Prevalence of intracranial large artery stenosis and occlusion in patients with acute ischaemic stroke or TIA

2013 ◽  
Vol 35 (3) ◽  
pp. 349-355 ◽  
Author(s):  
Alessia Mattioni ◽  
Silvia Cenciarelli ◽  
Geert Jan Biessels ◽  
Tom van Seeters ◽  
Ale Algra ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Artery Stenosis ◽  
Large Artery ◽  
Stenosis And Occlusion

scholarly journals Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis

2020 ◽  
Vol 5 (4) ◽  
pp. 361-367
Author(s):  
Yong-Lin Liu ◽  
Han-Peng Yin ◽  
Dong-Hai Qiu ◽  
Jian-Feng Qu ◽  
Huo-Hua Zhong ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Artery Stenosis ◽  
Neurological Deterioration ◽  
Susceptibility Weighted Imaging ◽  
Large Artery ◽  
Signal Loss ◽  
Anterior Circulation ◽  
Early Neurological Deterioration

Background and purposeEarly neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA).MethodsThis was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. We collected clinical variables and initial haematological and neuroimaging findings. MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere. The degree of hyperintensity of MHVs was classified into four grades: none, subtle, moderate and extensive. END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms. Multivariate logistic regressions were conducted to investigate the predictors of END.ResultsThe study included 61 patients (51 males and 10 females) with a mean age of 62.4±12.6 years. Thirty-five (57.4%) patients presented with MHVs: 8 (13.1%) were graded as subtle MHVs, while 23 (37.7%) and 4 (6.6%) were graded as moderate or extensive MHVs, respectively. Twenty patients (32.8%) presented with END. Logistic regression analysis showed that compared with patients without MHVs, moderate MHVs (adjusted OR 5.446, 95% CI 1.360 to 21.800; p=0.017) and extensive MHVs (adjusted OR 15.240, 95% CI 1.200 to 193.544; p=0.036) were significantly associated with END.ConclusionsMHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.

scholarly journals Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis

2015 ◽  
Vol 44 (4) ◽  
pp. 655-661 ◽  
Author(s):  
D. J. Ryan ◽  
R. A. Kenny ◽  
S. Christensen ◽  
J. F. M. Meaney ◽  
A. J. Fagan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischaemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Artery Stenosis ◽  
Large Artery ◽  
Older Subjects

scholarly journals Large artery occlusion diagnosed by computed tomography angiography in acute ischaemic stroke: Frequency, predictive factors, and safety

2014 ◽  
Vol 29 (5) ◽  
pp. 261-266
Author(s):  
J.A. Matías-Guiu ◽  
C. Serna-Candel ◽  
J.M. Espejo-Domínguez ◽  
M. Fernández-Matarrubia ◽  
P. Simal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischaemic Stroke ◽  
Predictive Factors ◽  
Acute Ischaemic Stroke ◽  
Computed Tomography Angiography ◽  
Artery Occlusion ◽  
Large Artery ◽  
Stroke Frequency

scholarly journals Initial experience with the novel EmboTrap II clot-retrieving device for the treatment of ischaemic stroke

2019 ◽  
Vol 25 (3) ◽  
pp. 271-276 ◽  
Author(s):  
Iacopo Valente ◽  
Sergio Nappini ◽  
Leonardo Renieri ◽  
Alessandro Pedicelli ◽  
Emilio Lozupone ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Large Artery ◽  
The Novel ◽  
Neurological Outcomes ◽  
Stent Type ◽  
Radiological Data

Introduction We report our experience with the novel stent-type clot-retrieval device EmboTrap II for the revascularization of large artery occlusions in acute ischaemic stroke. Materials and methods Twenty-nine patients with acute ischaemic stroke due to large artery occlusion underwent mechanical thrombectomy with the new EmboTrap II in two Italian centres. Clinical, procedural and radiological data were collected. Angiographic results and neurological outcomes were analysed. Results Only large vessel occlusions were included. Intravenous thrombolysis was administered in 72% of patients. Successful reperfusion (TICI 2b-3) was obtained in 76% of patients treated exclusively with EmboTrap II. No device-related permanent complications occurred. Conclusion In our experience, mechanical thrombectomy with EmboTrap II is safe and effective. Reperfusion rate was comparable to that obtained with other stent retrievers.

scholarly journals Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

2017 ◽  
Vol 7 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Chee-Keong Wee ◽  
William McAuliffe ◽  
Constantine C. Phatouros ◽  
Timothy J. Phillips ◽  
David Blacker ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
Group Versus ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Neurological Improvement

Background and Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. Methods: We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0–1, or a decrease from baseline of ≤8, at 24 h after stroke onset. Results: Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.

scholarly journals Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) – study protocol for a randomised controlled trial

2021 ◽  
Vol 6 (2) ◽  
pp. 222-228
Author(s):  
Peter Kelly ◽  
Christian Weimar ◽  
Robin Lemmens ◽  
Sean Murphy ◽  
Francisco Purroy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Ischaemic Stroke ◽  
Usual Care ◽  
Artery Stenosis ◽  
Cardioembolic Stroke ◽  
Lipid Lowering ◽  
Large Artery ◽  
Vascular Events ◽  
Anti Inflammatory

Background Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events. Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone. Design CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat. Outcome The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal). Summary CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke. Schedule First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.

scholarly journals A STUDY ON PREVALENCE OF CAROTID ARTERY STENOSIS IN ACUTE ISCHAEMIC STROKE PATIENTS

2016 ◽  
Vol 5 (103) ◽  
pp. 7559-7565
Author(s):  
Kamatchi Karunanidhi ◽  
Dhurgesa Nanthini Vijaya Sundaram ◽  
Murugarajan Singaram
Keyword(s):  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Patients
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