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Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, Oh CW. Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease. J Korean Neurosurg Soc 2019; 63:69-79. [PMID: 31064040 PMCID: PMC6952727 DOI: 10.3340/jkns.2018.0182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016. METHODS Data was extracted from the national health-claim database provided by the NHIS for 2008-2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes. RESULTS In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The agestandardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively. CONCLUSION Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques.
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Affiliation(s)
- Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Al-Mufti F, Amuluru K, Manning NW, Khan I, Peeling L, Gandhi CD, Prestigiacomo CJ, Pushchinska G, Fiorella D, Woo HH. Emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to tandem occlusion. Br J Neurosurg 2017; 31:573-579. [PMID: 28298139 DOI: 10.1080/02688697.2017.1297377] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Acute occlusions of the extracranial internal carotid artery (ICA) and a major intracranial artery respond poorly to intravenous tissue plasminogen activator (tPA) and present an endovascular challenge. The aim of our study was to retrospectively delineate the feasibility of the combined use of emergent carotid stenting and intra-arterial (IA) Abciximab with intracranial revascularization in the setting of acute ischemic stroke and carotid occlusions at our institution. METHODS Eleven patients with complete cervical carotid occlusion with or without concomitant intracranial ICA and/or MCA occlusion were identified from a single center, retrospective review of patients admitted to the Stroke unit. We evaluated all cases for complications of emergent cervical ICA recanalization employing carotid stenting and IA Abciximab. RESULTS All patients had complete cervical carotid occlusion with (n = 8) or without (n = 3) concomitant intracranial ICA and/or MCA occlusion. Successful emergent cervical ICA recanalization was achieved in all cases. All patients were administered IA Abciximab (dose range 6-17 mg, average 11.4 mg) immediately following the cervical carotid stenting. There was complete recanalization in all patients with no procedural morbidity or mortality. A single case (1/11, 9%) developed asymptomatic hemorrhagic transformation. Upon discharge, 9 patients (9/11, 82%) had a mRS of 0-2 and 2 patients (2/11, 18%) had a mRS of 3. CONCLUSIONS In acute ICA-MCA/distal ICA occlusions, extracranial stenting followed by intracranial IA Abciximab and thrombectomy appears feasible, effective, and safe. Further evaluation of this treatment strategy is warranted.
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Affiliation(s)
- Fawaz Al-Mufti
- a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA
| | - Krishna Amuluru
- a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA
| | - Nathan W Manning
- b Department of Neurosurgery , Columbia University Medical Center , New York , NY , USA
| | - Imad Khan
- c Department of Neurology , University of Maryland Medical Center , Baltimore , MD , USA
| | - Lissa Peeling
- d Department of Neurosurgery , University of Saskatchewan , Saskatoon , SK , Canada
| | - Chirag D Gandhi
- a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA
| | | | - Galyna Pushchinska
- e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA
| | - David Fiorella
- e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA
| | - Henry H Woo
- e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA
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Yeo LLL, Kong WY, Paliwal P, Teoh HL, Seet RC, Soon D, Rathakrishnan R, Ong V, Lee TH, Wong HF, Chan BPL, Leow WK, Yuan C, Ting E, Gopinathan A, Tan BYQ, Sharma VK. Intravenous Thrombolysis for Acute Ischemic Stroke due to Cervical Internal Carotid Artery Occlusion. J Stroke Cerebrovasc Dis 2016; 25:2423-9. [PMID: 27344361 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/15/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Internal carotid artery (ICA) occlusions are poorly responsive to intravenous thrombolysis with tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS). Most study populations have combined intracranial and extracranial ICA occlusions for analysis; few have studied purely cervical ICA occlusions. We evaluated AIS patients with acute cervical ICA occlusion treated with IV-tPA to identify predictors of outcomes. METHODS We studied 550 consecutive patients with AIS who received IV-tPA and identified 100 with pure acute cervical ICA occlusion. We evaluated the associations of vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and leptomeningeal collateral vessel status via 3 different grading systems, with functional recovery at 90 days, mortality, recanalization of the primary occlusion, and symptomatic intracranial hemorrhage (SICH). Modified Rankin Scale score 0-1 was defined as an excellent outcome. RESULTS The 100 patients had mean age of 67.8 (range 32-96) and median NIHSS score of 19 (range 4-33). Excellent outcomes were observed in 27% of the patients, SICH in 8%, and mortality in 21%. Up to 54% of the patients achieved recanalization at 24 hours. On ordinal regression, good collaterals showed a significant shift in favorable outcomes by Maas, Tan, or ASPECTS collateral grading systems. On multivariate analysis, good collaterals also showed reduced mortality (OR .721, 95% CI .588-.888, P = .002) and a trend to less SICH (OR .81, 95% CI .65-1.007, P = .058). Interestingly, faster treatment was also associated with favorable functional recovery (OR 1.028 per minute, 95% CI 1.010-1.047, P = .001). CONCLUSIONS Improved outcomes are seen in patients with early acute cervical ICA occlusion and better collateral circulation. This could be a valuable biomarker for decision making.
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Affiliation(s)
- Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore.
| | - Wan Yee Kong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Prakash Paliwal
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock L Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Raymond C Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Derek Soon
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Rahul Rathakrishnan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Venetia Ong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine and School of Medical Technology, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Fai Wong
- College of Medicine and School of Medical Technology, Chang Gung University, Taoyuan, Taiwan; Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Wee Kheng Leow
- Department of Computer Science, National University of Singapore, Singapore
| | - Cheng Yuan
- Department of Computer Science, National University of Singapore, Singapore
| | - Eric Ting
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Adachi K, Sadato A, Hayakawa M, Maeda S, Hirose Y. Acute carotid artery stenting in symptomatic high-grade cervical carotid artery stenosis. Neurosurg Rev 2016; 40:45-51. [DOI: 10.1007/s10143-016-0737-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
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AbuRahma A. Part Two: Against the Motion. Carotid Endarterectomy is not Safer than Stenting in the Hyperacute Period After Onset of Symptoms. Eur J Vasc Endovasc Surg 2015; 49:627-633. [DOI: 10.1016/j.ejvs.2015.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Naylor AR, AbuRahma AF. Debate: Whether carotid endarterectomy is safer than stenting in the hyperacute period after onset of symptoms. J Vasc Surg 2015; 61:1642-51. [PMID: 26004334 DOI: 10.1016/j.jvs.2015.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The carotid artery has been a regular battleground for debates regarding many issues, including appropriate management of symptomatic and asymptomatic lesions, the conduct, timing, and safety of such interventions, and now, whether endarterectomy or stenting is safer in the hyperacute period. Our discussants agree that, as a prophylactic procedure, a carotid intervention should occur early after index symptoms to prevent as many strokes as possible. However, which intervention is best?
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Affiliation(s)
- A Ross Naylor
- Vascular Research Group, Division of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester, United Kingdom.
| | - Ali F AbuRahma
- Division of Vascular Surgery & Endovascular Surgery, West Virginia University, Charleston, WVa.
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Mishra A, Stockley H, Goddard T, Sonwalker H, Wuppalapati S, Patankar T. Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke. Interv Neuroradiol 2015; 21:205-14. [PMID: 25943850 DOI: 10.1177/1591019915583213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Tandem occlusions involving both the extracranial internal carotid artery (ICA) and an intracranial artery typically respond poorly to intravenous (IV) tissue plasminogen activator (t-PA). We retrospectively review our experience with proximal ICA stenting and stent-assisted thrombectomy of the distal artery. METHODS The data included patients that underwent carotid stenting and mechanical thrombectomy between 2012-2013. Radiographic, clinical, and procedural data were drawn from case notes, imaging records and discharge reports. Clinical outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs). RESULTS Seven patients, with a mean age of 66.4 years and a mean admission NIHSS of 18.3, underwent this procedure and were included. Each presented with an occlusion of the proximal ICA, with additional occlusions of the ICA terminus (n = 3), middle cerebral artery (n = 5), or anterior cerebral artery (n = 1). Recanalisation of all identified occlusions was achieved in all patients, with a Thrombolysis in Myocardial Infarction (TIMI) score of 3 and a Thrombolysis in Cerebral Infarction (TICI) score >2b achieved in each case. Mean time from onset of stroke symptoms to recanalisation was 287 min; mean time from first angiography to recanalisation was 52 min. Intracranial haemorrhages occurred in two patients, with no increase in NIHSS. There were no mortalities. Mean NIHSS at discharge was 4.9, and mRs at 90 days was one in all patients. CONCLUSIONS Treatment of tandem extracranial ICA and intracranial occlusions in the setting of acute ischaemic stroke with extracranial carotid artery stenting followed by adjunctive intracranial mechanical thrombectomy is both safe and effective, but further evaluation of this treatment modality is necessary.
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Affiliation(s)
- Ankit Mishra
- GKT School of Medical Education, King's College London, UK
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Son S, Choi DS, Oh MK, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience. J Neurointerv Surg 2014; 7:238-44. [PMID: 24634445 DOI: 10.1136/neurintsurg-2014-011141] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The feasibility, safety and effectiveness of emergency carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to proximal internal carotid artery (ICA) stenosis or occlusion are still controversial. In this study we analyzed our experience with eCAS in patients with AIS. METHODS Twenty-two eCAS procedures for proximal ICA stenosis or occlusion were performed in 22 patients at our institution between January 2011 and November 2013. The mean time from stroke symptom onset to presentation was 204 min (range 50-630 min) and the mean initial score on the National Institutes of Health Stroke Scale (NIHSS) was 12.55 (range 5-23). Ten patients had total occlusion of the proximal ICA and the remaining 12 patients had near total occlusion or severe stenosis (mean degree 90.7%, range 80-100%). Eleven patients also had tandem occlusion on the more distal intracranial arteries. RESULTS Successful stent insertion was achieved in all patients and additional thrombectomy using a Solitaire stent or Penumbra aspiration catheter achieved a Thrombolysis In Cerebral Infarction grade of more than 2a in all patients with distal tandem occlusion. Procedure-related complications occurred in one patient (cerebral hyperperfusion syndrome) who recovered successfully. The mean NIHSS score at discharge was 3.55 (range 0-18). The mean modified Rankin Scale score at 3 months was 1 ± 1.67 (range 0-6). CONCLUSIONS eCAS in patients with AIS due to proximal ICA stenosis or occlusion appears to be a technically feasible and effective method for achieving good clinical outcomes.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea
| | - Dae Seob Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Kyun Oh
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea Rehabilitation Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki-Jong Park
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byeong Hoon Lim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Ratanaprasatporn L, Grossberg JA, Spader HS, Jayaraman MV. Endovascular treatment of acute carotid occlusion. Clin Neurol Neurosurg 2013; 115:2521-3. [PMID: 24239517 DOI: 10.1016/j.clineuro.2013.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Acute cervical carotid occlusion is one of the most challenging scenarios encountered in endovascular stroke treatment. PATIENTS AND METHODS A retrospective analysis of 11 consecutive non-dissection stroke patients with concomitant cervical carotid and intracranial occlusion treated with intraarterial (IA) mechanical thrombectomy and/or pharmacologic thrombolysis over five years at two academic hospitals was performed. Data was analyzed using Fisher's exact test. RESULTS Patients included 3 females and 8 males. Average age was 64.7 years (range 30-94 years). All patients had both cervical carotid and intracranial occlusions. Intracranial occlusion involved the internal carotid artery in 7 patients and the middle cerebral artery in 4 patients. All of the patients received intracranial IA Tissue Plasminogen Activator (tPA). Six patients received carotid stents for cervical occlusion as part of their treatment. Five patients received only IA tPA via collateral circulation. Of the patients receiving stents, 5 of 6 (83.3%) had successful recanalization (Thrombolysis in Cerebral Ischemia 2b or 3 flow). Only 1 of 5 (20%) patients who did not receive stents prior to intracranial treatment had successful recanalization. The difference in recanalization rates approached statistical significance (p=.08). There were 4 total in-hospital mortalities: 2 in the group that received stents prior to thrombolysis and 2 in the non-stent group. There were 2 clinically significant hemorrhages in the study, both in the stent group. CONCLUSIONS Revascularization of the cervical carotid occlusion prior to treatment of the intracranial occlusion led to increased rates of recanalization in patients with tandem extracranial and intracranial occlusions. Whether a clinical benefit can be consistently derived likely relies on other factors, including the evaluation of cerebral perfusion.
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Affiliation(s)
- L Ratanaprasatporn
- Departments of Radiology and Neurosurgery, Brown University, Rhode Island Hospital, 593 Eddy Street, APC 6, Providence, USA
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Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3199] [Impact Index Per Article: 290.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
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Carotid stenting in acute ischemic stroke patients with intraluminal thrombus. Neuroradiology 2010; 53:773-8. [PMID: 21052654 DOI: 10.1007/s00234-010-0788-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/19/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Carotid stenosis with intraluminal thrombus is associated with a high risk of early recurrent stroke. We evaluated the feasibility and outcome of carotid stenting in acute ischemic stroke patients with carotid stenosis and intraluminal thrombus. METHODS Among 295 consecutive acute ischemic stroke patients who were referred for intra-arterial thrombolytic (IAT) therapy, six patients with carotid stenosis and intraluminal thrombus were treated by stent assisted angioplasty. The clinical characteristics, feasibility, and clinical outcomes were assessed. RESULTS All patients had severe stenosis of the underlying carotid bulb (mean, 86.8%; range, 71-99%) with adjacent intraluminal thrombus. Stent assisted angioplasty resulted in successful recanalization in all six patients. Thrombus was captured with the filter device in four patients. Three patients with tandem occlusion of the ipsilateral proximal middle cerebral artery were successfully recanalized with intra-arterial urokinase. No patients suffered procedure related complications or symptomatic hemorrhage. Four patients showed good long-term outcome (3 month mRS; 0-2). CONCLUSIONS Stent assisted angioplasty is a feasible treatment option for acute ischemic stroke patients caused by carotid stenosis with intraluminal thrombus and may be effective in preventing early recurrent stroke.
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Affiliation(s)
- David M. Pelz
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
| | - Elad I. Levy
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
| | - L. Nelson Hopkins
- From the University Hospital (D.M.P.), London Health Sciences Centre, Departments of Diagnostic Radiology and Nuclear Medicine, and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Department of Neurosurgery (E.I.L., L.N.H.), Millard Fillmore Gates Hospital, Kaleida Health; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York,
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