Internal Borderzone Infarction is Associated with Hemodynamic Compromise in Patients with Carotid Occlusion but Not with Recurrent Stroke

2014 ◽  
Vol 9 (5) ◽  
pp. E24-E24 ◽  
Author(s):  
Suzanne Persoon ◽  
L. Jaap Kappelle ◽  
Jeroen Hendrikse ◽  
Gert Jan de Borst ◽  
Albert van der Zwan ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Hemodynamic Compromise

Abstract WP33: Reperfusion Therapy in Carotid Artery Occlusion with Collaterals Through the Circle of Willis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong Hwan Ahn ◽  
In Sung Choo ◽  
Hyun Gu Kang ◽  
Ji Yeon Jung ◽  
Sang Woo Ha
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Carotid Occlusion ◽  
Large Artery ◽  
Clinical Worsening

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

scholarly journals Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

2015 ◽  
Vol 23 (1) ◽  
pp. 127-132 ◽  
Author(s):  
D. Damania ◽  
N. T.‐M. Kung ◽  
M. Jain ◽  
A. R. Jain ◽  
J. A. Liew ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Symptomatic Carotid ◽  
Factors Associated

Abstract WP169: Endovascular Recanalization For The Total Occlusion Of The Internal Carotid Artery At Subacute To Chronic Stage: Clinical Outcome And Pitfalls

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tomoaki Terada
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Carotid Occlusion ◽  
Chronic Stage ◽  
Embolic Protection ◽  
Hemodynamic Compromise ◽  
Endovascular Recanalization ◽  
Internal Carotid Occlusion

Objective: The efficacy and pitfalls of endovascular recanalization for totally occluded internal carotid occlusion were evaluated. Materials and methods: Twenty-five cases (twenty six lesions) of symptomatic internal carotid occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. At the same period, total 1200 carotid artery stenting was performed in our group. Parodi’s embolic protection system or modified Parodi’s technique was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal internal carotid artery to the common carotid artery. Results: Recanalization of the occluded ICA was possible in 23/26 (88.5%) lesions. The occlusion points were cervical internal carotid artery : 19, and petrous - cavernous ICA : 4 in successfully recanalized cases. The patient’s ischemic symptom disappeared completely after the treatment and new ischemic symptoms did not appear related to the treated leision. Single photon emission computed tomography findings demonstrated the improvement of hemodynamic compromise in all cases with hemodynamic compromise. One case (4.3%) caused right middle cerebral artery branch occlusion during the procedure but his neurological symptoms were stable because of preexisting hemiparesis. One case (4.3%) demonstrated asymptomatic re-occlusion at the treated site. Discussion: Endovascular recanalization was possible and effective to improve hemodynamic compromise, although the incidence of this treatment is only 2.2% of the total 1200 carotid artery stenting in our series. However, there still several problems existed, such as hyperperfusion syndrome after recanalization, cerebral embolism during the treatment, and durability after treatment, and difficult identification of the occlusion point before the treatment. Conclusion: Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for the symptomatic internal carotid occlusion with hemodynamic compromise or refractory to antiplatelet therapy, even in the subacute to chronic stage of the illness.

Surgery and Neurointervention for Intracranial Atherosclerotic Steno-occlusive Disease

US Neurology ◽  
2014 ◽  
Vol 10 (01) ◽  
pp. 56
Author(s):  
Sepideh Amin-Hanjani ◽  
Simon Chun Ho Yu ◽  
Fady Charbel ◽  
Joji Inamasu ◽  
Yoko Kato ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Recurrent Stroke ◽  
High Volume ◽  
Occlusive Disease ◽  
Carotid Occlusion ◽  
Cerebral Revascularization ◽  
Ischemic Event ◽  
Operative Morbidity ◽  
Hemodynamic Impairment ◽  
Maximal Medical Therapy

Neurosurgeons and neurointerventionists interested in cerebral revascularization to prevent stroke from intracranial atherosclerotic stenoocclusive disease were disappointed in 2011 with the closure of two important negative studies: the Carotid Occlusion Surgery Study (COSS) and Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study. Debates are centered on what causes these failures. While extracranial-intracranial (EC-IC) bypass and neurointervention (angioplasty and/or stenting) cannot be considered a routine intervention for patients presenting with initial ischemic event in the setting of atherosclerotic steno-occlusive disease, selected patients with severe hemodynamic impairment and/or recurrent symptoms despite maximal medical therapy may still benefit from surgery and neurointervention at high-volume centers, which can offer the procedure with low peri-operative morbidity.

scholarly journals Surgery and Neurointervention for Intracranial Atherosclerotic Steno-occlusive Disease

2013 ◽  
Vol 8 (2) ◽  
pp. 170
Author(s):  
Sepideh Amin-Hanjani ◽  
Simon Chun Ho Yu ◽  
Fady Charbel ◽  
Joji Inamasu ◽  
Yoko Kato ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Recurrent Stroke ◽  
High Volume ◽  
Occlusive Disease ◽  
Carotid Occlusion ◽  
Intracranial Stenosis ◽  
Ischaemic Event ◽  
Operative Morbidity ◽  
Maximal Medical Therapy

Neurosurgeons and neurointerventionists interested in cerebral revascularisation to prevent stroke from intracranial atherosclerotic steno-occlusive disease were disappointed in 2011 with the closure of two important negative studies: the Carotid Occlusion Surgery Study (COSS) and Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study. Debates are centred on what causes these failures. While extracranial-intracranial (EC-IC) bypass and neurointervention (angioplasty and/ or stenting) cannot be considered a routine intervention for patients presenting with initial ischaemic event in the setting of atherosclerotic steno-occlusive disease, selected patients with severe haemodynamic impairment and/or recurrent symptoms despite maximal medical therapy may still benefit from surgery and neurointervention at high-volume centres, which can offer the procedure with low peri-operative morbidity.

Perfusion imaging and recurrent cerebrovascular events in intracranial atherosclerotic disease or carotid occlusion

2018 ◽  
Vol 13 (6) ◽  
pp. 592-599 ◽  
Author(s):  
Daniel C Sacchetti ◽  
Shawna M Cutting ◽  
Ryan A McTaggart ◽  
Andrew D Chang ◽  
Morgan Hemendinger ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Perfusion Imaging ◽  
Infarct Volume ◽  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Atherosclerotic Disease ◽  
Stroke Recurrence ◽  
Imaging Data ◽  
Intracranial Atherosclerotic Disease ◽  
Cerebrovascular Events

Background Large vessel disease stroke subtype carries the highest risk of early recurrent stroke. In this study we aim to look at the association between impaired perfusion and early stroke recurrence in patients with intracranial atherosclerotic disease or total cervical carotid occlusion. Methods This is a retrospective study from a comprehensive stroke center where we included consecutive patients 18 years or older with intracranial atherosclerotic disease or total cervical carotid occlusion admitted with a diagnosis of ischemic stroke within 24 h from symptom onset with National Institute Health Stroke Scale < 15, between 1 December 2016 and 30 June 2017. Patients with (1) evidence of ≥ 50% stenosis of a large intracranial artery or total carotid artery occlusion, (2) symptoms referable to the territory of the affected artery, and (3) perfusion imaging data using the RAPID processing software were included. The primary predictor was unfavorable perfusion imaging defined as Tmax > 6 s mismatch volume (penumbra volume–infarct volume) of 15 ml or more. The outcome was recurrent cerebrovascular events at 90 days defined as worsening or new neurological symptoms in the absence of a nonvascular cause attributable to the decline, or new infarct or infarct extension in the territory of the affected artery. We used Cox proportional hazards models to determine the association between impaired perfusion and recurrent cerebrovascular events. Results Sixty-two patients met our inclusion criteria; mean age 66.4 ± 13.1 years, 64.5% male (40/62) and 50.0% (31/62) with intracranial atherosclerotic disease. When compared to patients with favorable perfusion pattern, patients with unfavorable perfusion pattern were more likely to have recurrent cerebrovascular events (55.6% (10/18) versus 9.1% (4/44), p < 0.001). This association persisted after adjusting for potential confounders (adjusted hazard ratio 10.44, 95% confidence interval 2.30–47.42, p = 0.002). Conclusion Perfusion mismatch predicts recurrent cerebrovascular events in patients with ischemic stroke due to intracranial atherosclerotic disease or total cervical carotid occlusion. Studies are needed to determine the utility of revascularization strategies in this patient population.

Sekundärprävention nach ischämischem Schlaganfall

Praxis ◽  
2003 ◽  
Vol 92 (5) ◽  
pp. 168-178
Author(s):  
Baumgartner ◽  
Georgiadis
Keyword(s):  
Recurrent Stroke ◽  
Facteurs De Risque ◽  
Heart Protection Study ◽  
Accident Vasculaire Cérébral ◽  
Study Progress ◽  
Intervention Chirurgicale ◽  
Heart Protection ◽  
Stroke Study

Ce travail de revue présente la prévention secondaire des accidents vasculaire cérébraux par le traitement des facteurs de risque vasculaire, les inhibiteurs de l'agrégation plaquettaire, l'anticoagulation ou les thérapies endovasculaires. Deux études publiées récemment (PROtection aGainst Recurrent Stroke Study (PROGRESS) et la Heart Protection Study (HPS) ont pour la première fois pu démontrer l'efficacité d'un traitement contre l'hypertension et par statines dans la prévention secondaire après un accident vasculaire cérébral. PROGRESS a montré que la combinaison de perindopril et d'indapamide permet de réduire de 43% la survenue d'accidents vasculaires cérébraux ischémiques et hémorragiques chez les patients hypertendus ou normotendus alors que HPS a mis en évidence une diminution de 20% des accidents vasculaires cérébraux ischémiques chez les patients avec des taux sériques normaux ou élevés de cholestérol. Les sténoses carotidiennes symptomatiques avec un resserrement distal > ou égal à 70% sont opérées par endartérectomie; en cas de sténose distale de 50–69% une décision individuelle est prise; une endartérectomie n'est pas indiquée en cas de sténose < 50%. Les patients chez lesquels une source cardiaque d'embolie est mise en évidence doivent être anticoagulés (INR 2.5, intervalle: 2–3) à l'exception des myxomes cardiaques et des endocardites bactériennes. Si aucune intervention chirurgicale sur une artère cérébrale n'est indiquée ou si le patient ne doit pas être anticoagulé, on traite par un inhibiteur de l'agrégation plaquettaire: 100 mg d'aspirine ou la combinaison d'aspirine et de dipyridamol sont le traitement de choix. En cas de récidive d'ischémie sous aspirine ou d'intolérance à l'aspirine, le clopidogrel est prescrit. Comme alternative au clopidogrel en cas de récidive d'ischémie, une anticoagulation (INR 2.0, intervalle: 1.5–2.5) peut être prescrite.

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