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Teivane A, Jurjāns K, Vētra J, Grigorjeva J, Kupcs K, Masiliūnas R, Miglāne E. Tenecteplase or Alteplase Better in Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Single Center Observational Study. Medicina (Kaunas) 2022; 58:1169. [PMID: 36143846 DOI: 10.3390/medicina58091169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The study aimed to investigate the efficacy of intravenous thrombolysis with Tenecteplase before thrombectomy for acute ischemic stroke (AIS) patients compared with previous results using Alteplase. Previous trials for Tenecteplase have indicated an increased incidence of vascular reperfusion. In April 2021, we started to primarily give Tenecteplase to patients eligible to undergo thrombectomy. Materials and Methods: In this retrospective observational single-center non-randomized study, we analyzed directly admitted patients with AIS who had occlusion of the internal carotid, middle cerebral, or basilar artery and who underwent thrombectomy, as well as the recanalization rate for these patients at the first angiographic assessment (mTICI score 2b–3), and complications. Results: We included 184 patients (demographic characteristics did not differ between Tenecteplase and Alteplase groups (mean age 68.4 vs. 73.0 years; female sex 53.3% vs. 51.1%, NIHSS 14 (IQR 4–26) vs. 15 (2–31). Forty-five patients received Tenecteplase and 139 Alteplase before endovascular treatment (EVT). Pre-EVT (endovascular treatment) recanalization was more likely to occur with Tenecteplase rather than Alteplase (22.2% vs. 8.6%, p = 0.02). Successful reperfusion (mTICI 2b–3) after EVT was achieved in 155 patients (42 (93.4%) vs. 113 (81.3), p = 0.07). Hemorrhagic imbibition occurred in 15 (33.3%) Tenecteplase-treated patients compared with 39 (28.1%) Alteplase-treated patients (p = 0.5). Patients treated with Tenecteplase had higher odds of excellent functional outcome than Alteplase-treated patients (Tenecteplase 48.6% vs. Alteplase 26.1%; OR 0.37 (95% CI 0.17–0.81), p = 0.01). Conclusions: Tenecteplase (25 mg/kg) could have superior clinical efficacy over Alteplase for AIS patients with large-vessel occlusion (LVO), administered before EVT. The improvement in reperfusion rate and the better excellent functional outcome could come without an increased safety concern.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hause S, Oldag A, Breja A, Neumann J, Wilcke J, Schreiber S, Heinze HJ, Skalej M, Halloul Z, Goertler M. Acute symptomatic extracranial internal carotid occlusion - natural course and clinical impact. VASA 2019; 49:31-38. [PMID: 31621550 DOI: 10.1024/0301-1526/a000826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: To assess the vascular and clinical course of acute symptomatic extracranial internal carotid artery (ICA) occlusion. Patients and methods: Patients with an acute ischemic event in the anterior circulation and corresponding extracranial ICA occlusion at CT angiography and/or color-coded duplex sonography underwent recurrent duplex follow-up for detection of spontaneous recanalization. Stroke recurrence and functional outcome 4.5 months after the ischemic index event assessed by modified Rankin scale served as secondary outcome parameters. Results: 133 patients (91 men, mean age 62.3 years, SD 10.8) demonstrated symptomatic occlusion of the extracranial ICA with open intracranial ICA and open middle cerebral artery and were followed-up for spontaneous recanalization. Twenty-eight recanalized spontaneously, 25 to high-grade focal stenosis within 12 days, revealing an early cumulative recanalization rate of 23 %. Detection of recanalization was independently associated with de novo dual anti-platelet therapy (adjusted odds ratio [OR], 3.24; 95 % confidence interval [CI], 1.34 to 7.80). Ischemic recurrence occurred in 16 patients, of which 10 deemed to be embolic and 5 hemodynamic. Spontaneous ICA recanalization and an exhausted cerebrovascular reserve in the hemisphere distal to the occluded ICA were both independently associated with the occurrence of a recurrent ischemic event at Cox regression. An increasing NIHSS score at admission, a decreasing middle cerebral artery flow velocity and an ischemic recurrence independently predicted poor outcome (modified Rankin scale 3 to 6) in multivariate analysis. Conclusions: Acute symptomatic extracranial ICA occlusion is an unstable condition with frequent spontaneous recanalization to severe stenosis and early embolic stroke recurrence, demanding appropriate prevention especially in those patients with only mild deficit.
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Affiliation(s)
- Stephan Hause
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Andreas Oldag
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Andrea Breja
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Jens Neumann
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Juliane Wilcke
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Stefanie Schreiber
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Martin Skalej
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Institute of Neuroradiology, Magdeburg University Hospital, Magdeburg, Germany
| | - Zuhir Halloul
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of General, Abdominal and Vascular Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Michael Goertler
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
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Takeda Y, Kimura T, Ichi S. Fluctuating patency of atherosclerotic cervical internal carotid artery treated by carotid endarterectomy successfully: a case report. Br J Neurosurg 2019:1-3. [PMID: 31204515 DOI: 10.1080/02688697.2019.1629392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Spontaneous recanalization of an atherosclerotic internal carotid artery (ICA) occlusion has been previously reported as a rare phenomenon, but spontaneous re-occlusion shortly after recanalization under antiplatelet therapy has not been documented yet. A 63-year-old man presented with impaired consciousness and left-sided hemiparesis. Magnetic resonance imaging showed new infarction in the right middle cerebral artery territory because of right cervical internal carotid artery occlusion, which became spontaneously patent on computed tomography angiography on the sixth day of admission. So carotid endarterectomy was planned. However, the ICA was recurrently occluded on the preoperative magnetic resonance angiogram three weeks later on admission, which condition was also confirmed during the subsequent surgery. In patients with severe ICA stenosis, patency may dynamically change even under antiplatelet therapy.
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Affiliation(s)
- Yasuhiro Takeda
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Toshikazu Kimura
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Shunsuke Ichi
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
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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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Panigrahi NK, Raju J, Baruah DK, Srinivas M, Varma RK. Extraluminal Migration of a Drug-Eluting Stent Into a Thrombosed Coronary Aneurysm With Preserved Antegrade Flow in the Right Coronary Artery. JACC Cardiovasc Interv 2017; 10:834-836. [PMID: 28365264 DOI: 10.1016/j.jcin.2017.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | - Jagannadh Raju
- Department of Cardiolgy, Apollo Hospital, Visakhapatnam, India
| | | | - Metta Srinivas
- Department of Radiology, Apollo Hospital, Visakhapatnam, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
INTRODUCTION Definitive treatment of symptomatic atheromatous internal carotid artery occlusion remains controversial, as far as in rare cases, late spontaneous recanalization has been seen. METHODS We consecutively studied 182 patients (January 2003 to August 2012) with an ischemic stroke in the internal carotid artery territory and diagnosis of atheromatous internal carotid artery occlusion during hospitalization. FINDINGS Seven patients presented a late spontaneous recanalization (>3 months) of the internal carotid artery. We described therapeutic attitude according to usual care in these patients. CONCLUSIONS The authors attempt to highlight the unusual condition of recanalization after a symptomatic atheromatous chronic internal carotid artery occlusion. If these patients can be treated similar to patients with asymptomatic carotid pathology, then this needs to be clarified. However, due to the risk of ipsi- and contralateral ischemic strokes, revascularization techniques should be considered in certain cases. More studies are needed to establish the most appropriate therapeutical approach in order to avoid arbitrary treatment of these patients.
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Affiliation(s)
- Montserrat G Delgado
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro P Vega
- Department of Radiology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos H Lahoz
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergio Calleja
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
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