scholarly journals Frequency, Clinical Significance and Course of Cerebral Ischemic Events after Carotid Endarterectomy Evaluated by Serial Diffusion Weighted Imaging

2004 ◽  
Vol 27 (2) ◽  
pp. 167-171 ◽  
Author(s):  
O Wolf ◽  
P Heider ◽  
M Heinz ◽  
H Poppert ◽  
T Schmidt-Thieme ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Clinical Significance ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted ◽  
Cerebral Ischemic ◽  
Ischemic Events

Preoperative single-slab 3D time-of-flight magnetic resonance angiography predicts development of new cerebral ischemic events after carotid endarterectomy

2009 ◽  
Vol 111 (1) ◽  
pp. 141-146 ◽  
Author(s):  
Taro Suzuki ◽  
Kuniaki Ogasawara ◽  
Ryonoshin Hirooka ◽  
Makoto Sasaki ◽  
Masakazu Kobayashi ◽  
...  
Keyword(s):  
At Risk ◽  
Mr Imaging ◽  
Carotid Endarterectomy ◽  
Signal Intensity ◽  
Mr Angiography ◽  
Time Of Flight ◽  
Neurological Deficits ◽  
Patients At Risk ◽  
Cerebral Ischemic ◽  
Ischemic Events

Object Preoperative impairment of cerebral hemodynamics predicts the development of new cerebral ischemic events after carotid endarterectomy (CEA), including neurological deficits and cerebral ischemic lesions on diffusion weighted MR imaging. Furthermore, the signal intensity of the middle cerebral artery (MCA) on single-slab 3D time-of-flight MR angiography (MRA) can assess hemodynamic impairment in the cerebral hemisphere. The purpose of the present study was to determine whether, on preoperative MR angiography, the signal intensity of the MCA can be used to identify patients at risk for development of cerebral ischemic events after CEA. Methods The signal intensity of the MCA ipsilateral to CEA on preoperative MR angiography was graded according to the ability to visualize the MCA in 106 patients with unilateral internal carotid artery stenosis (≥ 70%). Diffusion weighted MR imaging was performed within 3 days of and 24 hours after surgery. The presence or absence of new postoperative neurological deficits was also evaluated. Results Cerebral ischemic events after CEA were observed in 16 patients. Reduced signal intensity of the MCA on preoperative MR angiography was the only significant independent predictor of postoperative cerebral ischemic events. When the reduced MCA signal intensity on preoperative MR angiography was defined as an impairment in cerebral hemodynamics, MR angiography grading resulted in an 88% sensitivity and 63% specificity, with a 30% positive- and a 97% negative-predictive value for the development of postoperative cerebral ischemic events. Conclusions Signal intensity of the MCA on preoperative single-slab 3D time-of-flight MR angiography is useful for identifying patients at risk for cerebral ischemic events after CEA.

A Comparison of Diffusion-Weighted Imaging Abnormalities Following Balloon Remodeling for Aneurysm Coil Embolization in the Ruptured vs Unruptured Setting

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 516-524 ◽  
Author(s):  
Stephen R Lowe ◽  
Tarun Bhalla ◽  
Holly Tillman ◽  
M Imran Chaudry ◽  
Aquilla S Turk ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Demographic Factors ◽  
Vascular Territory ◽  
Resonance Imaging ◽  
Single Institution ◽  
Unique Challenge ◽  
Unruptured Aneurysms ◽  
Diffusion Weighted ◽  
Device Use ◽  
Ischemic Events

Abstract BACKGROUND The prothrombotic milieu seen in subarachnoid hemorrhage (SAH) poses a unique challenge to neurovascular surgeons with regard to device use and microcatheter practice. OBJECTIVE To determine how demographic factors and balloon practices impact diffusion-weighted imaging (DWI) abnormalities and outcomes in patients with SAH compared to those without (non-SAH). METHODS We retrospectively analyzed 77 patients with SAH treated by balloon-assisted coiling in a single institution compared with 81 consecutive patients with unruptured aneurysms treated by balloon-assisted coiling at the same institution. Data were collected with regard to demographic factors, procedural and anatomic considerations, and DWI abnormalities on postprocedural magnetic resonance imaging. RESULTS SAH patients were significantly more likely to have DWI abnormality (75% vs 21%, P < .0001) and had a higher number and volume of DWI (4.0 vs 3.0, P = .0421 and 1.3 vs 0.3 cc, P = .0041) despite similar balloon practices. SAH patients were not more likely to have DWI abnormality in vascular territory distal to the treated aneurysm but had a higher likelihood of DWI in a vascular territory unrelated to the aneurysm (81.5% vs 47.1%, P = .0235). Patients without DWI abnormality were significantly more likely to have a good outcome as defined by modified Rankin Score 0 to 2 (95.6% vs 81.6%, P = .0328). Patients with DWI abnormality more often underwent 4-vessel angiography (70.5% vs 48.0%, P = .0174), but this was not found to be significant on multivariate analysis. CONCLUSION Balloon-assisted coiling does not result in increased incidence of downstream ischemic events in SAH patients compared to non-SAH patients and is safe in this cohort of patients. Other factors, such as 4-vessel angiography of the SAH milieu itself, may predispose patients to a higher rate of ischemic events.

Health related quality of life of the patients after transient ischaemic attack: is carotid endarterectomy (CEA) or carotid artery stenting (CAS) more influential?

2018 ◽  
Vol 16 (1) ◽  
pp. 61-68
Author(s):  
Mariusz Trystuła
Keyword(s):  
Quality Of Life ◽  
Carotid Endarterectomy ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Cerebral Ischemic ◽  
One Year ◽  
Ischemic Events

Although randomized trials have proven the benefit of revascularization with the use of carotid endarterectomy (CEA) or stenting (CAS) for appropriate patients, health care purchasers increasingly look beyond clinical outcome toward measures of health-related quality of life (HRQoL) in apportioning limited resources. 36 patients after TIA participated in this study. One group (n=18) had undergone CEA, whereas the second group (n=18) had undergone CAS. Both groups were matched according to age and sex. The Short Form 36 (SF-36) was used to assess the differences in patient-perceived HRQoL in two groups of patients who had suffered minor cerebral ischemic events. No significant difference in health profile between the CEA and CAS was detected for the eight SF-36 domains. However, the CEA group rated a significantly improved change in general health after one year compared with the CAS group (p<0.001). A greater proportion of the CEA group comparing to the CAS group thought their treatment had been successful and that their health had been improved (p<0.001). Both groups shared the same level of anxiety over potential future cerebral ischemic events (p=0.3). Patients' perception of HRQoL measured by the SF-36 domains was almost identical between the CEA and CAS apart from a small but significant improvement in self-reported overall health in the CEA group after one year follow up. HRQoL outcome measures may be of value in future clinical trials of cerebral revascularization to compare the effectiveness of carotid revascularization with the particular method of operation.

Silent ischemic events after Pipeline embolization device: a prospective evaluation with MR diffusion-weighted imaging

2016 ◽  
Vol 8 (11) ◽  
pp. 1136-1139 ◽  
Author(s):  
Leonardo B C Brasiliense ◽  
Morgan A Stanley ◽  
Sanjeet S Grewal ◽  
Harry J Cloft ◽  
Eric Sauvageau ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Older Patients ◽  
Demographic Data ◽  
Thromboembolic Events ◽  
Pipeline Embolization Device ◽  
High Metal Content ◽  
Endovascular Interventions ◽  
Diffusion Weighted ◽  
Increased Risk ◽  
Ischemic Events

BackgroundThe development of ischemic events is relatively common after endovascular interventions, and flow diverters may pose a particular threat owing to their increased technical complexity and high metal content.ObjectiveTo investigate the incidence and potential risk factors for thromboembolic lesions after treatment with a Pipeline embolization device (PED).MethodsThis prospective study included a total of 59 patients electively treated with a PED over 12 months. Postprocedural diffusion-weighted imaging sequences of the brain were obtained 24 h after interventions to detect ischemic lesions. Demographic data, aneurysm characteristics, antiplatelet management, and perioperative data were correlated with the rate of ischemic events.ResultsThe incidence of silent ischemic events after use of a PED was 62.7% (37 patients) and neurological symptoms occurred in 8.1% of affected patients. Development of ischemic events was significantly associated with older patients (≥60 years; p=0.038). Routine use of platelet function assays and newer P2Y12 receptor inhibitors (ticagrelor) were not associated with fewer thromboembolic events.ConclusionsThromboembolic events are relatively common after treatment with a PED with an incidence comparable to stent-assisted and conventional coiling but the risk of neurological morbidity from ischemic burden is low. Older patients are at particularly increased risk of thromboembolic events.

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 Magnetic Resonance Imaging of Acute Stroke

1998 ◽  
Vol 18 (6) ◽  
pp. 583-609 ◽  
Author(s):  
Alison E. Baird ◽  
Steven Warach
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Stroke ◽  
Perfusion Imaging ◽  
Diffusion Weighted Imaging ◽  
Mr Angiography ◽  
Great Promise ◽  
Proton Density ◽  
Diffusion Weighted ◽  
Cerebral Ischemic

In the investigation of ischemic stroke, conventional structural magnetic resonance (MR) techniques (e.g., T1-weighted imaging, T2-weighted imaging, and proton density-weighted imaging) are valuable for the assessment of infarct extent and location beyond the first 12 to 24 hours after onset, and can be combined with MR angiography to noninvasively assess the intracranial and extracranial vasculature. However, during the critical first 6 to 12 hours, the probable period of greatest therapeutic opportunity, these methods do not adequately assess the extent and severity of ischemia. Recent developments in functional MR imaging are showing great promise for the detection of developing focal cerebral ischemic lesions within the first hours. These include (1) diffusion-weighted imaging, which provides physiologic information about the self-diffusion of water, thereby detecting one of the first elements in the pathophysiologic cascade leading to ischemic injury; and (2) perfusion imaging. The detection of acute intraparenchymal hemorrhagic stroke by susceptibility weighted MR has also been reported. In combination with MR angiography, these methods may allow the detection of the site, extent, mechanism, and tissue viability of acute stroke lesions in one imaging study. Imaging of cerebral metabolites with MR spectroscopy along with diffusion-weighted imaging and perfusion imaging may also provide new insights into ischemic stroke pathophysiology. In light of these advances in structural and functional MR, their potential uses in the study of the cerebral ischemic pathophysiology and in clinical practice are described, along with their advantages and limitations.

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