scholarly journals Endovascular and surgical management of carotid artery restenosis

2007 ◽  
Vol 54 (3) ◽  
pp. 43-46 ◽  
Author(s):  
D.Z. Sagic ◽  
Z.D. Antonic ◽  
B.B. Petrovic ◽  
S.N. Duvnjak ◽  
M.S. Peric ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Endovascular Treatment ◽  
Transient Ischemic Attack ◽  
Myocardial Infraction ◽  
Ischemic Attack ◽  
Stroke Death ◽  
Surgical Group ◽  
Major Stroke

Background. The incidence of recurrent carotid stenosis after primary endarterectomy ranges from 10-34%. We presented our four year experience and comparing reoperation versus endovascular treatment. Methods. In period from 2001 to 2005, 50 patients, 37 men and 13 women, were treated surgically and endovascular due to restenosis. Results. There were no minor or major stroke, death and myocardial infarction periprocedural and in first 30 days in either group. In endovascular group one patients 3,17% had transient ischemic attack and two patients 11,76% in surgical group. One patient died from myocardial infraction in follow up in surgical group. There were no restenosis >50% in endovascular group, two patients have restenosis >50% in surgical group. Conclusions. Endovascular treatment of carotid artery restenosis represents a safe and efficient way of treatment, connected with minor number of serious complications than redo operation.

scholarly journals Outcomes of Carotid Artery Stenting in High-Risk Patients With Carotid Artery Stenosis

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 448-454 ◽  
Author(s):  
Scott A. Meyer ◽  
Chirag D. Gandhi ◽  
David M. Johnson ◽  
H. Richard Winn ◽  
Aman B. Patel
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Neck Surgery ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Risk Patients ◽  
Ischemic Attack ◽  
Major Stroke

Abstract OBJECTIVE Carotid artery angioplasty and carotid artery stenting (CAS) offer a viable alternative to carotid endarterectomy for symptomatic and asymptomatic patients; however, the complication rates associated with CAS may be higher than previously documented. We evaluated the safety and efficacy of CAS in high surgical risk patients in a single neurovascular center retrospective review. METHODS An institutional review board–approved retrospective review of the clinical variables and treatment outcomes of 101 consecutive patients (109 stents) from July 2001 to March 2007 with carotid stenosis were analyzed. Both symptomatic and asymptomatic stenoses were studied in high surgical risk patients as defined by the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial. Specifically, those patients with clinically significant cardiac disease (congestive heart failure, abnormal stress test, or need for open-heart surgery), severe pulmonary disease, contralateral carotid occlusion, contralateral laryngeal nerve palsy, recurrent stenosis after carotid endarterectomy, previous radical neck surgery, or radiation therapy to the neck, and an age older than 80. RESULTS Seventy-four percent of the patients were symptomatic (n = 81), and the mean stenosis in symptomatic patients was 83%. Reasons for stenting included cardiac/pulmonary/medical risk (60%), contralateral internal carotid artery occlusion (8%), recurrent stenosis after carotid endarterectomy (11%), carotid dissection (6%), age older than 80 (7%), previous radical neck surgery (7%), and previous neck radiation (1%). Stent deployment was achieved in 108 of 109 vessels (99%). Distal embolic protection devices were used in 72% of cases treated. The overall rate of in-hospital adverse events (transient ischemic attack, intracranial hemorrhage, minor stroke, major stroke, myocardial infarction, and death) was 8.3% (9 of 109). Of these events, 2 patients (1.8%) experienced a hemispheric transient ischemic attack (neurological symptoms that resolved within 24 hours), 2 others (1.8%) had transiently symptomatic acute reperfusion syndrome. The 30-day stroke/death/myocardial infarction risk was 4.6% (n = 5). Of these patients, 3 had minor strokes (2.7%) defined as a modified Rankin Scale score less than 3 at 1-year follow-up, 1 had a major stroke (0.9%) defined as a modified Rankin Scale score of 3 or more at 1-year follow-up, and 1 patient died after a periprocedural myocardial infarction (0.9%). CONCLUSION CAS can be performed with a low 30-day complication rate, even with a higher percentage of symptomatic lesions. The results support the use of CAS in high surgical risk patients with both significant symptomatic and asymptomatic carotid artery disease.

scholarly journals Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

CJEM ◽  
2016 ◽  
Vol 18 (5) ◽  
pp. 331-339 ◽  
Author(s):  
Gregory W. Hosier ◽  
Stephen J. Phillips ◽  
Steve P. Doucette ◽  
Kirk D. Magee ◽  
Gordon J. Gubitz
Keyword(s):  
Myocardial Infarction ◽  
Transient Ischemic Attack ◽  
Disease Risk ◽  
Survival Curve ◽  
Cox Proportional Hazards ◽  
Vascular Imaging ◽  
Vascular Death ◽  
Ischemic Attack ◽  
The Impact

AbstractObjectives1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic.MethodsRetrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.ResultsOf the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p<0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08–0.99, p=0.048).ConclusionThe majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.

Preoperative Use of Statins in Carotid Artery Stenting: A Systematic Review and Meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 624-631 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Anil K. Jonnalagadda ◽  
Rohan V. Chitale ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Meta Analysis ◽  
Statin Treatment ◽  
Baseline Characteristics ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
Ischemic Attack

Purpose: To determine through meta-analysis whether administration of statins before carotid artery stenting (CAS) is associated with fewer periprocedural adverse events. Methods: All randomized and observational English-language studies of periprocedural statin administration prior to CAS that reported the outcomes of interest (stroke, transient ischemic attack, myocardial infarction, and death at 30 days) were included in a random-effects meta-analysis. The I2 statistic was used to assess heterogeneity. Meta-regression analysis was performed to determine whether an association of statin treatment with risk of outcome events was influenced by other trial-level baseline characteristics of statin-treated and untreated patients. Results: Eleven studies comprising 4088 patients were included. Patients who received statins prior to CAS had a significantly lower risk of stroke (OR 0.39, 95% CI 0.27 to 0.58, p<0.01; I2=0%) and death (OR 0.30, 95% CI 0.10 to 0.96, p=0.042; I2=0%). Statin use was not associated with a reduced risk of transient ischemic attack or myocardial infarction. In meta-regression analysis, other trial-level baseline characteristics had no significant influence on the association of statin treatment with death or stroke. Conclusion: Statin therapy prior to CAS is associated with decreased risk of perioperative stroke and death without any effect on the rates of transient ischemic attack or myocardial infarction.

Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shinichiro Uchiyama ◽  
Takao Hoshino ◽  
Hugo Charles ◽  
Kenji Kamiyama ◽  
Taizen Nakase ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Transient Ischemic Attack ◽  
Japanese Patients ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Vascular Events ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

scholarly journals The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

2018 ◽  
Vol 25 (4) ◽  
pp. 523-533 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Stent Design ◽  
Open Cell ◽  
Stent Restenosis ◽  
Closed Cell ◽  
Ischemic Attack ◽  
In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) OPERATED ON BY ENDARTERECTOMY (CEA)

2021 ◽  
Vol 19 (1) ◽  
pp. 1-9
Author(s):  
Ewa Wilczek-Rużyczka ◽  
Andrzej Mirski ◽  
Maciej Korab ◽  
Mariusz Trystuła
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Human Brain ◽  
Transient Ischemic Attack ◽  
Internal Carotid ◽  
Event Related Potentials ◽  
Critical Stenosis ◽  
Left Brain ◽  
Related Potentials ◽  
Ischemic Attack

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) protocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety.

Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

2021 ◽  
Vol 19 ◽  
Author(s):  
Shuxiang Yang ◽  
Lu Zhao ◽  
Lulu Pei ◽  
Shuang Cao ◽  
Yuan Gao ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
First Year ◽  
Kaplan Meier ◽  
Predictive Outcome ◽  
One Year ◽  
Ischemic Attack ◽  
Cumulative Risks

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the first year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

scholarly journals Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3393-3399 ◽  
Author(s):  
Marion Boulanger ◽  
Linxin Li ◽  
Shane Lyons ◽  
Nicola G. Lovett ◽  
Magdalena M. Kubiak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Risk Score ◽  
Transient Ischemic Attack ◽  
Artery Disease ◽  
Ischemic Attack
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