Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

2020 ◽  
Vol 49 (2) ◽  
pp. 200-205
Author(s):  
Juha-Pekka Pienimäki ◽  
Niko Sillanpää ◽  
Pasi Jolma ◽  
Sara Protto
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Acute Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Collateral Circulation ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Significant Difference

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Singh ◽  
Tom Stys ◽  
Valerie Bares ◽  
Jeffrey Wilson ◽  
Adam Stys
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Coronary Artery Calcium ◽  
Carotid Artery Stenosis ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Plaque Burden ◽  
Significant Difference

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age <60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p<.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC <100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

scholarly journals Ischemic stroke secondary to self-inflicted carotid sinus massage: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Edgar R. Lopez-Navarro ◽  
Götz Greif ◽  
Carl-Albrecht Haensch ◽  
Adrian Ringelstein ◽  
Robert Larbig
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Stroke Unit ◽  
Carotid Sinus ◽  
White Male ◽  
Magnetic Resonance Images ◽  
Artery Stenosis ◽  
Carotid Sinus Massage

Abstract Background The risk of stroke after carotid sinus massage is greater if there is preexisting carotid stenosis or carotid plaques. We present the case of a patient with underlying 40% carotid stenosis, who developed a watershed stroke after a self-neck massage in our stroke unit. We show a well-documented case with magnetic resonance images before and after the neck massage. We report a case of a watershed brain infarct after a self-massage of the carotid sinus, with preexisting carotid artery stenosis. Neck massage continues to be a significant cause of stroke and should therefore not be performed by patients. Clinicians must be aware of the implications of a carotid sinus massage in both the outpatient and inpatient settings. Case presentation We admitted a 58-year-old white male patient, with no relevant medical history, to our department with a brain stem infarct. During his stay at our stroke unit, the patient performed a self-neck massage with consecutive bradycardia and asystole, resulting in left-side hemiparesis. The underlying cause of the hemodynamic stroke is believed to be secondary to this intensive neck massage performed by the patient. The patient also suffered from unknown right internal carotid artery stenosis. Conclusion Clinicians and patients must be aware that neck massage can lead to ischemic stroke. We postulate that repetitive impaired cardiac output can lead to a hemodynamic (watershed-type) stroke.

scholarly journals CAROTID ARTERY STENOSIS; IN ISCHEMIC STROKE PATIENTS

2017 ◽  
Vol 24 (08) ◽  
pp. 1126-1131
Author(s):  
MUHAMMAD ISHAQ KHATTAK ◽  
FARAMOZ KHAN ◽  
ZAHID FIDA ◽  
ADNAN ZAR
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Patients

scholarly journals Association of extracranial carotid artery stenosis in ischemic stroke in a Sri Lankan cohort of patients - An analytical cross-sectional study

2021 ◽  
Author(s):  
Ishani Rajapakshe ◽  
Devasmitha Wijesundara ◽  
Amila Chandrakumara ◽  
Bimsara Senanayake
Keyword(s):  
Ischemic Stroke ◽  
Sri Lanka ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Low Grade ◽  
Ageing Population ◽  
Sri Lankan ◽  
Stroke Patients ◽  
Extracranial Carotid Artery

Abstract Background and Objectives : The burden of stroke in Sri Lanka is on the increase with the current demographic transition toward an ageing population [1]. However, the association of symptomatic extracranial carotid artery stenosis (CAS) in ischemic stroke has not been prospectively evaluated in a Sri Lankan cohort of patients. Globally population-based studies have estimated about 15% of ischemic strokes are caused by large vessel occlusions. It is commonly believed that the prevalence of significant extracranial CAS is low in Sri Lanka compared to western populations [2, 3]. The purpose of the study is to systematically analyses and assess this long held notion and to search for other associated causative factors. Methods The study population comprised 164 acute ischemic stroke patients admitted to the National hospital of Sri Lanka over a period of 3 months. Carotid artery duplex scans were done by a single well-trained operator within 2 weeks of presentation and degree of CAS was classified as low (< 50%), moderate (50–69%), severe (> 70%) and complete occlusion according to NASCET criteria. Factors associated with CAS were identified by stepwise multiple logistic regression analysis. Results Out of 164 ischemic stroke patients 104 (63.4%) were male and 60 (36.6%) were female. The mean age of stroke patients was 62.2+- 14.21 years. 139 (84.8%) had low grade stenosis, 10 (6.1%) had moderate stenosis, 7 (4.2%) had severe stenosis and 8 (4.9%) had complete stenosis of carotid artery. Older age and presence of previous TIAs were significantly associated with CAS. Gender, hypertension, diabetes mellitus, hypercholesterolemia, IHD, previous stroke, previous TIA, previous use of antiplatelets, family history of stroke, previous use of statins and presence of carotid bruit were not significantly associated. Conclusion Extracranial carotid artery occlusion previously considered a rare cause of ischemic stroke in Sri Lanka was found to be having a prevalence similar to western populations in this study with over 15% having significant stenosis. Hence, we emphasize that early carotid doppler studies must be performed in all ischemic strokes at least within two weeks and necessary interventions carried out where it is deemed necessary.

scholarly journals Reproducibility of Semi-Automated Measurement of Carotid Stenosis on CTA

2010 ◽  
Vol 37 (4) ◽  
pp. 498-503 ◽  
Author(s):  
Jeremy H. White ◽  
Eric S. Bartlett ◽  
Aditya Bharatha ◽  
Richard I. Aviv ◽  
Allan J. Fox ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Artery Stenosis ◽  
Analysis Software ◽  
Manual Measurement ◽  
Significant Difference ◽  
Distal Internal Carotid Artery

Purpose:To compare the reproducibility of semi-automated vessel analysis software to manual measurement of carotid artery stenosis on computed tomography angiography (CTA).Methods:Two observers separately analyzed 81 carotid artery CTAs using semi-automated vessel analysis software according to a blinded protocol. The software measured the narrowest stenosis in millimeters (mm), distal internal carotid artery (ICA) in mm, and calculated percent stenosis based on NASCET criteria. One observer performed this task twice on each carotid, the second analysis delayed two months in order to mitigate recall bias. Two other observers manually measured the narrowest stenosis in mm, distal ICA in mm, and calculated NASCET percent stenosis in a blinded fashion. Correlation coefficients were calculated for each group comparing the narrowest stenosis in mm, distal ICA in mm, and NASCET percent stenosis.Results:The semi-automated vessel analysis software provided excellent intraobserver correlation for narrowest stenosis in mm, distal ICA in mm, and NACSET percent stenosis (Pearson correlation coefficients of 0.985, 0.954, and 0.977 respectively). The semi-automated vessel analysis software provided excellent interobserver correlation (0.925, 0.881, and 0.892 respectively). The interobserver correlation for manual measurement was good (0.595, 0.625, and 0.555 respectively). There was a statistically significant difference in the interobserver correlation between the semi-automated vessel analysis software observers and the manual measurement observers (P < 0.001).Conclusion:Semi-automated vessel analysis software is a highly reproducible method of quantifying carotid artery stenosis on CTA. In this study, semi-automated vessel analysis software determination of carotid stenosis was shown to be more reproducible than manual measurement.

scholarly journals Duplex Study of Carotid Artery in Patients with Ischemic Stroke

2013 ◽  
Vol 28 (2) ◽  
pp. 67-73
Author(s):  
Nasreen Sultana ◽  
AKM Faslul Bari ◽  
Touhidul Karim Majumder ◽  
Md Rafiqul Islam ◽  
Ferdous Ara Hossain
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Total Occlusion ◽  
Ischemic Lesion ◽  
Significant Stenosis

Objective: To determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients. Method: It was cross-sectional observational study which was carried out in neurology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of January 2010 to December 2011 and one hundred patients admitted with acute ischemic stroke were included in the study. Doppler ultrasound was performed during hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS - 14. Results: Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% ( n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found to have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion and 19% (n=11) had stenosis on the contralateral side. Out of significant stenosis ,mild (50% stenosis) in 12% (n=7) patients, moderate ( 51-69% ) stenosis in 50%( n= 30 ) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Conclusion: Carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke.DOI: http://dx.doi.org/10.3329/bjn.v28i2.17172 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 67-73

scholarly journals Investigation of Antiphosphatidyl-Serine Antibody and Antiphosphatidyl-Inositol Antibody in Ischemic Stroke Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Hirohisa Okuma ◽  
Yasuhisa Kitagawa ◽  
Shigeharu Takagi
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Venous Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Carotid Artery Stenosis ◽  
Antiphospholipid Antibodies ◽  
Antinuclear Antibody ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Intimal Medial Thickness

Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the presence of antiphospholipid antibodies (aPL). We measured β2-GPI aCL, IgGaCL, LA, antiphosphatidyl-serine antibody (PS), and antiphosphatidyl-inositol antibody (PI) in each patient at one month after the onset of stroke. In addition, carotid artery echography was performed in patients positive for PI or PS. Among the 250 patients, 13.6% (34/250) were positive for either PI or PS, and 6.8% (17/250) were positive for both. Carotid artery echography performed on these 34 patients showed that the frequencies of increased intimal-medial thickness (IMT) of 1.1 mm or more, plaque, and carotid artery stenosis of 50% or more were all significantly higher in patients positive for antinuclear antibody than those negative for the antibody (P<.05). PI and PS are associated with antinuclear antibody and precipitation of atherosclerosis. Ischemic stroke patients with SLE frequently showed a variety of antiphospholipid-protein antibodies.

scholarly journals Association between Oral Pathology, Carotid Stenosis, and Oral Bacterial DNA in Cerebral Thrombi of Patients with Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Olli Patrakka ◽  
Helena Mehtonen ◽  
Sari Tuomisto ◽  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Oral Health ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Oral Pathology ◽  
Artery Stenosis ◽  
Bacterial Dna ◽  
Carotid Artery Atherosclerosis

Background and purpose. Risk of acute ischemic stroke has been associated with carotid artery atherosclerosis as well as with periodontal disease. We studied whether oral pathology or carotid atherosclerosis was associated with the presence and quantity of bacterial DNA in their aspirated thrombi. Methods. Thrombus aspirates and control arterial blood were taken from 71 patients (70.4% male; mean age, 67.4 years) with acute ischemic stroke. Tooth pathology was registered using CT scans. Carotid stenosis was estimated with CTA and ultrasonography. The presence of bacterial DNA from aspirated thrombi was determined using quantitative PCR. We also analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease. Results. Bacterial DNA was found in 59 (83.1%) of the thrombus aspirates (median, 8.6-fold). Oral streptococcal DNA was found in 56 (78.9%) of the thrombus aspirates (median, 5.1-fold). DNA from A. actinomycetemcomitans and P. gingivalis was not found. Most patients suffered from poor oral health and had in median 19.0 teeth left. Paradoxically, patients with better oral health had more oral streptococcal DNA in their thrombus than the group with the worst pathology ( p = 0.028 ). There was a trend (OR 7.122; p = 0.083 ) in the association of ≥50% carotid artery stenosis with more severe dental pathology. Oral streptococcal DNA was detected in 2/6 of carotid endarterectomies. Conclusions. Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Although oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology. These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis.

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