scholarly journals Successful resolution of mobile thrombus in internal carotid artery with dabigatran and aspirin in an atherothrombotic cerebral infarction patient with non-valvular atrial fibrillation

Nosotchu ◽  
2017 ◽  
Vol 39 (4) ◽  
pp. 277-281
Author(s):  
Kiku Uwatoko ◽  
Yusuke Yakushiji ◽  
Toshihiro Ide ◽  
Emi Tabata ◽  
Masaaki Yoshikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Internal Carotid ◽  
Successful Resolution ◽  
Cerebral Infarction Patient ◽  
Atherothrombotic Cerebral Infarction

First Pass Effect With Neurothrombectomy for Acute Ischemic Stroke: Analysis of the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke Registry

Stroke ◽  
2021 ◽  
Author(s):  
Ashutosh P. Jadhav ◽  
Shashvat M. Desai ◽  
Osama O. Zaidat ◽  
Raul G. Nogueira ◽  
Tudor G. Jovin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Internal Carotid ◽  
Systematic Evaluation ◽  
Stroke Registry ◽  
First Pass

Background and Purpose: Achieving complete revascularization after a single pass of a mechanical thrombectomy device (first pass effect [FPE]) is associated with good clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion. We assessed patient characteristics, outcomes, and predictors of FPE among a large real-world cohort of patients (Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke registry). Methods: Demographics, clinical outcomes, and procedural characteristics were analyzed among patients in whom FPE (modified Thrombolysis in Cerebral Infarction 2c/3 after first pass) was achieved versus those requiring multiple passes (MP). Modified FPE and modified MP included patients achieving modified Thrombolysis in Cerebral Infarction 2B-3. Primary outcomes included 90-day modified Rankin Scale (mRS) score and mortality. Results: Among 984 Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke patients, 930 had complete 90-day follow-up. FPE was achieved in 40.5% (377/930) of patients and MP in 20.0% (186/930). Baseline characteristics were similar across all groups. The FPE group had fewer internal carotid artery occlusions compared with MP ( P =0.029). The FPE group had faster puncture to recanalization time ( P ≤0.001), higher rates of 90-day mRS score of 0 to 1 (52.6% versus 38.6%, P =0.003), mRS score of 0 to 2 (65.4% versus 52.0%, P =0.003), and lower 90-day mortality compared with the MP group (12.0% versus 18.7%, P =0.038). Similarly, compared with modified MP patients, the modified FPE group had fewer internal carotid artery occlusions ( P =0.004), faster puncture to recanalization time ( P ≤0.001), and higher rates of 90-day mRS score of 0 to 1 ( P =0.002) and mRS score of 0 to 2 ( P =0.003). Conclusions: Our findings demonstrate that FPE and modified FPE are associated with superior clinical outcomes.

scholarly journals Clinical risk factors predictive of thrombotic stroke with large cerebral infarction

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Worapot Rojsanga ◽  
Kittisak Sawanyawisuth ◽  
Verajit Chotmongkol ◽  
Somsak Tiamkao ◽  
Kannikar Kongbonkiat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Artery Stenosis ◽  
Stroke Risk ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Risk Factors

Large cerebral infarctions have high morbidity and mortality. Patients with large cerebral infarctions may have recurrent ischemia as high as 8.1% within 7 days; highest among other types of strokes. Data regarding risk factors for large cerebral infarction in Asian populations are still scant. All adult (age ≥15 years old) patients with the diagnosis of thrombotic ischemic stroke who were treated at Srinagarind Hospital, Khon Kaen University, Thailand from January 2012 to December 2013 were studied. Large cerebral infarctions are defined by clinical criteria of having cerebral cortical impairment, brain stem or cerebellar dysfunction with infarction sizes of more than 1.5 cm. The association of various stroke risk factors and large infarction strokes were calculated using multiple logistic regression analysis. There were 276 thrombotic stroke patients who met the study criteria; classified as large cerebral infarctions in 59 patients (21.38%) and small cerebral infarctions in 217 patients (78.62%). Baseline characteristics and risk factors for stroke were comparable between both groups. The large cerebral infarction group had a significantly larger proportions of right internal carotid artery stenosis, plaques on the left side, left internal carotid artery stenosis, and internal carotid artery stenosis at any side than the small cerebral infarction group. Among various stroke risk factors, only internal carotid artery stenosis at any side was the only significant factor associated with large cerebral infarction with an adjusted odds ratio of 11.14 (95% CI: 3.46, 35.82). In conclusion, significant internal carotid artery stenosis is associated with large cerebral infarction.

Multiple clipping technique for large and giant internal carotid artery aneurysms and complications: angiographic analysis

1994 ◽  
Vol 80 (4) ◽  
pp. 635-642 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Kenichiro Sugita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Surgical Clipping ◽  
Content Type ◽  
Clipping Technique ◽  
Fine Print

✓ Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconstruction of the parent artery with part of the aneurysmal wall was necessary in the majority of cases. Multiple clips were required for satisfactory clipping in 20 cases. Complications related to the clipping procedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with consequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analyzed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.

Evaluation of Recombinant Tissue Plasminogen Activator in Embolic Stroke

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 355-360 ◽  
Author(s):  
B. Barry Chehrazi ◽  
J. Anthony Seibert ◽  
Phillip Kissel ◽  
Larry Hein ◽  
John M. Brock
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Plasminogen Activator ◽  
Internal Carotid ◽  
Embolic Stroke ◽  
Tissue Type ◽  
External Carotid ◽  
Digital Subtraction ◽  
Triphenyltetrazolium Chloride

Abstract In an effort to determine the value of tissue-type plasminogen activator (TPA) in the treatment of embolic stroke, 17 rabbits were subjected to a model of embolic stroke in which 2-hour-old, tin-impregnated, autologous clots were embolized to the bifurcation of the internal carotid artery at the circle of Willis via retrograde injection into the cannulated external carotid artery. High-resolution digital subtraction radiography was used to localize clots intracranially at the carotid bifurcation. Circulation through the internal carotid artery and intracranial vessels was monitored with serial digital subtraction angiography before and after embolization and during treatment. Disappearance of the tin marker on the digital subtraction radiograph indicated dissolution of clot and was associated with reestablishment of circulation on the digital subtration angiogram. Experimental animals were treated with human-specific recombinant TPA 30 minutes, 2 hours, or 4 hours after clot embolization. TPA was administered as an intravenous bolus of 0.5 mg/kg followed by an infusion of 1 mg/kg/h for 2 hours. Digital subtraction angiograms were performed every 30 minutes. All clots dissolved, and cerebral circulation was reestablished within 120 minutes of treatment. In control animals treated with saline, embolized clots were stable, and the internal carotid artery remained occluded. At the completion of each study, the animal was perfused with freshly prepared, buffered 2,3,5-triphenyltetrazolium chloride (TTC) for demarcation of cerebral infarction. Control animals demonstrated infarction of 50 ± 3.6% of the ipsilateral cerebral hemisphere, with an infarct weight of 2.1 ± 0.2 g. The weight of cerebral infarction, as defined by the failure of tissue to stain with TTC, was reduced significantly in TPA-treated animals (P < 0.01). Treatment begun 30 minutes after clot embolization resulted in the most pronounced reduction in cerebral infarction. No intracerebral bleeding was observed. Results indicate that treatment with TPA is effective in dissolving embolic clots and reestablishing intracranial circulation. For best protection against cerebral infarction, however, treatment should be started as soon as possible.

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