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Hou Z, Cui R, Yu Y, Ma N. Endovascular Thrombectomy for a Progressive Stroke Patient With a High-Burden Carotid Free-Floating Thrombus. Ann Neurol 2024; 95:362-364. [PMID: 37845593 DOI: 10.1002/ana.26820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Carotid free-floating thrombus (FFT) is a rare cause of acute ischemic events. The optimal management of carotid FFT remains unclear. The optimal and individualized management of carotid FFT should be determined based on the underlying etiology, clinical manifestation, and imaging characteristics. we reported a case with endovascular thrombectomy for a progressive stroke patient with a high-burden carotid free-floating thrombus. ANN NEUROL 2024;95:362-364.
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Affiliation(s)
- Zhikai Hou
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rongrong Cui
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Daxing District People's Hospital, Beijing, China
| | - Ying Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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2
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Lioudaki S, Kontopodis N, Pontikoglou C, Gkalea V, Pappas T, Matsouka C, Papadaki E, Ioannou CV. Multiple Sites of Arterial Thrombosis in A 35-Year Old Patient after ChAdOx1 (AstraZeneca) Vaccination, Requiring Emergent Femoral and Carotid Surgical Thrombectomy. Ann Vasc Surg 2021; 79:438.e1-438.e4. [PMID: 34644642 DOI: 10.1016/j.avsg.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a rare complication following ChAdOx1 (AstraZeneca) vaccination. Venous thrombosis in unusual sites such as splachnic or intracranial thrombosis, is the commonest manifestation. CASE REPORT We report a 35-year-old male patient who presented with acute left leg ischemia and thrombocytopenia 11-days after vaccination requiring emergent thrombectomy. During work-up, a localized thrombus was detected in the left carotid bifurcation mandating carotid thrombectomy. Localized right iliac thrombus causing a non-limiting flow stenosis was treated conservatively. The platelet aggregating capacity of patient's plasma was confirmed in a functional assay, thereby establishing VITT. CONCLUSION To the best of our knowledge this is the first case presenting multiple arterial thromboses requiring surgical treatment after ChAdOx1 vaccination.
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Affiliation(s)
- Stella Lioudaki
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece.
| | | | - Vasiliki Gkalea
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Thomas Pappas
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Charis Matsouka
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Eleni Papadaki
- Hematology Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece
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Khanna O, Hafazalla K, Saiegh FA, Tahir R, Schunemann V, Theofanis TN, Mouchtouris N, Gooch MR, Tjoumakaris S, Rosenwasser RH, Jabbour PM. Simultaneous bilateral mechanical thrombectomy in a patient with COVID-19. Clin Neurol Neurosurg 2021; 206:106677. [PMID: 34020326 PMCID: PMC8117485 DOI: 10.1016/j.clineuro.2021.106677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
Owing to systemic inflammation and widespread vessel endotheliopathy, SARS-CoV-2 has been shown to confer an increased risk of cryptogenic stroke, particularly in patients without any traditional risk factors. In this report, we present a case of a 67-year-old female who presented with acute stroke from bilateral anterior circulation large vessel occlusions, and was incidentally found to be COVID-positive on routine hospital admission screening. The patient had a large area of penumbra bilaterally, and the decision was made to pursue bilateral simultaneous thrombectomy, with two endovascular neurosurgeons working on each side to achieve a faster time to recanalization. Our study highlights the utility and efficacy of simultaneous bilateral thrombectomy, and this treatment paradigm should be considered for use in patients who present with multifocal large vessel occlusions.
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Affiliation(s)
- Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karim Hafazalla
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rizwan Tahir
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Victoria Schunemann
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Thana N Theofanis
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Tsuji Y, Yoshida T, Shimizu F, Kimura S, Yagi R, Hiramatsu R, Wanibuchi M. Clinical Result of Mechanical Thrombectomy Using Sofia Plus with Acute Ischemic Stroke Compared with the Stent Retriever. World Neurosurg 2021; 149:e11-e15. [PMID: 33652131 DOI: 10.1016/j.wneu.2021.02.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Sofia catheter is a new large-bore aspiration catheter that allows easy access and good reperfusion. In this study, we analyzed the efficacy and safety of the Sofia catheter in comparison with stent retrievers as a contact aspiration thrombectomy (CAT) tool for large vessel occlusion. METHODS We enrolled patients with acute ischemic stroke who underwent endovascular thrombectomy from April 2017 and April 2020 in our hospital. Patients were retrospectively reviewed and divided into the stent retriever group (SR), the Sofia group, and all cases group. RESULTS A total of 114 patients were treated during the study period, including 27 in the stent retriever group and 15 in the Sofia group. Higher rates of the first-pass effect (FPE) (37% vs. 47%, P = 0.12) and significantly higher modified FPE (44% vs. 67%, P = 0.001) were observed in patients with SR and Sofia, respectively. Functional independence (modified Rankin Scale ≤2) at 30 days after onset was observed in 30% versus 47% (P = 0.47) of SR and Sofia, respectively. CONCLUSIONS The Sofia Plus is a large-bore aspiration catheter with high FPE and good accessibility. Use of this catheter resulted better angiographic outcome compared with the stent retriever, but there was no difference in clinical outcomes in this study. Further studies are needed to compare in new generation aspiration catheters.
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Affiliation(s)
- Yuichiro Tsuji
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | | | | | - Seigo Kimura
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Melnick KF, Winton J, Corliss BM, Fox WC, Hoh BL, Polifka AJ. Off-Label Utilization of Syphontrak Catheter for Mechanical Thrombectomy in Acute Stroke. World Neurosurg 2020; 143:e106-e111. [PMID: 32653512 DOI: 10.1016/j.wneu.2020.06.235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not known whether aspiration-specific catheters are necessary for successful mechanical thrombectomy, but if not, off-label use of more versatile catheters could offer significant cost savings over specialized aspiration catheters. The Syphontrak (Depuy Synthes, Raynham, MA, USA) support catheter is designed for introduction of devices into distal neurovasculature but is not specifically indicated for use in mechanical thrombectomy. We sought to compare our experience using this catheter to historical controls to show the non-inferiority of aspiration achieved. METHODS Data were collected retrospectively on patients who underwent mechanical thrombectomy using the Syphontrak catheter for aspiration at our institution. Patient demographics, procedure characteristics, and outcome information was recorded. Results were compared to five landmark studies on mechanical thrombectomy: MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND-IA. RESULTS There were 63 patients who underwent mechanical thrombectomy for anterior circulation ischemic stroke. Despite significantly older patients and greater time from symptom onset to groin puncture, Thrombolysis in Cerebral Infarction grade 2B or 3 reperfusion was achieved in significantly more patients than in MR CLEAN, ESCAPE, and REVASCAT. Development of symptomatic intracranial hemorrhage occurred in 6.4% of patients, which was not significantly different from MR CLEAN, ESCAPE, REVASCAT, and EXTEND-IA. Mortality was 19.1%, which was not significantly different from any of the trials. CONCLUSIONS These data support the off-label use of distal intracranial support catheters for this mechanical thrombectomy, which may result in significant cost savings over aspiration-specific catheters, especially in low-volume centers.
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Affiliation(s)
- Kaitlyn F Melnick
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
| | - Jesse Winton
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Brian M Corliss
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - W Christopher Fox
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Brian L Hoh
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Adam J Polifka
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
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Affiliation(s)
- Jonathan Gomez
- Department of Neurology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Stacey Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Abstract
RATIONALE Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump. PATIENT CONCERNS A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted to evaluate collateral circulation, intraluminal composition, and shape of the carotid stump. DIAGNOSES The patient was diagnosed with cerebral infarction and right carotid stump syndrome. INTERVENTION The patient underwent interventional recanalization of the occluded internal carotid artery, which relieved his symptoms and led to satisfactory therapeutic outcomes during the clinical follow-up. OUTCOMES A 9-month clinical follow-up revealed no stroke recurrence. LESSONS Interventional recanalization for the carotid artery stump syndrome is feasible. Accurate preoperative evaluation including collateral circulation, intraluminal composition, and shape of the carotid stump can assure a successful vascularization and guided management.
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Affiliation(s)
- Ziqi Xu
- Department of Neurology, The First Affiliated Hospital of College of Medicine
| | - Jinhua Wang
- Department of Neurology Beilun Branch of The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, The First Affiliated Hospital of College of Medicine
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Huh IY, Han IS, Lee HK, Shin YJ, Lee JM. Recurrent thrombosis after carotid endarterectomy secondary to activated protein C resistance and essential thrombocytosis: A case report. Medicine (Baltimore) 2018; 97:e13118. [PMID: 30383703 PMCID: PMC6221756 DOI: 10.1097/md.0000000000013118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Thrombosis is a major cause of morbidity in the perioperative period. Although many risk factors are known, activated protein C resistance is a prominent risk for thrombosis. Activated protein C resistance frequently occurs with recurrent thromboembolism. PATIENT CONCERNS A 59-year-old Korean woman patient with hypertension was admitted due to dysarthria and left side motor weakness. DIAGNOSIS AND INTERVENTIONS Magnetic resonance imaging showed subacute cerebral infarction with right frontoparietal lobe and stenosis at the right internal carotid artery. She underwent right carotid endarterectomy under general anesthesia. However, recurrent thrombosis on postoperative day 1 was noted at patient's right carotid artery, which prompted emergency surgery. Additional preoperative laboratory review revealed findings for activated protein C resistance, low protein S activity, antinuclear antibody (>1:160), anti-cardiolipin IgM antibody (16.6), and thrombocytosis, Janus kinase and factor V Leiden mutations. At the intensive care unit, heparin was continually infused until postoperative day 12 and was then switched to warfarin. OUTCOMES Patient was discharged at postoperative day 21 without any event. Patient had no signs of recurrence within the 3-year follow-up period, and she is still on oral warfarin and clopidogrel. LESSONS Screening test for hypercoagulability can be used to identify patients at higher risk of postoperative complications. If hypercoagulability state is confirmed by laboratory testing, a suitable anticoagulant treatment plan should be made within the perioperative period.
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Lindekleiv H, Berge E, Bruins Slot KMH, Wardlaw JM. Percutaneous vascular interventions versus intravenous thrombolytic treatment for acute ischaemic stroke. Cochrane Database Syst Rev 2018; 10:CD009292. [PMID: 30365156 PMCID: PMC6516947 DOI: 10.1002/14651858.cd009292.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Most ischaemic strokes are caused by blockage of a cerebral artery by a thrombus. Intravenous administration of recombinant tissue plasminogen activator given within 4.5 hours is now standard treatment for this condition. Percutaneous vascular interventions use an intra-arterial, mechanical approach for thrombus disruption or removal (thrombectomy). Recent randomised trials indicate that percutaneous vascular interventions are superior to usual care (usual care usually included intravenous thrombolysis). However, intravenous thrombolysis was usually given in both arms of the trial and there was a lack of direct comparison of percutaneous vascular interventions with intravenous thrombolysis. OBJECTIVES To assess the effectiveness and safety of percutaneous vascular interventions compared with intravenous thrombolytic treatment for acute ischaemic stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last search: August 2018). In addition, in September 2017, we searched the following electronic databases: CENTRAL, MEDLINE, Embase, and Science Citation Index; and Stroke Trials Registry, and US National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) that directly compared a percutaneous vascular intervention with intravenous thrombolytic treatment in people with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors applied the inclusion criteria, extracted data, and assessed risk of bias. We obtained both published and unpublished data. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included four trials with 450 participants. Data on functional outcome and death at end of follow-up were available for 443 participants from three trials. Compared with intravenous thrombolytic therapy, percutaneous vascular intervention did not improve the proportion of participants with good functional outcome (modified Rankin Scale score 0 to 2, risk ratio (RR) 1.01, 95% confidence interval (CI) 0.82 to 1.25, P = 0.92). The quality of evidence was low (outcome assessment was blinded, but not the treating physician or participants). At the end of follow-up, there was a non-significant increase in the proportion of participants who died in the percutaneous vascular intervention group (RR 1.34, 95% CI 0.84 to 2.14, P = 0.21). The quality of evidence was low (wide confidence interval). There was no difference in the proportion of participants with symptomatic intracranial haemorrhages between the intervention and control groups (RR 0.99, 95% CI 0.50 to 1.95, P = 0.97). The quality of evidence was low (wide confidence interval). Data on vascular status (recanalisation rate) were only available for seven participants from one trial; we considered this inadequate for statistical analyses. AUTHORS' CONCLUSIONS The present review directly compared intravenous thrombolytic treatment with percutaneous vascular interventions for ischaemic stroke. We found no evidence from RCTs that percutaneous vascular interventions are superior to intravenous thrombolytic treatment with respect to functional outcome. Quality of evidence was low (outcome assessment was blinded, but not the treating physician or participants). New trials with adequate sample sizes are warranted because of the rapid development of new techniques and devices for such interventions.
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Affiliation(s)
| | - Eivind Berge
- Oslo University HospitalDepartment of Internal MedicineOsloNorwayNO‐0407
| | | | - Joanna M Wardlaw
- University of EdinburghCentre for Clinical Brain SciencesThe Chancellor's Building49 Little France CrescentEdinburghUKEH16 4SB
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Santoro L, Schinzari F, Di Veronica A, Cardillo C, Santoliquido A. Carotid free-floating thrombus in woman with meningioma: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2015; 19:1442-1445. [PMID: 25967719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Several reports have previously described the coexistence of severe carotid artery disorders and brain tumors, in particular meningioma, mainly consisting of arterial occlusion or obstruction due to direct compression by tumor mass, with possible presence of transient neurological symptoms as well as complete cerebral infarction. Free-floating thrombus (FFT) is an uncommon condition, characterized by the presence of thrombotic material partially attached to the arterial wall with evidence of heartbeat associated floating. To our knowledge, our case represents the first report in literature about presence of internal carotid FFT in patient affected by meningioma. CASE REPORT In this report, sharing singular images and videos of this uncommon condition, we present the first case of a right internal carotid artery FFT in a 59-year-old woman affected by meningioma, successfully treated with antiplatelet medication together with anticoagulation and high dose of statins. CONCLUSIONS Our case confirms the possible association between carotid artery disorders and meningioma, involving for the first time a FFT. These findings make desirable to explore carotid district in patients with brain tumors, especially meningioma, even if symptoms suggestive of ischemic suffering are not present, in order to make an early diagnosis, so preventing marked ischemic events.
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Affiliation(s)
- L Santoro
- Department of Internal Medicine, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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Kim YW, Kang DH, Hwang JH, Park J, Hwang YH, Kim YS. Rescue strategy for acute carotid stent thrombosis during carotid stenting with distal filter protection using forced arterial suction thrombectomy with a reperfusion catheter of the Penumbra System: a technical note. Acta Neurochir (Wien) 2013; 155:1583-8. [PMID: 23689967 DOI: 10.1007/s00701-013-1744-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among the procedural complications related to carotid artery stenting (CAS), internal carotid artery (ICA) flow arrest is one of the most drastic complications, as it can cause major ischemic stroke. Acute carotid stent thrombosis (ACST) is a rare etiology of ICA flow arrest during carotid artery stenting with distal filter protection, but the most devastating. Moreover, no definitive management strategy has been established so far for treating ACST. METHODS We introduce a rescue management strategy for differential diagnosis of ICA flow arrest and for recanalization of ACST with a simple endovascular mechanical thrombectomy technique. RESULTS In three cases of ICA flow arrest caused by ACST, selective angiography with a 1.7 F microcatheter provided confirmative diagnosis. Recanalization was then achieved with a Penumbra System (PS) reperfusion catheter using the forced arterial suction thrombectomy (FAST) technique. Successful recanalization with a Thrombolysis In Cerebral Infarction score of 3 was achieved for all three patients. Recanalization was confirmed with follow-up angiography at least 24 h after the procedure. No complications associated with this technique occurred. CONCLUSIONS Based on our preliminary experiences, selective microangiography can be helpful for rapid diagnosis of ACST, and the present mechanical thrombectomy technique, using a modification of the PS, can play a role in adjuvant management or as a last resort for the treatment of ACST during CAS.
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Affiliation(s)
- Yong-Won Kim
- Department of Neurology, Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Republic of Korea
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12
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Tatli E, Barutcu A, Gazi E, Gunduz Y. Covered stents may provide extra protection during carotid artery stenting in high risk patients with an excessive thrombus burden. BMJ Case Rep 2013; 2013:bcr2013010258. [PMID: 23904425 PMCID: PMC3736395 DOI: 10.1136/bcr-2013-010258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Carotid artery disease is an important cause of mortality and morbidity related to atherosclerosis. Recently, percutaneous intervention procedures have been widely used to treat atherosclerotic carotid artery disease. We report the case of a 57-year-old male patient with a history of acute amaurosis fugax. Carotid angiography was performed as blood pressure differed between his left and right arms and there was a pan-systolic murmur on the left common carotid artery. Total occlusion of the proximal right brachiocephalic artery and a thrombus occluding 90-99% of the left internal carotid artery were detected by carotid angiogram. A self-expanding graft-covered stent was successfully implanted and there were no complications. This case shows that graft-covered stents may be a good alternative technique in special situations.
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Affiliation(s)
- Ersan Tatli
- Department of Cardiology, Ada Tıp Hospital, Sakarya, Turkey.
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13
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Bustamante A, Moniche-Alvarez F, Gonzalez-Marcos JR, Gutierrez I, Mayol A, Gonzalez-Garcia A. [Recurring arterial reocclusion following endovascular recanalisation in a patient with protein S deficiency]. Rev Neurol 2013; 57:44-45. [PMID: 23799601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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14
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Santhosh K, Joseph S. Manual aspiration thrombectomy through balloon tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion. Neuroradiology 2012; 54:1287. [PMID: 22836714 DOI: 10.1007/s00234-012-1072-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/12/2012] [Indexed: 11/24/2022]
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15
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Guida D, Biraschi F, Francione G, Orzi F, Fantozzi LM. Hemichorea-hemiballism syndrome following a thrombo-embolic striatal infarction. Neurol Sci 2012; 34:599-601. [PMID: 22532104 DOI: 10.1007/s10072-012-1098-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/12/2012] [Indexed: 11/24/2022]
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Ivancić A, Medved I, Cicvarić T, Protić A, Marinović M, Pavlović N. Perioperative and early postoperative neurological deficit in older patients during carotid artery thrombendarterectomy. Coll Antropol 2010; 34 Suppl 2:205-208. [PMID: 21305736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke prevention. Between 2006 and 2009, 209 patients underwent surgical intervention at the Clinical Hospital Center in Rijeka for high degree of carotid artery narrowing. In the group younger than 65 years of age, which consisted of 53 patients, a neurological deficit was noted in 4 patients (7.54%) in the perioperative and early postoperative course. In the group of individuals older than 65 years of age, which consisted of 156 patients, a neurological deficit was noted in 9 patients (5.76%). There was no significant statistical difference in the incidence of neurological deficit, nor in the mortality in individuals older than 65 years of age during carotid arteries thrombendarterectomy.
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Affiliation(s)
- Aldo Ivancić
- Department of Surgery, University Hospital of Rijeka, Rijeka, Croatia.
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Rader M, Ramsay P, Maxwell R, Baxter B. Internal carotid artery thrombosis after blunt trauma--salvage therapy with the penumbra thrombectomy system. Am Surg 2010; 76:343-345. [PMID: 20349674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Stamers K, Skagers A, Pastars K, Tomisheva N, Ratniece M. Functional activity of rabbit salivary glands in reduced and restored regional arterial blood supply conditions. Stomatologija 2010; 12:28-32. [PMID: 20440094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Although the vascular pathology of carotid arteries is widespread, the function of salivary glands in reduced arterial flow conditions is not much investigated clinically and in experiments. At the same time blood supply is a keystone to normal functioning of every organ and especially of salivary secretion. The aim of this study was to estimate functional activity of salivary glands in reduced and restored blood supply conditions in experiment by sialoscintigraphy which is an approved method for functional assessment of salivary glands. METHODS The ligature of a. carotis communis dextra was performed on 20 Californian rabbits. After 28 days sialoscintigraphy with Tc99 pertechnetate and revascularization through resection of the occluded part of a. carotis communis and reconstruction with venous autograft was performed. One month later sialoscintigraphy was done. RESULTS The functional activity of rabbit salivary glands after the ligature of a. carotis communis is strongly depressed. The revascularized glands accumulated isotope slowly, but the level of accumulation was higher than on the control side. CONCLUSION The ligature and reconstruction of a common carotid artery on rabbits confirm the important role of the arterial blood supply in functional activity of salivary glands and may be an appropriate experimental model for investigation of ischemic disease of salivary glands.
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Affiliation(s)
- Kaspars Stamers
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, Latvia.
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19
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Randakeviciene G, Gleizniene R, Rastenyte D, Lukosevicius S. Secondary thrombosis of the left internal carotid artery caused by a motor vehicle accident: a radiological case. Medicina (Kaunas) 2010; 46:275-281. [PMID: 20571296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A rare case of occlusion of the internal carotid artery following a motor vehicle accident in a 34-year-old female victim who initially presented with clear consciousness and had normal computed tomogram of the brain is reported. Seven hours after the accident, the patient was unexpectedly diagnosed with the left hemisphere infarction, and two days later, she suffered from right hemiplegia and coma. The follow-up brain computed tomography scan showed an acute infarction of the left hemisphere of the cerebrum and severe cerebral edema. Anticoagulation therapy was administered, and emergency craniotomy for brain decompression was carried out. After 3.5 months, she was discharged and underwent regular follow-up in the outpatient department. Four years after the motor vehicle accident, the patient had intact awareness, was functionally independent, but remained with motor aphasia, right hand paralysis, and right leg paresis.
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Affiliation(s)
- Goda Randakeviciene
- Department of Radiology, Kaunas University of Medicine, 50009 Kaunas, Lithuania
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20
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Knobloch K, Beil C, Wilhelmi M, Jagodzinski M, Gerich T. A catastrophic car crash: right main bronchial rupture with concomitant thrombosis of the right carotid artery, vertebral artery dissection, and dislocated cervical spine fracture. J Trauma 2009; 66:587. [PMID: 19204539 DOI: 10.1097/ta.0b013e318034302e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Karsten Knobloch
- Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Germany.
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21
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Tonev A, Stojanov N, Zahariev T. [Hyperperfusion syndrome after carotid endarterectomy]. Khirurgiia (Mosk) 2009:54-56. [PMID: 20509526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hyperperfusion syndrome is a complication with frequency about 3 per cent and unclear etiological factors who mostly lead to hard neurological deficit and/or death for the patient. Symptoms are headaches, fits, confusion, focal neurological sings to intracerebral hemorrhage. The prevention and control are accomplished by active monitoring of intracranial blood flow and systolic blood pressure. Hyperperfusion syndrome can be clinicaly performed with or without hemorrhage. We present a case of hyperperfusion syndrome after carotid endarterectomy of 59-years-old man operated at the Department of Vascular surgery and Angiology of "St. Ekaterina" hospital. The patient had thrombosis of one carotid artery and stenosis of the other and two old cerebral infarctions. In the early postoperative period the patient developed a clinical picture of awake coma with quadriparesis and right plegia. On the 14-th day after the surgical intervention the patient left the clinic in better condition and was directed to his neurologist for observation.
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Maksimović ZV, Jakovljević N, Putnik S, Jadranin D, Marković D, Koncar I. Simultaneous surgical treatment of ruptured abdominal aortic aneurysm and acute carotid occlusive disease. Acta Chir Iugosl 2009; 56:101-103. [PMID: 19504997 DOI: 10.2298/aci0901101m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Combined rupture of abdominal aortic aneurysm and acute thrombosis of internal carotid artery is extremely rare but fatal combination resulting in high mortality rate. Presented case, shows successfully performed simultaneous surgery of ruptured abdominal aortic aneurysm and acute cerebrovascular insult caused by thrombosis of carotid artery in 81 year-old male. Post operative course was uneventfull. At 24 months follow up patient was in good condition, with full neurological recovery. Simultaneous surgical treatment of acute occlusive carotid disease and ruptured abdominal aortic aneurysm (RAAA) seems to be the only life saving procedure for this rare, but very complicated condition. To our knowledge, this is the first reported successful simultaneous surgical treatment of RAAA and acute thrombosis of internal carotid artery.
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Affiliation(s)
- Z V Maksimović
- Department of Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade
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23
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Holt PJE, Poloniecki JD, Loftus IM, Thompson MM. The Relationship between Hospital Case Volume and Outcome from Carotid Endartectomy in England from 2000 to 2005. Eur J Vasc Endovasc Surg 2007; 34:646-54. [PMID: 17892955 DOI: 10.1016/j.ejvs.2007.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 07/22/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the outcome of carotid endarterectomy in England with respect to the hospital case-volume. METHODS Data were from English Hospital Episode Statistics (2000-2005). Admissions were classified as elective or emergency. Risk-adjusted data were analysed through modelling of death rate, complication rate and length of admission with regard to the year of procedure and annual hospital volume of surgery. Hospitals with elevated death rates were identified and the evidence quantified that they had outlying mortality rates. RESULTS There were 280,081 diagnoses of extra-cranial atherosclerotic arterial disease in which 18,248 CEA were performed. The mean mortality rates were 1.04% for elective and 3.16% for emergency CEA. A volume-related improvement in mortality (p=0.047) was seen for elective CEA. Length of stay decreased as annual volume increased for elective and emergency CEA (p<0.001). 20% of the operations were performed in 67.1% of the hospitals, each of which performed fewer than 10 CEA per annum. A number of hospitals had elevated death rates. CONCLUSIONS Volume-related improvements in outcome were demonstrated for elective CEA. Minimum volume-criteria of 35 CEA per annum should be established in England. Hospitals performing low annual volumes of surgery should consider arrangements to network services.
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Affiliation(s)
- P J E Holt
- St George's Vascular Institute, 4th floor, St James' Wing, St George's Hospital, London SW17 0QT, UK.
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24
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Abstract
Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its principal branches, leading to narrowing and occlusion of the vessels. Since the clinical manifestations depend on the location and severity of the lesions, stroke may be the initial presentation of the disease. Here we report the case of a young man with TA and complete thrombotic occlusion of the right common carotid artery who underwent surgical intervention at our institution. His postoperative computed tomography angiogram performed after 3 months revealed also total occlusion of the left anterior descending coronary artery from its proximal portion.
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Affiliation(s)
- Melih Hulusi
- Cardiovascular Surgery Department, GATA Military Training Hospital, Istanbul, Turkey
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25
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Flint AC, Duckwiler GR, Budzik RF, Liebeskind DS, Smith WS. Mechanical thrombectomy of intracranial internal carotid occlusion: pooled results of the MERCI and Multi MERCI Part I trials. Stroke 2007; 38:1274-80. [PMID: 17332445 DOI: 10.1161/01.str.0000260187.33864.a7] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute stroke from occlusion of the intracranial internal carotid artery (ICA) generally has a poor prognosis and appears to respond poorly to intravenous thrombolysis. Mechanical thrombectomy is a newly available modality for acute stroke therapy, but it is unknown whether this endovascular therapy may have a role in the specific setting of intracranial ICA occlusion. We therefore assessed the success rate of the Merci Retriever mechanical thrombectomy device in recanalization of intracranial ICA occlusions and sought to determine whether ICA recanalization with this therapy can result in better outcomes. METHODS All patients with acute stroke from intracranial ICA occlusion were identified in the MERCI and Multi MERCI Part I trials. We determined the success rate of ICA recanalization with endovascular thrombectomy and then assessed clinical outcomes according to whether vessel recanalization was successful. RESULTS Eighty patients with acute stroke from intracranial ICA occlusion were identified. Of these 80 patients, 53% had successful ICA recanalization with the Merci Retriever alone and 63% had ICA recanalization with use of the Merci Retriever plus adjunctive endovascular treatment. Baseline patient characteristics and procedural complications did not differ between the recanalized and nonrecanalized groups. Good clinical outcome, defined by a modified Rankin Scale of 0 to 2 at 90 days, occurred in 39% of patients with ICA recanalization (n=19 of 49) and in 3% of patients without ICA recanalization (n=1 of 30) (P<0.001; one patient was lost to follow up for 90-day modified Rankin Scale). Ninety-day mortality was 30% (n=15 of 50) in the recanalized group and 73% (n=22 of 30) in the nonrecanalized group (P<0.001). Symptomatic hemorrhage was not significantly different between the recanalized (6% [n=3 of 50]) and nonrecanalized (16.7% [n=5 of 30]) groups (P=0.14). Hemorrhage rates were also not found to be influenced by use of intravenous thrombolysis before mechanical thrombectomy. Multivariable logistic regression identified ICA recanalization (OR=28.4, 95% CI=2.6 to >99.9) and lack of history of hypertension (OR=0.15, 95% CI=0.04 to 0.57) as significant predictors of a good 90-day outcome. Failure to recanalize the ICA (OR=0.16, 95% CI=0.05 to 0.51) and age (per decade, OR=1.07, 95% CI=1.03 to 1.13) were significant predictors of mortality at 90 days. CONCLUSIONS Mechanical thrombectomy of acute intracranial ICA occlusion using the Merci Retriever device, alone or in combination with adjunctive endovascular therapy, has a high rate of successful vessel recanalization. Subjects with successful ICA recanalization by this method have improved poststroke clinical outcome and survival compared with subjects in which the ICA is not successfully recanalized.
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Affiliation(s)
- Alexander C Flint
- Department of Neurology, University of California, San Francisco, San Francisco CA 94143-0114, USA.
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26
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Bhatti AF, Leon LR, Labropoulos N, Rubinas TL, Rodriguez H, Kalman PG, Schneck M, Psalms SB, Biller J. Free-floating thrombus of the carotid artery: Literature review and case reports. J Vasc Surg 2007; 45:199-205. [PMID: 17210411 DOI: 10.1016/j.jvs.2006.09.057] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 09/28/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Free-floating thrombus (FFT) of the carotid artery is an uncommon entity that usually presents as an acute emergency. Management is based on case reports and series because the natural history and optimal treatment are unknown. This study was conducted to systematically review the world literature in an attempt to better understand FFT, its presentation, distribution, management, and outcome. METHOD A literature search in all languages was performed of the PubMed database (> or =1950s) and Medline database (1966-November 2004). All relevant articles were reviewed and their references analyzed in a similar manner for further literature. Cases from the authors' institutions were reviewed as well. All cases within the reports were individually assessed for inclusion or exclusion. Inclusion required that the FFT originate or anchor within the carotid artery (ie, excluding emboli, arch thrombi with extensions into the carotid artery), be partially occluding (ie, excluding occlusions, "string-sign," microscopic thrombus), and ideally have an elongated or protrusive morphology, circumferential flow around the distal portion, and cyclical motion with the cardiac cycles. RESULTS There were 61 reports reviewed, of which 43 contained FFT cases. These reports had 342 cases (including the current series) that were reviewed, of which 145 met our inclusion criteria. A database was created for qualitative and quantitative assessment of all cases. When data were pooled, appropriate statistical analysis was performed. A limitation of the study is that FFT is under-reported and ill defined, which limited the analysis in quantity and quality. In addition, reporting is not uniform, and therefore, significant data were not always present. In attempting to define FFT and include or exclude cases, subjectivity is inherent. CONCLUSIONS FFT is more frequently reported in men than women, with a ratio of nearly 2:1 (P < .0001), and at a younger age than in most patients with carotid disease (P < .0001 when compared with North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Surgery Trial). Symptoms are present in 92% of patients. There was a trend for patients with FFT to be hypercoagulable (47% of those serologically tested). The internal carotid artery was the most commonly affected (75%), with atherosclerosis being the most common associated pathology. Medical and surgical management have both been used, with neither clearly superior to the other. Medical management for stabilizing neurologic deficits has less risk and less benefit than surgical intervention.
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Affiliation(s)
- Ahmad F Bhatti
- Department of Vascular Surgery, Loyola University Medical Center, Maywood, IL 60153-3304, USA.
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27
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Abstract
BACKGROUND AND PURPOSE Different strategies have been employed to recanalize acutely occluded middle cerebral and internal carotid arteries (ICA) in the setting of acute stroke including intravenous and intra-arterial tPA. However, pharmaceutical thrombolysis alone, may not be effective in patients with a large amount of clot volume (complete M1, terminal internal carotid artery). We report our initial experience with endovascular clot disruption using a soft silicone balloon in addition to intravenous or intra-arterial thrombolysis with tPA. METHODS This is a retrospective review of nine patients with symptoms of acute stroke from clot in the middle cerebral or internal carotid territories who were treated with intracranial balloon angioplasty. All patients presented with symptoms of acute anterior circulation stroke less than six hours from onset. Patients in whom computed tomography (CT) angiography confirmed the presence of large vessel clot (terminal ICA, M1 or proximal M2) were included in the study. A CT perfusion was performed providing maps of cerebral blood volume, flow and mean transit time. If the patient presented less than three hours from onset then intravenous tissue plasminogen activator (tPA) was also administered. Intra-arterial tPA was delivered into the clot. If the volume of clot was judged to be significant by the treating neurointerventionist, then a limited trial of tPA was administered intra-arterially followed by balloon angioplasty of persistant clot. The time from imaging to vessel recanalization was recorded. Clinical outcomes were assessed using the modified Rankin scale and Barthel Index. RESULTS Diagnostic CT perfusion studies were performed in 7 (78%), all of which showed a significant amount of salvageable tissue as judged by the treating neurointerventionist and neurologist. Recanalization (TIMI 2 or 3) was possible in 8 (89%). There were no cases of symptomatic intracranial hemorrhage and 2 (22%) asymptomatic hemorrhages. The average time from performance of the initial emergency CT to vessel recanalization was 2.1 hours with mean time from symptom onset to vessel recanalization of 4.1 hours. Five (56%) patients had good outcomes, 1 (11%) had mild and 3 (33%) had moderate to severe disability. CONCLUSION Clot angioplasty can potentially shorten recanalization times in well-selected patients and can be an effective complimentary procedure in patients with tPA resistant clot. Angioplasty can be performed with a very low complication rate using the technique described and may be associated with good outcomes.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon/methods
- Angioplasty, Balloon/trends
- Anticoagulants/therapeutic use
- Brain Infarction/diagnostic imaging
- Brain Infarction/drug therapy
- Brain Infarction/surgery
- Carotid Artery Thrombosis/diagnostic imaging
- Carotid Artery Thrombosis/drug therapy
- Carotid Artery Thrombosis/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/drug effects
- Carotid Artery, Internal/surgery
- Cerebrovascular Circulation/drug effects
- Cerebrovascular Circulation/physiology
- Female
- Humans
- Infarction, Middle Cerebral Artery/diagnostic imaging
- Infarction, Middle Cerebral Artery/drug therapy
- Infarction, Middle Cerebral Artery/surgery
- Male
- Middle Aged
- Middle Cerebral Artery/diagnostic imaging
- Middle Cerebral Artery/drug effects
- Middle Cerebral Artery/surgery
- Postoperative Complications/prevention & control
- Retrospective Studies
- Stroke/diagnostic imaging
- Stroke/drug therapy
- Stroke/surgery
- Time Factors
- Tissue Plasminogen Activator/therapeutic use
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Cheemun Lum
- Department of Diagnostic Imaging-Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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28
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Wheatley GH, Sacchi A, Diethrich EB. Diagnosis and treatment of a symptomatic internal carotid artery embolism. J Am Coll Surg 2006; 202:1020. [PMID: 16735220 DOI: 10.1016/j.jamcollsurg.2005.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Revised: 10/14/2005] [Accepted: 11/03/2005] [Indexed: 11/22/2022]
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29
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Wholey MH. Current status of carotid artery stent placement. J Cardiovasc Surg (Torino) 2006; 47:101-5. [PMID: 16572083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Shimano H, Nagasawa S, Miyatake SI, Kawanishi M, Yamaguchi K, Kawabata S, Kuroiwa T. Model analysis of coil embolization of cerebral aneurysms: prediction of thrombus formation in aneurysms based on the coil embolization rate. Neurol Res 2006; 28:172-6. [PMID: 16551435 DOI: 10.1179/016164106x98044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Intra-aneurysmal coil embolization has been established as a common method for the intravascular treatment of cerebral aneurysms, but few studies have evaluated its long-term results. Because there is no sufficient objective landmark of complete embolization, determination of its application depends on a surgeon's experience. METHODS A glass cerebral aneurysm model was produced, and the changes in intra-aneurysmal hemodynamics were examined. Nylon thread with a diameter of 0.33 mm, resembling the coils clinically used for embolization, was used to fill in the model. After perfusion of glycerin solution to represent human blood, the half life of a dye injected into the aneurysm was optically measured, and the relationship between the half life and the volume embolization rate (VER) of nylon thread in the aneurysm was examined. RESULTS The maximal VER obtained by filling nylon thread in the aneurysm was 41.7+/- 2.9%. The half life of the dye increased with the VER and was significantly increased at VER>30%. DISCUSSION The half life of the dye in the aneurysm reflected stagnation of intra-aneurysmal hemodynamics, suggesting that the prolongation of the half life enhances thrombus formation. The results of this study suggested that VER>30% is sufficient for effective coil embolization.
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Affiliation(s)
- Hiroshi Shimano
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
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Setacci C, de Donato G, Setacci F, Chisci E, Cappelli A, Pieraccini M, Castriota F, Cremonesi A. Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases. J Vasc Surg 2005; 42:993-6. [PMID: 16275459 DOI: 10.1016/j.jvs.2005.06.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 06/01/2005] [Indexed: 11/21/2022]
Abstract
We report three cases of symptomatic acute carotid thrombosis occurring after carotid artery stenting (CAS). CASE 1: A patient presented with crescendo transient ischemic attacks on the second day after CAS. Ultrasound images demonstrated incomplete in-stent thrombosis due to plaque protrusion. The urgent surgical procedure consisted of stent removal and carotid thromboendarterectomy. CASE 2: A case of complete thrombosis of a carotid stent occurred 4 days after implantation in a patient with essential thrombocythemia diagnosed by chance. The surgical strategy included stent removal and carotid thromboendarterectomy. CASE 3: Cardiac multiple embolisms in a patient with chronic atrial fibrillation caused concomitant leg ischemia and acute carotid stent occlusion 2 hours after CAS. Cerebral reperfusion was established by embolectomy, without removing the stent. At the same time, the right leg ischemia was resolved by a thromboembolectomy with a Fogarty catheter. These three cases demonstrate that acute thrombosis after carotid stenting can be managed successfully with emergent surgical intervention. Thromboendarterectomy with stent removal or in selected cases, simple thromboembolectomy, can minimize neurologic sequelae in patients suffering from acute post-stenting carotid thrombosis.
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Affiliation(s)
- Carlo Setacci
- Department of Vascular and Endovascular Surgery, University of Siena, Siena, Italy
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Suzuki M, Tsutsumi Y, Uchiyama S, Iwata M. Carotid ultrasonographic appearance of the rupture of an unstable atheromatous plaque in a patient with acute ischemic stroke. Intern Med 2005; 44:1320-1. [PMID: 16415558 DOI: 10.2169/internalmedicine.44.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Miki Suzuki
- Department of Neurology, Tokyo Women's Medical University, Japan
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Wells P, Estrera A. Blunt traumatic innominate pseudoaneurysm and left common carotid occlusion with an associated bovine aortic arch. J Thorac Cardiovasc Surg 2005; 130:928-9. [PMID: 16153969 DOI: 10.1016/j.jtcvs.2005.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 02/19/2005] [Accepted: 03/02/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Patrick Wells
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Dallas, Dallas, Tex 75390, USA.
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Hirano K, Shimono T, Imanaka-Yoshida K, Miyamoto K, Fujinaga K, Kajimoto M, Miyake Y, Nishikawa M, Yoshida T, Uchida A, Shimpo H, Yada I, Hirata H. Method of Cell Transplantation Promoting the Organization of Intraarterial Thrombus. Circulation 2005; 112:I111-6. [PMID: 16159801 DOI: 10.1161/01.circulationaha.104.525071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background—
Endovascular aortic repairs have been developed as less invasive treatments for aortic aneurysms. Some aneurismal cavities, however, remain without organization, causing a re-expansion of the aneurysms. We studied cell transplantation into the aneurismal sac to promote the organization of thrombus for the complete healing of aneurysms.
Methods and Results—
Skin fibroblasts and skeletal myoblasts were isolated from rats for cell transplantation. An intraarterial thrombus model was made by ligation of the carotid artery. Culture medium (medium group, n=11), collagen gel (gel group, n=11), fibroblasts with collagen gel (F group, n=15), myoblasts with collagen gel (M group, n=12), or mixture of fibroblasts and myoblasts with collagen gel (F+M group, n=14) were injected into the thrombus. After 28 days, histologically, the arterial lumens of the F and M groups were partly filled with fibrous tissues, whereas in the F+M group organization was almost completed and luminal sizes diminished. Immunohistochemical staining demonstrated that α-smooth muscle actin-positive cells were more abundantly contained in the organized area of the F+M group than in the other groups. We also analyzed cellular function in vitro with immunofluorescence; coculture of fibroblasts and myoblasts showed that the fraction of α-smooth muscle actin-positive fibroblasts increased. This phenomenon accounts for the rapid organization of thrombus in the F+M group in vivo.
Conclusions—
Cell transplantation accelerated thrombus organization. Especially, myoblasts enhanced differentiation of fibroblasts into myofibroblasts, contributing to rapid thrombus organization. Cell transplantation into unorganized spaces seems applicable to endovascular treatment of aneurysms.
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Affiliation(s)
- Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
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35
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Abstract
The high mortality rate previously reported and the absence of proven advantage of urgent carotid endarterectomy over natural history, has discouraged consideration of this operation. We want to report on two patients with stroke in evolution and fluctuating stroke, who underwent immediate surgery with excellent results. With these cases we aim to demonstrate that selected patients with stroke in evolution or fluctuating stroke due to recent carotid thrombosis have a good prognosis after emergency surgery. We think that in these selected cases endovascular therapy is at this moment a waste of time.
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Affiliation(s)
- G Van der Mieren
- Department of Vascular and Thoracic Surgery, Heilig-Hart ziekenhuis Lier, Lier
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36
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Lubnin AI, Usachev DI, Iakovlev SB, Lukshin VA, Bukharin EA, Israelian LA, Ogurtsova AA, Abusaid S, Abramov TA. [Stepwise surgical treatment in a patient with concomitant cerebrovascular pathology]. Zh Vopr Neirokhir Im N N Burdenko 2005:24-8; discussion 28. [PMID: 16485823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The paper describes a relatively rare clinical case of stepwise surgical treatment in a patient with concomitant cerebrovascular pathology: thrombosis of the left internal carotid artery + critical stenosis of the right internal carotid artery + arteriovenous malformation of the right occipital lobe. The patient underwent open right carotid endarterectomy left extra-intracranial microvascular anastomotic application, and histoacryl endovascular embolization of the major afferents and arteriovenous malformation stroma in the stepwise fashion. Management policy, possible complications, and ways of their prevention in these patients are discussed.
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Abstract
Two patients with acute complete carotid bulb occlusion were treated using intra-arterial aspiration thrombectomy a mean of 3 hours after stroke onset. A slightly angulated 8-F guiding catheter designed for general interventional use was employed to aspirate the thrombus in the carotid artery. Manual aspiration through a 50-mL syringe resulted in effective removal of the thrombus followed by good patency of the internal carotid artery. Aspiration thrombectomy is a simple, feasible and effective rescue procedure for patients with acute complete carotid bulb occlusion.
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Affiliation(s)
- Gao Feng Xu
- Department of Radiology, Yancheng 1st Hospital, Yancheng, Jiangsu Province, China
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38
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Angelini R, Rutolo E, Damario V, Spigonardo E. Partial acute thrombosis of internal carotid artery: a case report. Ann Ital Chir 2005; 76:85-7. [PMID: 16035677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The effectiveness of the urgent carotid TEA in patients with not stabilizes serious neurological symptoms, remains controversial. MATERIAL The authors report on a case of a partial acute carotid thrombosis. The patient had outcomes of pulmonary tumor dealt with surgical removal of the medium right lobe. At admission, the neurological examination evidenced non specific neurological deficits to both the advanced limbs above all. The blood test evidenced 628000 platelets. The color-doppler showed in the internal carotid artery of right the presence of floating thrombus, during very small fibro-calcified plate, likely ulcerated. RESULTS The patient was submitted to surgical urgent procedure without ulterior diagnostic deepening. Such attitude was justified from the total regression of the symptomatology and from the absence of alterations of the BEE. DISCUSSION The urgent surgical treatment has had good outcome. In literature there are similar cases but not place upon ones because of "aetiology" to the inner presence of floating thrombus in carotid not completely occluding in all and the three cases, causes do not correspond from alters platelet parameters, but thrombus was of cardiogenic origin in one case, it was caused by hormonal therapy for sterility in the second, there was thrombosis of carotid aneurysm in third. CONCLUSION We remark the importance of eco-color Doppler for urgent diagnosis of acute thrombosis, and timeliness of surgical treatment in the "acute" patient with attenuation or regression of the debut symptomatology.
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Affiliation(s)
- R Angelini
- U.O. di Chirurgia Vascolare, Ospedale Clinicizzato SS. Annunziata, Chieti
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39
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Pokrovskiĭ AV, Kuntsevich GI, Beloiartsev DF, Timina IE, Kolosov RV. Carotid thromboses in the early postoperative period after carotid endarterectomy. Angiol Sosud Khir 2005; 11:85-94. [PMID: 16037808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The paper analyzes 10 cases of internal carotid artery (ICA) thrombosis, which occurred after 635 carotid endarterectomies (CEA), carried out from January 1997 to July 2004. CEA procedures included 346 (54.5%) open CEAs with PTFE patch angioplasty and 289 (45.5%) eversion CEAs. Patients with thromboses in the reconstructed area (n=10) had the profiles of comorbidities and cerebrovascular insufficiency grade similar to the total CEA group (p>0.1). Differences concerned the higher rate of atrial fibrillation cases (10%), diabetes mellitus (30%) and contralateral ICA occlusions (20%) in the group of thromboses (p>0.1). Among these 10 patients, 5 underwent eversion CEA (1.44% of the total eversion CEA group) and 5 - open CEA with patch angioplasty (1.73%). In 8 patients thromboses manifested as local neurological symptoms in the area supplied by the operated carotid artery. One patient demonstrated the progression of general cerebral symptomatology, while in the tenth patient thrombosis was accompanied with cerebral coma. Urgent ultrasonography in 7 patients failed to detect a blood flow in ICA, that proved the diagnosis of ICA thrombosis; in 3 patients ultrasonography showed a mural thrombosis. Nine patients underwent reoperation in emergency, while for the tenth patient an intervention was contraindicated due to the thrombosis of middle cerebral artery, unstable clinical state (cerebral coma) and progression of neurological symptomatology. PTFE arterial graft was implantedin 7 reoperated patients with ICA thrombosis, thrombectomy from ICA was carried out in 1 patient and in another one patient a thrombectomy from reconstructed segment with PTFE patch angioplasty of the arteriotomy defect was fulfilled. In 3 reoperated patients a complete resolution of neurological symptoms was evident 24 hours after intervention, in 2 patients neurological symptomatology regressed over 2-4 weeks. In another 3 reoperated patients local neurological symptoms persisted; 1 patient demonstrated postoperative progression of neurological symptomatology and coma with fatal outcome. The last patient, for whom a reoperation was contraindicated, died due to aggravation of cerebral coma. Dynamic follow-up in early postoperative period after CEA, especially in the first 6 hours, as well as an urgent duplex scanning of the reconstructed area in case of neurological symptoms development, provides timely diagnosis of postoperative thrombosis and the success of reoperations. Adjustments to patient's cardiac status and appropriate intraoperative heparinization can decrease the risk of this complication. An urgent reoperation aimed at the restoration of carotid blood flow, immediately after the diagnosis of thrombosis (provided the absence of deep coma), promotes a complete or partial regression of neurological symptoms and helps to prevent a progression of cerebrovascular disturbances.
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Berthet JP, Marty-Ané CH, Picard E, Branchereau P, Mary H, Veerapen R, Alric P. Acute Carotid Artery Thrombosis: Description of 12 Surgically Treated Cases. Ann Vasc Surg 2005; 19:11-8. [PMID: 15714361 DOI: 10.1007/s10016-004-0074-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The morbidity and mortality of stroke secondary to acute internal carotid artery thrombosis range from 40 to 69% and from 15 to 55%, respectively, after purely medical treatment. This report describes a series of 12 patients who underwent urgent surgical treatment for primary acute carotid artery thrombosis between January 1999 and December 2002. Upon admission, all patients had severe neurologic deficits contralateral to carotid artery thrombosis. One patient experienced ongoing changes in the level of consciousness. The interval between the onset of symptoms and admission was less than 6 hr in all cases. Initial work-up in all patients included a brain computed tomographic scan with contrast injection and carotid duplex scan. The operative procedure consisted of carotid thomboemdarterectomy after shunt placement with prosthetic patch closure. Intraoperative angiography was performed in all cases. Following treatment, we observed deterioration of neurologic status leading to death in one case; improvement with partial regression of initial neurologic deficit in two cases, including one patient who died from causes unrelated to carotid artery disease; and full neurologic recovery in nine cases. The delay to revascularization was longer than 6 hr in both patients who died. These data support surgical intervention for carotid artery thrombosis in selected patients without major disturbances of consciousness or hemorrhagic infarction, provided that the delay to revascularization is less than 6 hr.
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Imanaka K, Nishimura M, Masuoka A, Ogiwara M, Kato M, Asano H, Kyo S. Lethal thrombus in the carotid artery during operation for acute aortic dissection with cerebral malperfusion. Ann Thorac Surg 2004; 77:1448-9. [PMID: 15063291 DOI: 10.1016/s0003-4975(03)01155-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2003] [Indexed: 10/26/2022]
Abstract
A drowsy patient with acute type A aortic dissection and cerebral malperfusion required emergency operation. Because the right carotid artery was totally obstructed, cerebral perfusion was first restored by cannulating it and the left femoral artery before midline sternotomy. However, a long fresh thrombus was found flowing backward from the obstructed carotid artery. This thrombus was removed, and both arteries were connected through a Y-shaped extracorporeal circulation circuit to reperfuse the brain. During the subsequent aortic procedure, both arteries were used for arterial inflow. Such thrombi can cause grave postoperative neurologic dysfunction. Carotid artery cannulation is mandatory in such cases.
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Affiliation(s)
- Kazuhito Imanaka
- Department of Cardiovascular Surgery, Saitama Medical School, Iruma-gun, Japan.
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42
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Chant H, Ashleigh R, McCollum C. Thrombectomy for Acute Internal Carotid Thrombosis: Five Thrombectomy Devices Compared. Eur J Vasc Endovasc Surg 2004; 27:403-8. [PMID: 15015191 DOI: 10.1016/j.ejvs.2003.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2003] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the safety and efficiency of commercially available thrombectomy catheters in clearing simulated internal carotid artery (ICA) thrombosis. DESIGN Comparative in vitro study. MATERIALS AND METHODS A model of the ICA was filled with human thrombus, the 'circle of Willis' back pressure was set at either 10 or 30 cm of water. Five thrombectomy devices (Hydrolyser, Clot Buster, Acolysis System, AngioJet and Fogarty embolectomy catheter) were compared for (i) efficiency at removing thrombus, (ii) pressure changes at the tip of each device, and (iii) distal embolisation by flow cytometry. RESULTS Thrombus clearance was greatest with the AngioJet (median 95%, range 92-97%) and least with the Acolysis System (median 34%, range 12-50%). The Clot Buster and Hydrolyser were safest as they produced only negative tip pressures, the AngioJet and Balloon catheter produced positive and negative pressures risking distal embolisation. The Acolysis system produced no pressure change during use. Distal embolisation (of particles between 5 and 40 microm diameter) was greatest with the Fogarty balloon catheter at 10 cm water (P<0.05) and least with the Hydrolyser and Clot Buster. CONCLUSION Balloon embolectomy for ICA thrombosis risks further embolic cerebral damage. The Hydrolyser and the Clot Buster show the greatest promise for ICA thrombectomy.
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Affiliation(s)
- H Chant
- Department of Vascular Surgery, Bristol Royal Infirmary, UK
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González A, Mayol A, Gil-Peralta A, González-Marcos JR, Boza F, Ruano J. Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach. Neuroradiology 2004; 46:313-7. [PMID: 15034695 DOI: 10.1007/s00234-004-1168-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 11/23/2003] [Indexed: 11/29/2022]
Abstract
Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy.
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Affiliation(s)
- A González
- Sección de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain.
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44
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Krasnikov AV, Lagoda OV, Barkhatov DI, Krotenkova MV, Dzhibaladze DN. [Asymptomatic stenoses and thromboses of the carotid arteries: hemodynamic and ultrasound aspects]. Angiol Sosud Khir 2004; 10:17-21. [PMID: 15627130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The problem of asymptomatic stenoses of the internal carotid artery (ICA) has become a matter of great concern especially after ultrasonography of the great arteries of the head and, first of all, duplex scanning were introduced on a wide-scale basis into practice of the physicians of varying specialties. The growing population of patients with asymptomatic stenoses raises the problem of their further management with the purpose of preventing ischemic stroke. In connection with significant advances in vascular surgery carotid endarterectomy (CEE) has assumed an increasing role in the treatment of carotid stenoses. In spite of the fact that the efficacy of CEE for hemodynamically significant stenoses has already been proven, nevertheless at present there is no final decision concerning the problem of the indications for surgical treatment of patients with asymptomatic stenoses. The aim of this study was to assess in detail the vascular system of the brain in patients presenting with stenosis greater than 60% and ICA thrombosis, to distinguish the groups at a high risk for stroke and to delineate the treatment measures for its prevention.
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45
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Abstract
Extracranial-intracranial arterial bypass was frequently utilized in the 1970s and early 1980s to treat patients with atherosclerotic occlusive carotid arterial lesions not amenable to extracranial arterial revascularization procedures. After a large randomized trial reported in 1985 that there was no benefit of surgery in these patients, the procedure was generally abandoned as a treatment for symptomatic atherosclerotic cerebrovascular disease. In the past two decades, multiple studies have shown that patients with impaired cerebral hemodynamics distal to an occlusive cerebrovascular lesion have a significantly increased risk of subsequent stroke. Two new randomized, controlled clinical trials of extracranial-intracranial arterial bypass in patients with symptomatic atherosclerotic occlusive cerebrovascular disease that are using cerebral hemodynamic criteria for patient selection are currently in progress. At the present time, extracranial-intracranial arterial bypass should not be performed on these patients outside of a clinical trial.
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Affiliation(s)
- Robert L Grubb
- Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St. Louis, MO 63110-1093, USA.
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46
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Moody AR, Murphy RE, Morgan PS, Martel AL, Delay GS, Allder S, MacSweeney ST, Tennant WG, Gladman J, Lowe J, Hunt BJ. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation 2003; 107:3047-52. [PMID: 12796133 DOI: 10.1161/01.cir.0000074222.61572.44] [Citation(s) in RCA: 325] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thromboembolic disease secondary to complicated carotid atherosclerotic plaque is a major cause of cerebral ischemia. Clinical management relies on the detection of significant (>70%) carotid stenosis. A large proportion of patients suffer irreversible cerebral ischemia as a result of lesser degrees of stenosis. Diagnostic techniques that can identify nonstenotic high-risk plaque would therefore be beneficial. High-risk plaque is defined histologically if it contains hemorrhage/thrombus. Magnetic resonance direct thrombus imaging (MRDTI) is capable of detecting methemoglobin within intraplaque hemorrhage. We assessed this as a marker of complicated plaque and compared its accuracy with histological examination of surgical endarterectomy specimens. METHODS AND RESULTS Sixty-three patients underwent successful MRDTI and endarterectomy with histological examination. Of these, 44 were histologically defined as complicated (type VI plaque). MRDTI demonstrated 3 false-positive and 7 false-negative results, giving a sensitivity and specificity of 84%, negative predictive value of 70%, and positive predictive value of 93%. The interobserver (kappa=0.75) and intraobserver (kappa=0.9) agreement for reading MRDTI scans was good. CONCLUSIONS MRDTI of the carotid vessels in patients with cerebral ischemia is an accurate means of identifying histologically confirmed complicated plaque. The high contrast generated by short T1 species within the plaque allows for ease of interpretation, making this technique highly applicable in the research and clinical setting for the investigation of carotid atherosclerotic disease.
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Affiliation(s)
- Alan R Moody
- Department of Academic Radiology, Medical School, University Hospital, Nottingham, UK.
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47
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Dellaretti Filho MA, de Sousa AA, Carvalho GTC, de Castro MF. [Occlusion of the common carotid artery treated with a subclavian-internal carotid artery bypass]. Arq Neuropsiquiatr 2003; 61:453-5. [PMID: 12894283 DOI: 10.1590/s0004-282x2003000300023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe the case of a 62 years old woman with several transient isquemic attacks. The neuroradiological study demonstrated occlusion of the common carotid artery with revascularization of the internal carotid artery by anastomosis with the inferior thyroid artery and an aneurysm of internal carotid artery at the emergency of the anterior choroidal artery. The patient was treated with a bypass between the subclavian artery and the internal carotid artery with complete regression of the symptoms.
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Affiliation(s)
- Marcos Antônio Dellaretti Filho
- Serviço de neurocirurgia da Santa Casa de Belo Horizonte, Facultadade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brasil
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48
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Dudanov IP, Lashkov GL, Izhikov IA, Sulaĭman AB, Lashkov EG. [Internal carotid artery thrombosis in skull base fractures]. Vestn Khir Im I I Grek 2003; 162:91-3. [PMID: 14569788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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49
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Fuentes J, Montenegro R, Casaretto E, Quelas J, Procikieviez O, Canga C, Florez Nicolini F. [Acute carotid thrombosis in penetrating traumatism: is revascularization necessary in the patient without central neurological deficit?]. Rev Fac Cien Med Univ Nac Cordoba 2003; 60:71-6. [PMID: 14763435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Carotid lesions require priority in both evaluation and treatment due to their high morbidity and mortality. Controversy about therapeutic behavior in these patients with or without central neurological deficit is still under in discussion. OBJECTIVES To present a patient with acute carotid thrombosis due to a shotgun wound and discuss its therapeutic behavior. SETTING Hospital de Urgencias in Córdoba city. MATERIAL AND METHODS A 15-year-old male patient is presented with a "point-blank" shotgun wound in the soft parts of the left cervical region, and a left carotid thrombosis with no central neurological deficit. RESULTS Wound toilette and carotid revascularization by means of resection and venous by-pass with external carotid ligature was performed. The procedure was finished by delaging for plastic reconstruction of the cervical injury. Carotid postoperative angiographic control showed good permeability with no carotid flow alteration. CONCLUSION Penetrating carotid injuries should be resolved, if technically possible, with revascularization of the carotid sector. This procedure has to be aborted if the patient is in coma or the lesion is difficult to repair, in such a case ligature should be carried out.
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Affiliation(s)
- Javier Fuentes
- Servicio de Cirugia-Sección Cirugía Vascular, Cátedra de Emergentología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina.
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50
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Yellin A, Simansky DA, Refaely Y, Smolinsky AK. Concomitant CABG, lobectomy and CEA--a possible solution for a complex situation. Isr Med Assoc J 2002; 4:848. [PMID: 12389364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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