Incidence and Risk Factors for Diffusion-Weighted Imaging (+) Lesions After Intracranial Stenting and Its Relationship With Symptomatic Ischemic Complications

Stroke ◽  
2014 ◽  
Vol 45 (11) ◽  
pp. 3298-3303 ◽  
Author(s):  
Keun Young Park ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Ji Hoe Heo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diffusion Weighted Imaging ◽  
Intracranial Stenting ◽  
Diffusion Weighted ◽  
Ischemic Complications

Relationship between carotid plaque characteristics and new ischemic lesions after stenting detected by computed tomography angiography

2019 ◽  
Vol 61 (1) ◽  
pp. 47-55
Author(s):  
Hongying Qu ◽  
Xiaokun Zhang ◽  
Miao Zhang ◽  
Yongan Gao ◽  
Jie Lu
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Plaque ◽  
Diffusion Weighted Imaging ◽  
Irregular Surface ◽  
Irregular Surfaces ◽  
Diffusion Weighted ◽  
Peripheral Position

Background Although carotid artery stenting achieves definite benefits, it carries a higher rate of embolization compared with carotid endarterectomy. The incidence of embolization may be related to plaque stability. Purpose To assess for any relationship between plaque characteristics and cerebral emboli following carotid artery stenting. Material and Methods Sixty-three patients with severe carotid stenosis underwent carotid artery stenting. They were divided into two groups according to whether new ischemic lesions were detected on diffusion-weighted imaging after carotid artery stenting. We evaluated the types and locations of calcification in plaques and extent of calcification. We then assessed for a correlation between each of these factors and occurrence of new lesions on diffusion-weighted imaging after carotid artery stenting. Results The locations of calcification, percentage of plaque enhancement, and the number of plaques with irregular surface or ulceration were significantly different between the two groups. A peripheral position of calcification (close to the adventitia), enhancing plaques, and plaques with irregular surfaces or ulceration were statistically significant predictors of intracerebral embolization after carotid artery stenting. No significant differences in type of plaque or degree of calcification were found between two groups. Conclusion Peripheral calcification, enhancing plaques, and plaques with irregular surfaces were risk factors for intracerebral embolization after carotid artery stenting. These plaque characteristics should be considered when choosing the optimal treatment for patients.

Perioperative Ischemic Complications of the Brain After Carotid Endarterectomy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 286-294 ◽  
Author(s):  
Matthew O. Hebb ◽  
Joseph E. Heiserman ◽  
Kirsten P. N. Forbes ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Diffusion Weighted Imaging ◽  
Safe Procedure ◽  
Carotid Revascularization ◽  
Diffusion Weighted ◽  
Marginal Mandibular Nerve ◽  
Ischemic Complications ◽  
The Brain ◽  
Radiological Studies

Abstract BACKGROUND The potential morbidity of cerebral ischemia after carotid endarterectomy (CEA) has been recognized, but its reported incidence varies widely. OBJECTIVE To prospectively evaluate the development of cerebral ischemic complications in patients treated by CEA at a high-volume cerebrovascular center. METHODS Fifty patients with moderate or severe carotid stenosis awaiting CEA were studied with perioperative diffusion-weighted imaging of the brain and standardized neurological evaluations. Microsurgical CEA was performed by 1 of 2 vascular neurosurgeons. Radiological studies were evaluated by faculty neuroradiologists who were blinded to the details of the clinical situation. RESULTS Preoperative diffusion-weighted imaging studies were performed within 24 hours of surgery. A second study was obtained within 24 (92% of patients), 48 (4% of patients), or 72 (4% of patients) hours after surgery. Intraluminal shunting was used in 1 patient (2%), and patch angioplasty was used in 2 patients (4%). No patient had diffusion-weighted imaging evidence of procedure-related cerebral ischemia. Nonischemic complications consisted of postoperative confusion in an 87-year-old man with a urinary tract infection and a marginal mandibular nerve paresis in another patient. Radiological studies were normal in both patients. CONCLUSION CEA is a relatively safe procedure that may be performed with an acceptable risk of cerebral ischemia in select patients. The low rate of ischemic complications associated with CEA sets a standard to which other carotid revascularization techniques should be held. The current results are presented with a discussion of the senior author's preferred surgical technique and a brief review of the literature.

scholarly journals Predictors of Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽  
2021 ◽  
Author(s):  
Shyam Prabhakaran ◽  
David S. Liebeskind ◽  
George Cotsonis ◽  
Azhar Nizam ◽  
Edward Feldmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Diffusion Weighted Imaging ◽  
Adjusted Odds Ratio ◽  
Recurrent Stroke ◽  
Brain Mri ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease ◽  
Diffusion Weighted ◽  
Artery Embolism

Background and Purpose: While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence. Methods: We performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of intracranial atherosclerotic disease patients with recent (<21 days) stroke/transient ischemic attack, 50% to 99% stenosis and who underwent 6- to 8-week magnetic resonance imaging (MRI) per protocol. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6 to 8 weeks compared to index brain MRI. Qualifying events and clinical and imaging outcomes were centrally ascertained by 2 independent reviewers. We assessed the association between baseline clinical and imaging variables and recurrent infarct in bivariate models and multivariable logistic regression to identify independent predictors of infarct recurrence. Results: Of 105 enrolled patients in MYRIAD, 89 (84.8%) were included in this analysis (mean age, 64±12 years, 54 [60.7%] were male, and 53 [59.6%] were White). The median time from qualifying event to MRI was 51+16 days, on which 22 (24.7%) patients had new or recurrent infarcts. Younger age (57.7 versus 66.0 years; P <0.01), diabetes (32.6% versus 14.6%, P =0.05), index stroke (31.3% versus 4.6%, P =0.01), anterior circulation location of stenosis (29.7% versus 12.0%, P =0.08), number of diffusion-weighted imaging lesions (>1: 40.0%, 1: 26.9% versus 0: 4.4%, P <0.01), and borderzone infarct pattern (63.6% versus 25.0%, P =0.01) on baseline MRI were associated with new or recurrent infarcts. Age (adjusted odds ratio, 0.93 [95% CI, 0.89–0.98], P <0.01) and number of diffusion-weighted imaging lesions (adjusted odds ratio, 3.24 [95% CI, 1.36–7.71], P <0.01) were independently associated with recurrent infarct adjusting for hypertension, diabetes, and stenosis location (anterior versus posterior circulation). Conclusions: An index multi-infarct pattern is associated with early recurrent infarcts, a finding that might be explained by plaque instability and artery-to-artery embolism. Further investigation of plaque vulnerability in intracranial atherosclerotic disease is needed. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02121028.

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

2021 ◽  
Author(s):  
Zonggang Hou ◽  
Zhenxing Huang ◽  
Zhenye Li ◽  
Gen Li ◽  
Yaokai Xu ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Diffusion Weighted Imaging ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Acute Ischemia ◽  
Critical Ischemia ◽  
Diffusion Weighted ◽  
Ischemic Complications

Abstract Insular gliomas remain surgically challenge due to their complex anatomical position and microvascular supply. The incidence of ischemic complications is a risk that should not be ignored. The goal of this study was to analyze the incidence of ischemia and its risk factors, and also describe a single surgeon's arteries protection experience of insular gliomas resection. The authors studied 75 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Analysis included pre- and postoperative demographic, clinical, radiological including diffusion weighted imaging (DWI), as well as intraoperative neurophysiology data, and functional outcomes. Strategies such as “Residual Triangle”, “Basal Ganglia Reconstruction” and “Sculpting Technique” were used to protect lateral lenticulostriate arteries and main branches of M2 for maximal tumor resection according to the different classification of Berger-Sinai. Postoperative diffusion-weighted imaging showed acute ischemia in 44 patients, only 9 of whom developed new motor deficits. Flat inner edge (OR 0.144 95% CI 0.024, 0.876), and motor evoked potentials (MEPs) (<50%) (OR 18.182, 95% CI 3.311, 100.00) were determined to have significant associations with postoperative Critical Ischemia, which located in the posterior limb of the internal capsule or corona radiata. For insular gliomas resection, the protection of main branches of MCA is important. Insular gliomas resection might be with high incidence of ischemia uncovered by DWI which not always result in neurological deficits. Their own strategies maybe the feasible technical nuances allow the surgeon to achieve a thorough and safe resection. Motor evoked potentials is essential for its resection.

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection

2021 ◽  
pp. 1-8
Author(s):  
Stephen T. Magill ◽  
Minh P. Nguyen ◽  
Manish K. Aghi ◽  
Philip V. Theodosopoulos ◽  
Javier E. Villanueva-Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Neurological Deficit ◽  
Diffusion Weighted Imaging ◽  
Older Age ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Peritumoral Edema ◽  
Diffusion Weighted ◽  
Estimated Blood Loss

OBJECTIVEConvexity meningiomas are commonly managed with resection. Motor outcomes and predictors of new deficits after surgery are poorly studied. The objective of this study was to determine whether postoperative diffusion-weighted imaging (DWI) was associated with neurological deficits after convexity meningioma resection and to identify the risk factors for postoperative DWI restriction.METHODSA retrospective review of patients who had undergone convexity meningioma resection from 2014 to 2018 was performed. Univariate and multivariate logistic regressions were performed to identify variables associated with postoperative neurological deficits and a DWI signal. The amount of postoperative DWI signal was measured and was correlated with low apparent diffusion coefficient maps to confirm ischemic injury.RESULTSThe authors identified 122 patients who had undergone a total of 125 operations for convexity meningiomas. The median age at surgery was 57 years, and 70% of the patients were female. The median follow-up was 26 months. The WHO grade was I in 62% of cases, II in 36%, and III in 2%. The most common preoperative deficits were seizures (24%), extremity weakness/paralysis (16%), cognitive/language/memory impairment (16%), and focal neurological deficit (16%). Following resection, 89% of cases had no residual deficit. Postoperative DWI showed punctate or no diffusion restriction in 78% of cases and restriction > 1 cm in 22% of cases. An immediate postoperative neurological deficit was present in 14 patients (11%), but only 8 patients (7%) had a deficit at 3 months postoperatively. Univariate analysis identified DWI signal > 1 cm (p < 0.0001), tumor diameter (p < 0.0001), preoperative motor deficit (p = 0.0043), older age (p = 0.0113), and preoperative embolization (p = 0.0171) as risk factors for an immediate postoperative deficit, whereas DWI signal > 1 cm (p < 0.0001), tumor size (p < 0.0001), and older age (p = 0.0181) were risk factors for deficits lasting more than 3 months postoperatively. Multivariate analysis revealed a DWI signal > 1 cm to be the only significant risk factor for deficits at 3 months postoperatively (OR 32.42, 95% CI 3.3–320.1, p = 0.0002). Further, estimated blood loss (OR 1.4 per 100 ml increase, 95% CI 1.1–1.7, p < 0.0001), older age (OR 1.1 per year older, 95% CI 1.0–1.1, p = 0.0009), middle third location in the sagittal plane (OR 16.9, 95% CI 1.3–216.9, p = 0.0026), and preoperative peritumoral edema (OR 4.6, 95% CI 1.2–17.7, p = 0.0249) were significantly associated with a postoperative DWI signal > 1 cm.CONCLUSIONSA DWI signal > 1 cm is significantly associated with postoperative neurological deficits, both immediate and long-lasting. Greater estimated blood loss, older age, tumor location over the motor strip, and preoperative peritumoral edema increase the risk of having a postoperative DWI signal > 1 cm, reflective of perilesional ischemia. Most immediate postoperative deficits will improve over time. These data are valuable when preoperatively communicating with patients about the risks of surgery and when postoperatively discussing prognosis after a deficit occurs.

Relationship between low response to clopidogrel and periprocedural ischemic events with coil embolization for intracranial aneurysms

2015 ◽  
Vol 8 (7) ◽  
pp. 752-755 ◽  
Author(s):  
Takumi Asai ◽  
Shigeru Miyachi ◽  
Takashi Izumi ◽  
Noriaki Matsubara ◽  
Kenichi Haraguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coil Embolization ◽  
Diffusion Weighted Imaging ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Low Responders ◽  
Ischemic Complications ◽  
Independent Risk Factors ◽  
Aggregation Activity ◽  
Ischemic Events

ObjectivesLow response to antiplatelet drugs is one of the risk factors for ischemic events. We examined the influence of low response to clopidogrel on symptomatic ischemic events and new ischemic MRI lesions with endovascular intracranial aneurysmal coil embolization.Materials and methodsBetween August 2010 and July 2013, 189 procedures in 181 consecutive patients who underwent endovascular coiling and received clopidogrel before treatment were investigated retrospectively. Platelet aggregation activity was examined by VerifyNow analysis. Low response to clopidogrel was defined as P2Y12 reaction units ≥230 in this study. Symptomatic ischemic complications within 30 days and postoperative new ischemic lesions on MRI–diffusion weighted imaging were evaluated.Results66 of 189 (34.9%) cases were low responders to clopidogrel. Ischemic complications occurred in 2 of 66 (3.0%) low responders compared with 6 of 123 (4.9%) responders (p=0.72). A new high intensity spot larger than 5 mm was significantly more frequent in low responders (26 of 66; 39.4%) than in responders (26 of 121; 21.2%; p=0.01). On multivariate analysis, independent risk factors for larger new ischemic lesions were low response to clopidogrel, smokers, posterior location, and aneurysms with a larger neck.ConclusionsLow response to clopidogrel had little effect on clinical outcome although it increased asymptomatic large ischemic lesions in this cohort.

scholarly journals Thromboembolic Events during Endovascular Coil Embolization of Cerebral Aneurysms

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 112-116 ◽  
Author(s):  
T. Ishibashi ◽  
Y. Murayama ◽  
T. Saguchi ◽  
M. Ebara ◽  
K. Irie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Coil Embolization ◽  
Diffusion Weighted Imaging ◽  
Cerebral Aneurysms ◽  
Thromboembolic Events ◽  
Diffusion Weighted ◽  
Endovascular Coil Embolization ◽  
Intracerebral Aneurysm

Thromboembolic events was most important adverse event for coil embolization for intracerebral aneurysm. The present study investigated possible risk factors for thromboembolic events during coil embolization using diffusion-weighted imaging (DWI), comparing unruptured and ruptured lesions.

Comprehensive analysis of perforator territory infarction on postoperative diffusion-weighted imaging in patients with surgically treated unruptured intracranial saccular aneurysms

2020 ◽  
Vol 132 (4) ◽  
pp. 1088-1095 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Hiroyasu Kamiyama ◽  
Takanori Miyazaki ◽  
Yu Kinoshita ◽  
Nakao Ota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Aneurysm Surgery ◽  
Poor Outcome ◽  
Diffusion Weighted ◽  
Direct Injury ◽  
Saccular Aneurysms

OBJECTIVEPerforator territory infarction (PTI) is still a major problem needing to be solved to achieve good outcomes in aneurysm surgery. However, details and risk factors of PTI diagnosed on postoperative MRI remain unknown. The authors aimed to investigate the details of PTI on postoperative diffusion-weighted imaging (DWI) in patients with surgically treated unruptured intracranial saccular aneurysms (UISAs).METHODSThe data of 848 patients with 1047 UISAs were retrospectively evaluated. PTI was diagnosed on DWI, which was performed the day after aneurysm surgery. Clinical and radiological characteristics were compared between UISAs with and without PTI. Poor outcome was defined as an increase in 1 or more modified Rankin Scale scores at 12 months after aneurysm surgery.RESULTSPostoperative DWI was performed in all cases, and it revealed PTI in 56 UISA cases (5.3%). Forty-three PTIs occurred without direct injury and occlusion of perforators (43 of 56, 77%). Poor outcome was more frequently observed in the PTI group (17 of 56, 30%) than the non-PTI group (57 of 1047, 5.4%) (p < 0.0001). Thalamotuberal arteries (p < 0.01), lateral striate arteries (p < 0.01), Heubner’s artery (p < 0.01), anterior median commissural artery (p < 0.05), terminal internal carotid artery perforators (p < 0 0.01), and basilar artery perforator (p < 0 0.01) infarctions were related to poor outcome by adjusted residual analysis. On multivariate analysis, statin use (OR 10, 95% CI, 3.3–31; p < 0.0001), specific aneurysm locations (posterior communicating artery [OR 4.1, 95% CI 2.1–8.1; p < 0.0001] and basilar artery [OR 3.1, 95% CI 1.1–8.9; p = 0.031]), larger aneurysm size (OR 1.1, 95% CI 1.1–1.2; p = 0.043), and permanent decrease of motor evoked potential (OR 38, 95% CI 3.1–468; p = 0.0045) were related to PTI.CONCLUSIONSDespite efforts to avoid PTI, it occurred even without direct injury, occlusion of perforators, or evoked potential abnormality. Therefore, surgical treatment of UISAs, especially with the aforementioned risk factors of PTI, should be more carefully considered. The evaluation of PTI in the territory of the above-mentioned perforators could be useful in helping predict the clinical course in patients after aneurysm surgery.

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