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Johansson E, Holmgren M, Henze A, Fox AJ. Diagnosing carotid near-occlusion is a difficult task-but it might get easier. Neuroradiology 2022; 64:1709-1714. [PMID: 35829763 DOI: 10.1007/s00234-022-03007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Elias Johansson
- Clinical Science, Umeå University, Neurosciences, Umeå, Sweden. .,Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden.
| | | | | | - Allan J Fox
- Sunnybrook Health Science Center, University of Toronto, Toronto, Canada
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Lee SH, Suh DC, Cho SH, Sheen JJ, Lee DH, Kim JS. Subacute endovascular recanalization of symptomatic cerebral artery occlusion: a propensity score-matched analysis. J Neurointerv Surg 2017; 10:536-542. [PMID: 28899866 DOI: 10.1136/neurintsurg-2017-013219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs). METHODS Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion-perfusion mismatch. All patients underwent pre-transfemoral cerebral angiography and post-endovascular treatment. The patients were classified according to acute (onset-to-groin puncture time ≤6 hours) or subacute (onset-to-groin puncture time >6 hours) recanalization. Using propensity score analysis, recipients of acute and subacute recanalization underwent 1:1 matching. RESULTS Following 1:1 propensity score matching, 32 patients who underwent acute and 32 who underwent subacute intra-arterial thrombolysis were matched. There were no significant differences in National Institutes of Health Stroke Scale at discharge, modified Rankin scale (mRS), the proportion of patients with an mRS value of 0-2, mortality at discharge, intracerebral bleeding, postprocedural infarct extension, newly detected infarction, and hyperintense acute reperfusion marker on follow-up images between the acute and subacute recanalization groups. CONCLUSIONS In selected patients with clinically unstable cerebral artery occlusions, a diffusion-perfusion mismatch and small CT lesions, subacute and acute recanalization has comparable safety and efficacy rates.
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Affiliation(s)
- Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.,Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Hee Cho
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jae Jon Sheen
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Johansson E, Fox AJ. Carotid Near-Occlusion: A Comprehensive Review, Part 1--Definition, Terminology, and Diagnosis. AJNR Am J Neuroradiol 2015; 37:2-10. [PMID: 26316571 DOI: 10.3174/ajnr.a4432] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/08/2015] [Indexed: 12/28/2022]
Abstract
Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis.
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Affiliation(s)
- E Johansson
- From the Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Umeå, Sweden
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Johansson E, Öhman K, Wester P. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277:615-23. [PMID: 25297638 DOI: 10.1111/joim.12318] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse. METHODS This study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study (ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed. RESULTS The 90-day risk of recurrent stroke was 18% [95% confidence interval (CI) 12-25%; n = 29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n = 4) for patients with near-occlusion with full collapse (P = 0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event. CONCLUSIONS Patients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.
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Affiliation(s)
- E Johansson
- Department of Pharmacology and Clinical Neuroscience and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Chueh JY, Kühn AL, Puri AS, Wilson SD, Wakhloo AK, Gounis MJ. Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. Stroke 2013; 44:1396-401. [PMID: 23493730 DOI: 10.1161/strokeaha.111.670463] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the impact of proximal flow control on efficacy and safety of mechanical thrombectomy in an in vitro middle cerebral artery occlusion. METHODS Three independent variables, including clot type, device (Merci Retriever, Solitaire FR, and Trevo devices), and use of a balloon guide catheter, were used to ascertain the impact of proximal flow control on the size and number of distal emboli generated during thrombectomy. Secondary end points were the recanalization rate and amount of flow restored. RESULTS Use of the balloon guide catheter during thrombectomy of the fragile, hard clot significantly reduced the formation of large distal emboli with a diameter >1 mm, regardless of the device used (P<0.01). Applying aspiration via the balloon guide catheter in place of the conventional guide catheter resulted in a significant increase of flow reversal (P<0.0001). Prior to thrombectomy, deployment of the stent-trievers produced immediate flow restoration through the soft and hard clot occlusions, 69.2 ± 27.3 and 45.5 ± 22.8 mL/min, respectively, that was preserved after the balloon inflation because of collateral flow via the posterior communication artery. After deployment but before thrombectomy, no flow was restored when using the Merci Retriever. After thrombectomy, complete flow restoration was achieved in a majority of cases. The Merci Retriever required more thrombectomy attempts to achieve hard clot removal compared with the stent-trievers when the conventional guide catheter was used (1.5 versus 1.1). CONCLUSIONS The risk of distal embolization was significantly reduced with the use of the balloon guide catheter.
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Affiliation(s)
- Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
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Xu DS, Abruzzo TA, Albuquerque FC, Dabus G, Eskandari MK, Guterman LR, Hage ZA, Hurley MC, Hanel RA, Levy EI, Nichols CW, Ringer AJ, Batjer HH, Bendok BR. External Carotid Artery Stenting to Treat Patients With Symptomatic Ipsilateral Internal Carotid Artery Occlusion. Neurosurgery 2010; 67:314-21. [PMID: 20644416 DOI: 10.1227/01.neu.0000371728.49216.3b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
The external carotid artery (ECA) anastomoses in many distal territories supplied by the internal carotid artery (ICA) and is an important source of collateral circulation to the brain. Stenosis of the ECA in ipsilateral ICA occlusion can produce ischemic sequelae.
OBJECTIVE
To examine the effectiveness of ECA stenting in treating symptomatic ipsilateral ICA occlusion.
METHODS
We retrospectively reviewed patient databases from 5 academic medical centers to identify all individuals who underwent ECA stenting after 1998. For all discovered cases, coinvestigators used a common submission form to harvest relevant demographic information, clinical data, procedural details, and follow-up results for further analysis.
RESULTS
Twelve patients (median age, 66 years; range, 45–79 years) were identified for our cohort. Vessel disease involvement included severe ECA stenosis ≥ 70% in 11 patients and ipsilateral ICA occlusion in all patients. Presenting symptoms included signs of transient ischemic attack, stroke, and amaurosis fugax. ECA stenting was associated with preservation of neurological status in 11 patients and resolution of symptoms in 5 patients at a median follow-up time of 26 months (range, 1–87 months; mean, 29 months). Symptomatic in-stent restenosis did not occur within any patient during the follow-up course.
CONCLUSION
We found ECA stenting in symptomatic ipsilateral ICA disease to be a potentially effective strategy to preserve neurological function and to relieve ischemic symptoms. Further investigation with larger studies and longer follow-up periods is warranted to elucidate the true indications of this management strategy.
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Affiliation(s)
- David S. Xu
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd A. Abruzzo
- Departments of Neurology, Neurological Surgery, and Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Guilherme Dabus
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mark K. Eskandari
- Department of Surgery, Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lee R. Guterman
- Department of Neurological Surgery, Buffalo Neurosurgery Group, West Seneca, New York
| | - Ziad A. Hage
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael C. Hurley
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ricardo A. Hanel
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida
| | - Elad I. Levy
- Departments of Neurological Surgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | | | - Andrew J. Ringer
- Departments of Neurological Surgery and Radiology, The Neuroscience Institute, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio
| | - H. Hunt Batjer
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bernard R. Bendok
- Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bennis S, Scarone P, Lepeintre JF, Aldea S, Gaillard S. Transtubular versus microsurgical approach for single lumbar disc herniation: a prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0478-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Endovascular recanalization for subacute symptomatic intracranial arterial occlusion: A report of two cases. Clin Neurol Neurosurg 2008; 110:1058-63. [DOI: 10.1016/j.clineuro.2008.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Accepted: 07/13/2008] [Indexed: 11/20/2022]
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Bhatt A, Majid A, Kassab M, Gupta R. Chronic total symptomatic carotid artery occlusion treated successfully with stenting and angioplasty. J Neuroimaging 2008; 19:68-71. [PMID: 18801001 DOI: 10.1111/j.1552-6569.2008.00212.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Treatment of symptomatic chronic totally occluded carotid artery has been limited to medical management. An ongoing clinical trial is examining the role of extracranial to intracranial bypass surgery in select patients with impaired cerebrovascular reserve based on PET imaging parameters. We describe a case utilizing stenting and angioplasty to treat a chronic total carotid occlusion as a potential alternative therapy. CLINICAL PRESENTATION A 55-year-old woman presented with a right hemispheric ischemic stroke in the setting due to a right internal carotid artery total occlusion. INTERVENTION She was treated medically with antiplatelet therapy and oral vasopressor agents. She returned with new symptoms 1 month later and was successfully treated with stenting and angioplasty. At the 9-month follow-up, she remains neurologically intact. CONCLUSION Stenting and angioplasty may be a therapeutic option in select patients with chronic total carotid occlusion. Further study is required to determine the safety profile of this treatment modality.
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Affiliation(s)
- Archit Bhatt
- Department of Neurology, Michigan State University/Sparrow Health Systems, East Lansing, MI, USA
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