass
| | - David D'Alessandro
- Cardiothoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Chris Stapleton
- Neuroendovascular, Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew Koch
- Neuroendovascular, Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass
| | - James Rabinov
- Neuroendovascular, Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass
| | - Arminder Jassar
- Cardiothoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Aman Patel
- Neuroendovascular, Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass
| | - Thabele Leslie-Mazwi
- Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, Mass; Neuroendovascular, Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass.
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26
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Mulatti GC, Puech-Leão P, De Luccia N, da Silva ES. Characterization and Natural History of Patients with Internal Carotid Occlusion: A Comparative Study. Ann Vasc Surg 2018; 53:44-52. [PMID: 30053548 DOI: 10.1016/j.avsg.2018.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/24/2018] [Accepted: 04/26/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND To characterize patients with internal carotid occlusion (ICO) with respect to demographic data, associated diseases, medical management, and risk factors and to compare these patients with those with nonsignificant stenosis (NSS; less than 50% stenosis). Secondary end points were new neurologic events, progression of contralateral degree of stenosis, cardiovascular symptoms, and death during follow-up. METHODS Retrospective analysis was performed using data collected from clinical records and added to a prospective database. Missing data were obtained during phone interviews or requested medical appointments. RESULTS From 2005 to 2013, 213 patients with ICO and 172 with NSS were studied (medium follow-up 37.81 months). Among the patients with ICO, a greater proportion were men, had a history of smoking, and presented with peripheral arterial disease and a lower creatinine clearance compared with those with NSS (P < 0.05). At the time of diagnosis, 76.1% of the patients with ICO were symptomatic compared with 35.5% of those with NSS (P = 0.000001). The patients in the ICO group exhibited significant progression of contralateral stenosis compared with those in the control group with progression on any side (15.0% vs. 2.3%, P = 0.00011). In addition, 18 patients in the ICO group (8.5%) exhibited new neurological symptoms compared with 13 (7.6%) in the NSS group (P = 0.41). When the ICO and NSS groups were combined, 10.8% of the initially symptomatic patients presented with new symptoms compared with 4.3% of those who were initially asymptomatic (P = 0.0218). The number of deaths was significantly higher among the patients in the ICO group (14.1% vs. 6.4%, P = 0.0150). CONCLUSIONS Patients presenting with ICO have more risk factors and higher mortality by any cause. Initially, symptomatic patients will likely present with more neurological symptoms during follow-up, independent of carotid morphology, ICO, or NSS. Efforts must be made to identify those at risk before occlusion and to prevent secondary events and death.
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Affiliation(s)
- Grace Carvajal Mulatti
- Vascular and Endovascular Division, Surgery Department, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
| | - Pedro Puech-Leão
- Vascular and Endovascular Division, Surgery Department, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Nelson De Luccia
- Vascular and Endovascular Division, Surgery Department, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Erasmo S da Silva
- Vascular and Endovascular Division, Surgery Department, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
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27
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Li W, Chen Z, Dai Z, Liu R, Yin Q, Wang H, Hao Y, Han Y, Qiu Z, Xiong Y, Sun W, Zi W, Xu G, Liu X. Management of acute tandem occlusions: Stent-retriever thrombectomy with emergency stenting or angioplasty. J Int Med Res 2018; 46:2578-2586. [PMID: 29726291 PMCID: PMC6124263 DOI: 10.1177/0300060518765310] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To compare outcomes following intracranial stent retriever-based intracranial thrombectomy (SRT) with emergency extracranial internal carotid artery (EICA) stenting or angioplasty alone in patients presenting with acute stroke due to tandem occlusions of the ICA. Methods Consecutive patients with acute anterior tandem occlusion who received an endovascular intervention within 6h of symptom onset between January 2013 and June 2016 were included in this prospective study. Demographic, radiological, procedural and clinical outcome data were compared between the stenting and the angioplasty alone groups. Results Of the 37 patients eligible for the study, 18 had angioplasty alone and 19 underwent stent placement. Successful recanalization rate was statistically significantly higher in the stenting group than in angioplasty alone group (74% vs. 39%) and although not statistically significant, more patients in the stenting group than in the angioplasty alone group had favourable outcomes (63% vs. 50%). There was no significant difference between groups in rates of symptomatic intracranial haemorrhage (SICH), cerebral herniation or mortality. Conclusion This study in a small sample size suggests that among patients with acute anterior tandem occlusion, SRT with EICA stenting tended to achieve higher recanalization and improved clinical outcomes at three months compared with SRT and angioplasty alone with a similar rate of SICH and mortality.
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Affiliation(s)
- Wei Li
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China.,2 Department of Neurology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhonglun Chen
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Zheng Dai
- 3 Department of Neurology, Wuxi People's Hospital, Jiangsu, China
| | - Rui Liu
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Qin Yin
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Huaiming Wang
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Yonggang Hao
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Yunfei Han
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Zhongming Qiu
- 4 Department of Neurology, 117th hospital of the people's liberation army, Hangzhou, China
| | - Yunyun Xiong
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Wen Sun
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Wenjie Zi
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Gelin Xu
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Xinfeng Liu
- 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
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Otite FO, Liaw N, Khandelwal P, Malik AM, Romano JG, Rundek T, Sacco RL, Chaturvedi S. Increasing prevalence of vascular risk factors in patients with stroke: A call to action. Neurology 2017; 89:1985-1994. [PMID: 29021359 PMCID: PMC5679417 DOI: 10.1212/wnl.0000000000004617] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/09/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate trends in prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and drug abuse) and cardiovascular diseases (carotid stenosis, chronic renal failure [CRF], and coronary artery disease [CAD]) in acute ischemic stroke (AIS) in the United States. METHODS We used the 2004-2014 National Inpatient Sample to compute weighted prevalence of each risk factor in hospitalized patients with AIS and used joinpoint regression to evaluate change in prevalence over time. RESULTS Across the 2004-2014 period, 92.5% of patients with AIS had ≥1 risk factor. Overall age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively, while those of carotid stenosis, CRF, and CAD were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age (hypertension: 44% in 18-39 years vs 82% in 60-79 years), race (diabetes: Hispanic 49% vs white 30%), and sex (drug abuse: men 3% vs women 1.4%). Using joinpoint regression, prevalence of hypertension increased annually by 1.4%, diabetes by 2%, dyslipidemia by 7%, smoking by 5%, and drug abuse by 7%. Prevalence of CRF, carotid stenosis, and CAD increased annually by 13%, 6%, and 1%, respectively. Proportion of patients with multiple risk factors also increased over time. CONCLUSIONS Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004-2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention.
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Affiliation(s)
- Fadar Oliver Otite
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.
| | - Nicholas Liaw
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Priyank Khandelwal
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Amer M Malik
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Seemant Chaturvedi
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
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29
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Malhotra K, Goyal N, Tsivgoulis G. Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management. Curr Atheroscler Rep 2017; 19:41. [PMID: 28861849 DOI: 10.1007/s11883-017-0677-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Acute internal carotid artery occlusion (ICAO) is associated with large infarcts and poor clinical outcomes and contributes to morbidity and mortality worldwide. In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO. RECENT FINDINGS Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO. Recent success of endovascular therapy for vessel occlusion in anterior circulation has expanded the horizons; however, few patients with cervical dissections and ICAO were included in these landmark trials. Acute ICAO responds poorly to intravenous thrombolysis and portends worse clinical outcomes. Extracranial and intracranial ICAOs have varied clinical course and imaging patterns, with discrete cervical ICAO usually associated with better clinical outcomes while tandem occlusions predispose poor outcomes. Diagnostic catheter-based angiogram is often required since appearances of ICAO using non-invasive neuroimaging modalities are often deceiving. Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, West Virginia University - Charleston Division, Charleston Area Medical Center, Charleston, WV, 25301, USA.
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.,Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Mao Y, Huang Y, Zhang L, Nan G. Spontaneous recanalization of atherosclerotic middle cerebral artery occlusion: Case report. Medicine (Baltimore) 2017; 96:e7372. [PMID: 28682888 PMCID: PMC5502161 DOI: 10.1097/md.0000000000007372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Intracranial vascular atherosclerotic occlusion is one of the most common causes of ischemic stroke world wide. The involvement of large intracranial vessels, in particular, the middle cerebral artery, is usually associated with unfavorable outcomes in patients. Spontaneous recanalization of atherosclerotic occlusion is relatively rare. PATIENT CONCERNS The first patient was a 43-year-old male with slurred speech and left-sided weakness for a duration of 24 hours. The second was a 59-year-old male with left-sided weakness over a period of 13 hours. The last was a 49-year-old female patient presented with a 1-month history of right-sided headache. DIAGNOSES Atherosclerotic middle cerebral artery occlusion. INTERVENTIONS In all cases, oral aspirin (100 mg; once daily), Plavix (75 mg; once daily), and Lipitor (40 mg; once daily) were used . Oral Plavix was stopped 3 months. OUTCOMES Spontaneous recanalization occured in the three cases of atherosclerotic middle cerebral artery occlusion. LESSONS Spontaneous recanalization may occur in both early and late stages of atherosclerotic middle cerebral artery occlusion. Clinicians should be aware of this particular condition, as it may represent a relatively favorable prognosis.
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Haider AS, Garg P, Watson IT, Leonard D, Khan U, Haque A, Nguyen P, Layton KF. Mechanical Thrombectomy for Acute Ischemic Stroke After Cardiac Surgery. Cureus 2017; 9:e1150. [PMID: 28503386 PMCID: PMC5426822 DOI: 10.7759/cureus.1150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Ischemic stroke is a rare yet devastating complication that may occur following cardiothoracic surgery. Fibrinolytic treatment is contraindicated due to elevated risk for hemorrhage. Mechanical thrombectomy entails a catheterized approach wherein the thrombus is physically removed from the vessel without the use of fibrinolytics, minimizing the possibility of intracranial hemorrhage. Here, we present two original cases of mechanical thrombectomy as treatment for patients experiencing emergent large vessel occlusion following cardiothoracic surgery. A literature review was conducted to determine current treatment guidelines, risk factors, and complications resulting from recanalization due to mechanical thrombectomy versus fibrinolytic therapy. One patient was admitted due to chronic, American College of Cardiology/American Heart Association stage D, New York Heart Association functional class IV heart failure and required complete, artificial hemodynamic support for two weeks and on the 19th day experienced neurologic decline secondary to a supraclinoid left internal carotid artery (ICA) occlusion. Mechanical thrombectomy resulted in distal reperfusion and neurologic improvement. The second patient presented with coronary artery disease and underwent triple coronary artery bypass grafting and endovein harvesting. On post-operative day 2, the patient experienced a left ICA occlusion extending to the cavernous ICA resulting in speech impairment and right-sided weakness. The patient was heparinized and underwent mechanical thrombectomy, resulting in immediate speech and muscle strength recovery. Medical advances allow mechanical thrombectomy to be performed in a timely and effective manner at specialized treatment centers. It offers endovascular treatment modalities to a unique patient population with postoperative stroke. In such patients, thrombectomy can safely provide reperfusion while reducing the risk of complications associated with conventional thrombolytics.
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Affiliation(s)
- Ali S Haider
- Department of Neurosurgery, Scott and White Hospital, Temple, TX
| | | | | | | | - Umair Khan
- School of Medicine, St. Georges University
| | - Ahmed Haque
- Department of Anesthesiology, University of Texas Medical Branch at Galveston
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Ma Y, Gu Y, Tong X, Wang J, Kuai D, Wang D, Ren J, Duan L, Maimaiti A, Cai Y, Huang Y, Wang X, Cao Y, You C, Yu J, Jiao L, Ling F. The Carotid and Middle cerebral artery Occlusion Surgery Study (CMOSS): a study protocol for a randomised controlled trial. Trials 2016; 17:544. [PMID: 27852286 PMCID: PMC5111211 DOI: 10.1186/s13063-016-1600-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion with haemodynamic insufficiency are at high risk for recurrent stroke when treated medically. METHODS The Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS) trial is an ongoing, government-funded, prospective, multicentre, randomised controlled trial. The CMOSS will recruit 330 patients with symptomatic ICA or MCA occlusion (parallel design, 1:1 allocation ratio) and haemodynamic insufficiency. Participants will be allocated to best medical treatment alone or best medicine plus extracranial-intracranial (EC-IC) bypass surgery. The primary outcome events are all strokes or deaths occurring between randomisation and 30 days post operation or post randomisation and ipsilateral ischaemic stroke within 2 years. Recruitment will be finished by December 2016. All the patients will be followed for at least 2 years. The trial is scheduled to complete in 2019. DISCUSSION The CMOSS will test the hypothesis that EC-IC bypass surgery plus best medical therapy reduces subsequent ipsilateral ischaemic stroke in patients with symptomatic ICA or MCA occlusion and haemodynamic cerebral ischaemia. This manuscript outlines the rationale and the design of the study. CMOSS will allow for more critical reappraisal of the EC-IC bypass for selected patients in China. TRIAL REGISTRATION NCT01758614 with ClinicalTrials.gov. Registered on 24 December 2012.
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Affiliation(s)
- Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fu Dan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Xiaoguang Tong
- Department of Neurosurgery, Huanhu Hospital, No. 6 Jizhao Road, Tianjin, 300350, China
| | - Jiyue Wang
- Department of Neurosurgery, Brain Hospital, No. 45 Huashan Road, LiaoCheng, Shandong, 252000, China
| | - Dong Kuai
- Department of Neurosurgery, The 1st Affiliated Hospital of ShanXi Medical University, No. 85 South Jiefang Road, Taiyuan, Shanxi, 030001, China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong, 250012, China
| | - Jun Ren
- Department of Neurosurgery, The 2nd Affiliated Hospital of LanZhou University, No. 80 Cuiyingmen Road, Lanzhou, Gansu, 730030, China
| | - Lian Duan
- Department of Neurosurgery, The 307 Hospital of PLA, No. 8 Dongda Street, Beijing, 100071, China
| | - Aili Maimaiti
- Department of Neurosurgery, The 1st Affiliated Hospital of XinJiang Medical University, No. 137 South Liyushan Road, Wulumuqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Yiling Cai
- Department of Neurology, The 306 Hospital of PLA, No. 9 Anxiangbeili, Beijing, 100101, China
| | - Yujie Huang
- Department of Neurosurgery, Drum Tower Hospital, Medical School of Nanjing University, No. 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Xiaojian Wang
- Department of Neurosurgery, The 1st Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, 650101, China
| | - Yi Cao
- Department of Neurosurgery, The 2nd Affiliated Hospital of Kunming Medical University, No. 324 Dianmian Road, Kunming, Yunnan, 610041, China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Street, Chengdu, Sichuan, 610041, China
| | - Jiasheng Yu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, Hubei, 430030, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
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Paraskevas KI, Mikhailidis DP, Liapis CD. Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors. Angiology 2016; 58:329-35. [PMID: 17626988 DOI: 10.1177/0003319707301754] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this article is to investigate the association between internal carotid artery occlusion (ICAO) and the presence of atherosclerotic disease and vascular risk factors. The clinical characteristics and risk factors of 120 patients presenting with ICAO were retrospectively reviewed. All patients (n = 120) had at least 1 of the 4 vascular risk factor (diabetes, smoking, hypercholesterolemia, and hypertension); 2, 3, or all 4 risk factors were present in 14 to 82 of the patients (11.7% to 68.3%), 10 to 39 of the patients (8.3% to 32.5%), and 9 of the patients (7.5%), respectively. A total of 84 patients (70%) with ICAO had disease in at least 1 additional vascular bed (aorta, coronary or lower limb arteries). In addition to ICAO, vascular disease was present in 2 and all 3 of these arterial beds in 42 (35%) and 9 (7.5%) patients, respectively. Furthermore, stenosis or occlusion of the ipsilateral or contralateral vertebral arteries was recorded in 19 of 120 patients (15.8%). Regarding the contralateral carotid artery, 1 patient had bilateral ICAO. One patient had contralateral common carotid artery occlusion, and 1 patient was excluded from the analysis because of surgery to the contralateral carotid artery. Of the remaining 117 patients, 34 (29.0%) had less than 50% contralateral carotid artery stenosis. Thirty-two patients (27.4%) had 50% to 69%, and 51 (43.6%) had 70% to 99% stenosis. Ultrasonographic imaging of the carotid plaque of the contralateral carotid artery revealed that 52 of the 120 arteries (43.3%) were uniformly or predominantly echolucent (types I and II, respectively). Fifty-nine (49.2%) were predominantly or uniformly echogenic (types III and IV), and 9 (7.5%) could not be classified. A similar distribution of echomorphology was observed on the occluded side. ICAO is associated with widespread atherosclerotic disease and a high prevalence of vascular risk factors. Detection of ICAO should prompt the investigation of other arterial beds and treatment of risk factors.
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Affiliation(s)
- Kosmas I Paraskevas
- Department of Clinical Biochemistry and Academic Department of Surgery, Royal Free Hospital, London, United Kingdom
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Xie D, Hu D, Zhang Q, Sun Y, Li J, Zhang Y. Increased high-sensitivity C-reactive protein, erythrocyte sedimentation rate and lactic acid in stroke patients with internal carotid artery occlusion. Arch Med Sci 2016; 12:546-51. [PMID: 27279846 PMCID: PMC4889675 DOI: 10.5114/aoms.2014.47879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/12/2014] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Internal carotid artery occlusion (ICAO) causes high annual rates of mortality and morbidity. It has been established that atherosclerosis is the normal cause of ICAO. As the pathogenesis of atherosclerosis may involve blood lipids, inflammatory factors and other biomarkers, the aim of this study was to assess the changes in these biomarkers and investigate the relationship between these biomarkers and the development of ICAO in stroke patients. MATERIAL AND METHODS A total of 89 ischaemic stroke inpatients with ICAO (ICAO group) and 89 without ICAO (control group) were studied, retrospectively. The serum was collected from each patient on the 3(rd) day of admission, to measure the lipid parameters and biomarkers, e.g. high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and lactic acid (LA). Histories were taken including age, gender, smoking history, and disease history. Additional analysis was carried out to compare between the genders and evaluate the association between certain biomarkers and ICAO. RESULTS Among the 89 ICAO cases in this study, the serum levels of hs-CRP, ESR and LA were significantly higher than those in the control group (p ≤ 0.001). No significant differences were found in the mean levels of total cholesterol, triacylglycerol, HDL cholesterol or glucose, or the known risk factors. Gender also had no influence on these biomarkers. Logistic regression analysis indicated that hs-CRP, ESR and LA were significantly associated with ICAO (p ≤ 0.05). CONCLUSIONS These results suggest that hs-CRP, ESR and LA are associated with ICAO in ischaemic stroke patients, but gender has no effect. Therefore, Hs-CRP, ESR and LA may be useful in the early detection of patients with ICAO.
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Affiliation(s)
- Dan Xie
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Di Hu
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qin Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yufang Sun
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jimei Li
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongbo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Xu Y, Qian G, Wei L, Qin-Hua W, Bo D, Cheng-Chun L, Zhi-Hong Z, Li-Li Z, Zhi-Qiang X, Hua-Dong Z, Yan-Jiang W, Meng Z. Predictive Factors for the Spontaneous Recanalization of Large and Middle Cerebral Arteries after Acute Occlusion. J Stroke Cerebrovasc Dis 2016; 25:1896-900. [PMID: 27177923 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to investigate the predictive factors for the spontaneous recanalization of occluded arteries in patients with acute ischemic stroke. METHODS A total of 139 patients with consecutive acute ischemic stroke were enrolled from June 2010 to June 2013. The clinical and biochemical parameters were measured in each participant. Occlusion and recanalization of the carotid artery, the middle cerebral artery, and the vertebral and basilar arteries were identified by using computed tomographic angiography or digital subtraction angiography. RESULTS Among the 139 patients, 23 showed spontaneous recanalization, whereas 116 did not. In the patients with spontaneous recanalization, the proportion of atrial fibrillation was significantly lower (0% versus 29.31%, P= .01), whereas the proportion of stage 3 hypertension was significantly higher (60.87% versus 32.76%, P= .01) than that of those without recanalization. Logistic regression analysis showed that the proportion of atrial fibrillation was negatively (odds ratio [OR]: .117, 95% confidence interval [CI]: .015-.918, P= .04) associated with spontaneous recanalization, whereas the proportion of stage 3 hypertension was positively (OR: 4.316, 95% CI: 1.533-12.154, P= .01) associated with it. CONCLUSIONS Atrial fibrillation is associated with reduced spontaneous recanalization of the large and middle cerebral arteries in patients after acute ischemic stroke-induced occlusion, whereas stage 3 hypertension may contribute to the promotion of the recanalization.
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Affiliation(s)
- Yi Xu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ge Qian
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Li Wei
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wang Qin-Hua
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Deng Bo
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Liu Cheng-Chun
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhang Zhi-Hong
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhang Li-Li
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xu Zhi-Qiang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhou Hua-Dong
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wang Yan-Jiang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhang Meng
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
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Chang YT, Chang WN, Tsai NW, Huang CC, Wang HC, Kung CT, Su YJ, Lin WC, Chang HW, Cheng BC, Su CM, Chiang YF, Lu CH. Link between cerebral blood flow and autonomic function in survivors of internal carotid artery occlusion. J Neurol Sci 2015; 353:143-8. [PMID: 25956232 DOI: 10.1016/j.jns.2015.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/25/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Symptomatic internal carotid artery occlusion (ICAO) is an important cause of cerebral ischemia with poor long-term outcome. Reductions in baroreflex function is reported in carotid atherosclerosis and implicated in increased risk of recurrent cardiovascular events. A distributed network of forebrain regions can exert modulatory influences over the cardio-vagal and baroreflex functions. The successful clinical translation of these approaches offers insights into underlying modulatory mechanisms and to possible therapeutic strategy. METHODS This study enrolled 20 symptomatic ICAO survivors, 20 patients with small vessel disease (SVD) as risk control, and 20 healthy controls. All underwent a standardized evaluation of cardiovascular autonomic function testing that included baroreflex sensitivity (BRS), Valsalva ratio (VR), and heart rate response to deep breathing (HR_DB). The regional cerebral blood flow (rCBF) of the central autonomic network (CAN) was obtained from arterial spin-labeling magnetic resonance imaging. Parameters of autonomic function between symptomatic ICAO survivors with and those without recurrent cardiovascular events were compared. RESULTS Valsalva ratio and HR_DB levels were significantly higher in the control group, followed by the SVD and ICAO groups (p=0.009 and p=0.007, respectively). Spontaneous BRS and BRS during the early phase II of Valsalva maneuver levels were both significantly higher in the control group, followed by the SVD and ICAO groups (p<0.001 and p=0.042, respectively). The rCBF of CAN inversely correlated with spontaneous BRS. CONCLUSION Autonomic dysregulation, including reduced BRS and impaired cardio-vagal function in the convalescent stage ICAO, can persist for a long time. Reduced BRS is inversely correlated with CAN activity.
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Affiliation(s)
- Ya-Ting Chang
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsueh-Wen Chang
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Min Su
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Fang Chiang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
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Bilateral Asymmetrical Asterixis as Limb-shaking Transient Ischemic Attack in Bilateral Carotid Stenosis. J Stroke Cerebrovasc Dis 2015; 24:e29-30. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
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Luitse MJA, Velthuis BK, Dauwan M, Dankbaar JW, Biessels GJ, Kappelle LJ. Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke. Stroke 2014; 46:12-5. [PMID: 25492908 DOI: 10.1161/strokeaha.114.007169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (≥70%, near occlusions not included) on follow-up imaging in a consecutive series of patients with an acute symptomatic occlusion of the extracranial ICA. METHODS We included patients participating in the Dutch Acute Stroke Study (DUST), who had an acute symptomatic occlusion of the extracranial ICA that was diagnosed on computed tomographic angiography within 9 hours after onset of neurological symptoms. Follow-up imaging of the carotid artery had to be available within 7 days after admission. RESULTS Of the 1021 patients participating in DUST between May 2009 and May 2013, an acute symptomatic occlusion of the extracranial ICA was found in 126 (12.3%) patients. Follow-up imaging was available in 86 (68.3%) of these patients. At follow-up, a residual stenosis of <30% was found in 15 (17.4%; 95% confidence interval, 10.8-26.9) patients, a 30% to 49% stenosis in 3 (3.5%; 95% confidence interval, 0.8-10.2) patients, a 50% to 69% stenosis in 2 (2.3%; 95% confidence interval, 0.1-8.6) patients, and a ≥70% stenosis in 14 (16.3%; 95% confidence interval, 9.8-25.6) patients. A near or persistent occlusion was present in the remaining 52 (60.5%) patients. CONCLUSIONS A residual high-grade stenosis of the extracranial ICA occurs in 1 of 6 patients with a symptomatic occlusion in the acute stage of cerebral ischemia. Because this may have implications for secondary prevention, we recommend follow-up imaging in these patients within a week after the event. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
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Affiliation(s)
- Merel J A Luitse
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Birgitta K Velthuis
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Meenakshi Dauwan
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
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Intravenous thrombolysis in acute ischemic stroke due to occlusion of internal carotid artery – A Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS). Clin Neurol Neurosurg 2014; 120:124-8. [DOI: 10.1016/j.clineuro.2014.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/24/2014] [Accepted: 03/06/2014] [Indexed: 11/22/2022]
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Kang J, Park TH, Lee KB, Park JM, Ko Y, Lee SJ, Hong KS, Cho YJ, Lee JS, Lee J, Lee BC, Yu KH, Kim DH, Cha JK, Lee J, Jang MS, Han MK, Bae HJ. Symptomatic steno-occlusion in patients with acute cerebral infarction: prevalence, distribution, and functional outcome. J Stroke 2014; 16:36-43. [PMID: 24741563 PMCID: PMC3961813 DOI: 10.5853/jos.2014.16.1.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. Methods We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. Results In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). Conclusions Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.
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Affiliation(s)
- Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea. ; Department of Neurology, Samsung Changwon Medical Center, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Youngchai Ko
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Koyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Koyang, Korea
| | - Ji Sung Lee
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Myung Suk Jang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
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Abstract
Accurate predictors of early outcome in stroke patients have a number of important applications, such as introducing secondary prevention strategies, supporting treatment decisions or designing randomized clinical trials. Surprisingly, a generally accepted, reliable and well-validated mortality-prediction model is still unavailable. This review outlines the most important predictors of in-hospital mortality that could be assessed at admission to hospital emergency room within 24 h of ischemic stroke onset. A number of factors are discussed such as nonmodifiable factors (e.g., age, gender and genetic factors); type of stroke and its severity - measured by different clinical score scales; predictive models; laboratory markers; special neuroradiological and neurophysiological tests; and comorbid conditions at admission and quality of hospital care.
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Affiliation(s)
- Radoslaw Kazmierski
- Poznan University of Medical Sciences, Department of Neurology, ul. Przybyszewskiego 49, 60-355 Poznan, Poland.
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42
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Jolink WM, Heinen R, Persoon S, van der Zwan A, Kappelle LJ, Klijn CJ. Transcranial Doppler Ultrasonography CO2 Reactivity Does Not Predict Recurrent Ischaemic Stroke in Patients with Symptomatic Carotid Artery Occlusion. Cerebrovasc Dis 2014; 37:30-7. [DOI: 10.1159/000356349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
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Ibatullin MM, Kalinin MN, Kurado AT, Valeeva AA, Khasanova DR. [Multimodal imaging protocols and their predictive role in acute stroke functional outcome]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:9-15. [PMID: 25726796 DOI: 10.17116/jnevro20141141229-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of stroke functional outcome in the light of the aforementioned four Ps.
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Affiliation(s)
- M M Ibatullin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - M N Kalinin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - A T Kurado
- GAUZ "Mezhregional'nyĭ kliniko-diagnosticheskiĭ tsentr", Kazan'
| | - A A Valeeva
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - D R Khasanova
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
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44
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Eom KS, Kim DW, Choi SS, Kang SD. Spontaneous Recanalization of an Occluded Middle Cerebral Artery in a Patient With Moyamoya. Vasc Endovascular Surg 2013; 47:482-7. [DOI: 10.1177/1538574413495463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Moyamoya disease is a rare cerebrovascular disorder that is characterized by progressive stenosis of the distal portion of the internal carotid artery and its main branches. Here the authors present the first case of spontaneous recanalization of an occluded middle cerebral artery in a woman with moyamoya who had not undergone surgical or endovascular treatment. Although the exact mechanisms remain unclear, spontaneous recanalization in moyamoya could be considered a possible phenomenon. Thus, the neurosurgeons should always pay attention to the pathological variety of dynamic changes in the cerebrovascular structure in moyamoya.
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Affiliation(s)
- Ki Seong Eom
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Dae Won Kim
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea
| | - See-Sung Choi
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung Don Kang
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea
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45
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Recanalization of extracranial internal carotid artery occlusion after i.v. thrombolysis for acute ischemic stroke. PLoS One 2013; 8:e55318. [PMID: 23383152 PMCID: PMC3557237 DOI: 10.1371/journal.pone.0055318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/21/2012] [Indexed: 11/23/2022] Open
Abstract
Background Although extracranial internal carotid artery (e-ICA) occlusion is a common pathology in patients undergoing intravenous thrombolysis for treatment of acute ischemic stroke, no data on e-ICA recanalization rate or potential effects on outcome are yet available. Methods and Results This study included 52 consecutive patients with e-ICA occlusion and ischemic stroke undergoing standard intravenous thrombolysis. The rate of e-ICA recanalization was 30.8% [95%CI, 18.2–43.3], documented at 3.5 [2.0–11.8] (median [IQR]) days after stroke, as compared to 8.6% [95%CI, 3.5–13.7] in a series of 116 consecutive patients with symptomatic e-ICA occlusion not undergoing thrombolysis (P<0.001 for difference). Functional outcome three months after stroke did not significantly differ for those with or without e-ICA recanalization following intravenous thrombolysis (modified Rankin scale ≤2: 31.3% vs. 22.2%, odds ratio 1.6 [95%CI, 0.4–5.9], P = 0.506). In patients with e-ICA occlusion of atherothrombotic origin, recanalization resulted in most instances in residual high-grade stenosis (13 of 14). Conclusions Recanalization of e-ICA occlusion after stroke thrombolysis occurred in about one third of patients. Although e-ICA recanalization had no significant effect on patient outcome, control sonography in the early days after thrombolysis is recommended for the detection of potential residual e-ICA stenosis.
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46
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Paciaroni M, Agnelli G, Caso V, Pieroni A, Bovi P, Cappellari M, Zini A, Nichelli P, Inzitari D, Nesi M, Nencini P, Pezzini A, Padovani A, Tassinari T, Orlandi G, Chiti A, Gialdini G, Alberti A, Venti M, Acciarresi M, D'Amore C, Luda E, Tassi R, Martini G, Ferrarese C, Beretta S, Trentini C, Silvestrelli G, Lanari A, Previdi P, Ciccone A, Delodovici ML, Bono G, Galletti G, Marcheselli S, Del Sette M, Traverso E, Riva M, Silvestrini M, Cerqua R, Consoli D, Monaco S, Toni D. Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion: the ICARO-2 study. Cerebrovasc Dis 2012. [PMID: 23207482 DOI: 10.1159/000345081] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSES In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those without eICA occlusion. METHODS Consecutive patients treated with intravenous tissue-type plasminogen activator within 4.5 h from symptom onset included in the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) in 20 Italian centres were analyzed. Acute carotid occlusion was diagnosed using ultrasound examination, angio-CT scan or angio-MRI. Since the SITS-ISTR database did not plan to report the site of vessel occlusion, each participating center provided the code of the patient with eICA occlusion. Patients were divided into 2 groups, those with and those without eICA occlusion. Main outcome measures were: death, disability (modified Rankin Scale, mRS, 3-6) and any intracranial bleeding at 3 months. Multiple logistic regression analysis was performed to reveal predictors for main outcomes. The following variables of interest were included in the analysis: presence of eICA occlusion, age, gender, diabetes mellitus, hyperlipidemia, atrial fibrillation, congestive heart failure, previous stroke, current smoking, antiplatelet treatment at stroke onset, baseline NIHSS score, baseline blood glucose, cholesterol and blood pressure, history of hypertension and stroke onset to treatment time. RESULTS A total of 1,761 patients without eICA occlusion and 137 with eICA occlusion were included in the study. At 3 months, 42 patients were lost to follow-up (3 with eICA occlusion). Death occurred in 30 (22.4%) patients with eICA occlusion and in 175 (10.2%) patients without (p < 0.0001). Death or disability at 3 months occurred in 91 of 134 patients with eICA occlusion (67.9%) compared with 654 of 1,722 patients without eICA occlusion (37.9%, p < 0.0001). No or minimal disability at 3 months (mRS 0-1) was reported in 25 (18.7%) patients with eICA occlusion and in 829 (48.2%) patients without (p < 0.0001). Any intracranial bleeding detected by CT or MRI at posttreatment imaging was seen in 16 (11.7%) patients with eICA occlusion and in 314 (17.8%) of those without (p = 0.09). The proportion of symptomatic intracerebral hemorrhage was 5.8% for patients with eICA occlusion and 8.0% for patients without (p = 0.16). At logistic regression analysis, eICA occlusion was associated with mortality (odds ratio, OR 5.7; 95% confidence interval, CI 2.9-11.1) and mortality or disability (OR 5.0; 95% CI 2.9-8.7) at 90 days. CONCLUSIONS This cohort study in patients with acute ischemic stroke treated with thrombolysis showed an association between eICA occlusion and adverse outcome.
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Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
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47
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Fargen KM, Hoh BL. Angioplasty alone versus angioplasty and stenting for acute cervical carotid occlusions: technical and antiplatelet considerations. World Neurosurg 2012; 79:66-8. [PMID: 23103275 DOI: 10.1016/j.wneu.2012.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Kyle M Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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48
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Natural history of carotid artery occlusion. Ann Vasc Surg 2012; 27:186-93. [PMID: 22951063 DOI: 10.1016/j.avsg.2012.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/14/2012] [Accepted: 03/17/2012] [Indexed: 11/23/2022]
Abstract
Carotid artery occlusion (CAO) is a risk factor for stroke ipsilateral to the occlusion and puts patients in a high-risk category when contralateral endarterectomy is performed. The purpose of this study was to evaluate the long-term outcomes of patients with internal CAO and to determine risk factors predictive of subsequent neurological event, contralateral carotid intervention, or death. Patients with internal CAO shown by duplex ultrasonography were retrospectively identified and followed between January 2002 and June 2010 (follow-up: 1-101 months, mean: 52 months) at a tertiary care hospital. All had multiple duplex examinations available for review. Chi-square analysis was used to determine risk factors for neurologic event, contralateral intervention, or all-cause morality. Multivariate Cox proportional hazard analysis was conducted using univariate risk factors with P values <0.1. Survival was estimated using the Kaplan-Meier method (P < 0.05 significant). Eighty patients with internal CAO were identified and available for analysis. On initial encounter, 30 (38%) were symptomatic, with 26 (87%) having symptoms referable to the side of the occluded internal carotid artery. During follow-up, seven (9%) had a neurologic event, of which six (86%) were referable to the occluded side; 14 (18%) patients underwent a contralateral operation. Nineteen (24%) patients died during the period of study. Although numerous variables of multivessel disease were significant with χ(2) analysis, there was no significant risk factor associated with neurologic event on multivariate analysis. However, the development of a hemodynamically significant stenosis (>50%) or occlusion of the external carotid artery (ECA) ipsilateral to the occlusion on follow-up (P < 0.027) was associated with increased risk of death. Kaplan-Meier analysis showed 7-year survival for patients with ECA disease at follow-up was significantly worse (16.2% ± 10.3% [n = 21] vs. 79% ± 8.7% [n = 59]; P < 0.00001). Frequently, patients present with neurological symptoms referable to the side of the internal CAO. Eighty-six percent of neurologic events that occur in follow-up are attributable to the side of the occluded carotid, indicating that the occluded side continues to contribute to neurologic morbidity over time. Multivariate analysis revealed no single factor to be predictive of subsequent neurologic events. With significant risk of death in patients found to have ipsilateral ECA stenosis during follow-up, it seems reasonable to continue surveillance of the occluded carotid.
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49
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Dabus G, Linfante I. The natural history of acute ischemic stroke due to intracranial large-vessel occlusion: what do we know? Tech Vasc Interv Radiol 2012; 15:2-4. [PMID: 22464296 DOI: 10.1053/j.tvir.2011.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute ischemic stroke (AIS) is an important public health issue with major impact on not only patients and families but also on the society as well. Among patients who suffer from AIS, those who have the event due to large-vessel occlusion are thought to have the worse outcome. Because most of the effort in endovascular treatment of AIS is aimed toward this type of stroke, it is important to understand its natural history. The goal of this manuscript was to briefly discuss the natural history of AIS due to large-vessel occlusion based on recent literature.
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Affiliation(s)
- Guilherme Dabus
- Department of NeuroInterventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA.
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50
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Kazemi-Bajestani SMR, van der Vlugt M, de Leeuw FE, Blankensteijn JD, Bredie SJH. A high prevalence of carotid artery stenosis in male patients older than 65 years, irrespective of presenting clinical manifestation of atherosclerotic diseases. Angiology 2012; 64:281-6. [PMID: 22584247 DOI: 10.1177/0003319712445374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. Duplex sonography of the carotid arteries was performed in 434 of 473 eligible patients of whom 118 (27.8%) patients had significant CS ≥50%. The prevalence and severity of CS did not differ between patients who presented with neurological symptoms or acute coronary syndrome/peripheral artery disease (30.8% vs 25.9%, respectively). Among patients with CS, a higher rate of current smoking, a higher systolic blood pressure, and a lower glomerular filtration rate were observed compared with patients without CS. A history of coronary artery bypass graft was a significant predictor of the presence of CS (P = .003, odds ratio [OR] = 2.70 [1.40-5.19]). The prevalence of CS in elderly males with manifest atherosclerotic disease is high, irrespective of presenting clinical manifestation.
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