scholarly journals Letter by Benedict et al Regarding Article, “What Causes Disability After Transient Ischemic Attack and Minor Stroke? Results From the CT and MRI in the Triage of TIA and Minor Cerebrovascular Events to Identify High-Risk Patients (CATCH) Study”

Stroke ◽  
2013 ◽  
Vol 44 (4) ◽  
Author(s):  
Anna Benedict ◽  
Ee Win Khoo ◽  
Elaine Leung ◽  
Anne Hamilton-Bruce ◽  
Simon Koblar
Keyword(s):  
High Risk ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
High Risk Patients ◽  
Cerebrovascular Events ◽  
Risk Patients ◽  
Ischemic Attack ◽  
Ct And Mri

scholarly journals Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

2019 ◽  
Vol 32 (4) ◽  
pp. 294-302 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Norio Nakajima ◽  
Hidenori Miyake ◽  
Shunichi Fukuda ◽  
Tetsuya Tsukahara
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Transient Ischemic Attack ◽  
Carotid Artery Stenting ◽  
Minor Stroke ◽  
High Risk Patients ◽  
Embolic Protection ◽  
Risk Patients ◽  
Ischemic Attack

Purpose Carotid artery stenting (CAS) is a valuable alternative to carotid endarterectomy, especially in high-risk patients. However, the reported incidences of perioperative stroke and death remain higher than for carotid endarterectomy, even when using embolic protection devices (EPDs) during CAS. Our purpose was to evaluate 30-day major adverse events after CAS when selecting the most appropriate EPD. Methods We reviewed the clinical outcomes of 61 patients with 64 lesions who underwent CAS with EPDs. Patients who underwent CAS associated with thrombectomy and who had a preoperative modified Rankin scale score >3 were excluded from the analysis. The EPD was selected based on symptoms, carotid wall magnetic resonance imaging and lesion length, and we analyzed combined 30-day complication rates (transient ischemic attack, minor stroke, major stroke or death). Results Forty-nine patients were men and 12 were women. The median age was 72 years (range: 59–89 years) and 44 lesions were asymptomatic. A filter-type EPD was selected in 23 procedures, distal-balloon protection in 14 procedures and proximal-occlusive protection in 27 procedures. Two patients (3.1%) experienced a transient ischemic attack and one patient (1.6%) had a minor stroke within 30 days of the procedure. No patients experienced procedure-related morbidities (modified Rankin score >2) or death. Conclusions The perioperative stoke rate was low when we selected a proximal-occlusive-type EPD in high-risk patients with vulnerable carotid artery disease. Our algorithm for EPD selection was an effective tool in the perioperative management of carotid artery stenosis.

scholarly journals LO89: A multi-disciplinary quality improvement project to improve adherence to best practice guidelines for emergency department patients with transient ischemic attack

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S40
Author(s):  
A. Verma ◽  
A. Kapoor ◽  
J. Kim ◽  
N. Kujbid ◽  
K. Si ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Retrospective Chart Review ◽  
Stroke Recurrence ◽  
Improvement Project ◽  
Support Tool ◽  
High Risk Patients ◽  
Risk Patients ◽  
Ischemic Attack

Background: Canadian Stroke Guidelines recommend that Transient Ischemic Attack (TIA) patients at highest risk of stroke recurrence should undergo immediate vascular imaging. Computed tomography angiography (CTA) of the head and neck is recommended over carotid doppler because it allows for enhanced visualization of the intracranial and posterior circulation vasculature. Imaging while patients are in the emergency department (ED) is optimal for high-risk patients because the risk of stroke recurrence is highest in the first 48 hours. Aim Statement: At our hospital, a designated stroke centre, less than 5% of TIA patients meet national recommendations by undergoing CTA in the ED. We sought to increase the rate of CTA in high risk ED TIA patients from less than 5% to at least 80% in 10 months. Measures & Design: We used a multi-faceted approach to improve our adherence to guidelines including: 1) education for staff ED physicians; 2) agreements between ED and radiology to facilitate rapid access to CTA; 3) agreements between ED and neurology for consultations regarding patients with abnormal CTA; and 4) the creation of an electronic decision support tool to guide ED physicians as to which patients require CTA. We measured the rate of CTA in high risk patients biweekly using retrospective chart review of patients referred to the TIA clinic from the ED on a biweekly basis. As a balancing measure, we also measured the rate of CTA in non-high risk patients. Evaluation/Results: Data collection is ongoing. An interim run chart at 19 weeks shows a complete shift above the median after implementation, with CTA rates between 70 and 100%. At the time of submission, we had no downward trends below 80%, showing sustained improvement. The CTA rate in non-high risk patients did also increase. Disucssion/Impact: After 19 weeks of our intervention, 112 (78.9%) of high risk TIA patients had a CTA, compared to 10 (9.8%) in the 19 weeks prior to our intervention. On average, 10-15% of high risk patients will have an identifiable lesion on CTA, leading to immediate change in management (at minimum, an inpatient consultation with neurology). Our multi-faceted approach could be replicated in any ED with the engagement and availability of the same multi-disciplinary team (ED, radiology, and neurology), access to CTA, and electronic orders.

Morbidity and Mortality of Carotid Endarterectomy under Local Anesthesia: A Retrospective Study

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 445-450 ◽  
Author(s):  
Mario Zuccarello ◽  
Hwa-shain Yeh ◽  
John M. Tew
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Perioperative Complications ◽  
Minor Stroke ◽  
Perioperative Mortality ◽  
Occlusive Vascular Disease ◽  
Risk Patients ◽  
Ischemic Attack

Abstract It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.

Endovascular Repair of Ascending Aortic Pathologies With Tubular Endografts: A Single-Center Experience

2019 ◽  
Vol 26 (4) ◽  
pp. 439-445 ◽  
Author(s):  
Nikolaos Tsilimparis ◽  
Stefan Drewitz ◽  
Christian Detter ◽  
Konstantinos Spanos ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
High Risk ◽  
Endovascular Repair ◽  
Clinical Success ◽  
Aortic Insufficiency ◽  
Cardiovascular Complications ◽  
Minor Stroke ◽  
Single Center ◽  
High Risk Patients ◽  
Risk Patients ◽  
Aortic Pathologies

Purpose: To investigate the endovascular treatment of ascending aortic pathologies of high-risk patients unsuitable for open repair. Materials and Methods: From 2010 to 2017, 24 patients (mean age 70±15 years, range 29–90; 18 men) were treated at a single center for various pathologies of the ascending aorta, including acute or chronic type A aortic dissections (n=16), pseudoaneurysms (n=6), fixation of a dislocated percutaneous aortic valve (n=2), and miscellaneous indications (n=3). The patients were selected following an interdisciplinary case evaluation, attended by cardiologists and cardiac and vascular surgeons. The Zenith Ascend TAA Endovascular Graft was implanted; simultaneous procedures were performed in 13 patients. Of the total 27 Ascend TEVAR procedures (24 primary and 3 reinterventions), 17 were performed urgently and 10 electively. The primary outcome measure was 30-day survival. The secondary outcomes were cardiovascular complications, midterm survival, and reintervention rate. Results: Clinical success was achieved in all but 1 case. The 30-day survival was 79% (19/24); of the 5 deaths only 1 was directly related to the endograft implanted. In the 30-day postoperative period, there was 1 myocardial infarction, 2 major strokes, a mycotic pseudoaneurysm, a case of Ascend TEVAR–induced high-grade aortic insufficiency, and a minor stroke; 1 patient developed paraplegia after concurrent implantation of a 4-branched abdominal stent-graft. Two patients had a reintervention within 30 days for the pseudoaneurysm and the aortic insufficiency, respectively. During a mean follow-up of 11 months (0–35 months), there was 1 late death (cancer) and 1 additional reintervention at 10 months for a late type Ia endoleak (12.5% reintervention rate). Conclusion: Endovascular repair of ascending aortic pathologies with stent-grafts is a feasible treatment option with acceptable early and midterm outcomes in high-risk patients unsuitable for open surgery. The complexity of Ascend TEVAR might justify higher reintervention rates.

The PlA1/A2 polymorphism of glycoprotein IIIa and cerebrovascular events in hypertension: increased risk of ischemic stroke in high-risk patients

2007 ◽  
Vol 25 (3) ◽  
pp. 551-556 ◽  
Author(s):  
Francesca Lanni ◽  
Gaetano Santulli ◽  
Raffaele Izzo ◽  
Speranza Rubattu ◽  
Bastianina Zanda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
High Risk Patients ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Glycoprotein Iiia ◽  
Risk Patients
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