scholarly journals Risk of mechanical thrombectomy recanalization failure: Intraoperative nuances and the role of intracranial atherosclerotic disease

2021 ◽  
Vol 24 ◽  
pp. 101029
Author(s):  
Joshua H. Weinberg ◽  
Ahmad Sweid ◽  
Ashlee Asada ◽  
Rawad Abbas ◽  
Keenan Piper ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease

scholarly journals The Evolving Paradigm in the Management of Intracranial Atherosclerotic Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Ali K. Ozturk ◽  
Ketan R. Bulsara
Keyword(s):  
English Literature ◽  
Treatment Options ◽  
Atherosclerotic Disease ◽  
Endovascular Techniques ◽  
Intracranial Atherosclerotic Disease ◽  
History Of ◽  
Recurrent Strokes ◽  
Rigorous Treatment ◽  
Significant Health

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide and represents a significant health problem. The pathogenesis and natural history of ICAD are poorly understood, and rigorous treatment paradigms do not exist as they do for extracranial atherosclerosis. Currently, the best treatment for ICAD remains aspirin therapy, but many patients who are placed on aspirin continue to experience recurrent strokes. As microsurgical and endovascular techniques continue to evolve, the role of extracranial to intracranial bypass operations and stenting are increasingly being reconsidered. We performed a PubMed review of the English literature with a particular focus on treatment options for ICAD and present evidence-based data for the role of surgery and stenting in ICAD against medical therapy alone.

Abstract 68: Impaired Perfusion in Intracranial Atherosclerotic Disease Predicts Cognitive Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Jose G Romano ◽  
George A Cotsonis ◽  
Shadi Yaghi ◽  
Tristan Honda ◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Recurrent Stroke ◽  
Cognitive Outcomes ◽  
Cognitive Testing ◽  
Atherosclerotic Disease ◽  
Collateral Flow ◽  
Cognitive Changes ◽  
Intracranial Atherosclerotic Disease ◽  
Antegrade Flow

Background: Poor collateral circulation and hypoperfusion may lead to recurrent stroke in intracranial atherosclerotic disease (ICAD). The role of perfusion in silent strokes and potentially insidious cognitive impairment in ICAD is unknown. We used evidence of impaired perfusion at angiography in SAMMPRIS to predict subsequent cognitive changes. Methods: Angiography at enrollment in the SAMMPRIS trial was independently evaluated, blind to clinical data and cognitive testing. Antegrade flow in the symptomatic arterial territory and corresponding collateral flow were scored. Impaired perfusion was defined by poor antegrade and poor collateral flow. Serial testing with the Montreal Cognitive Assessment (MoCA) was done in subjects without aphasia or neglect at baseline, 4 mo, 12 mo and closeout, or until subjects had a clinical stroke endpoint. Results: 207 subjects (median age 61, range 33-81 years; 37% women) had baseline MoCA scores with angiography data on territorial perfusion. Baseline MoCA scores (mean 24.2±4.1) were similar between categories of antegrade flow and collateral circulation. Impaired perfusion was noted in 33/207 (16%). Serial MoCA revealed that changes in cognition over time were different at 4 mo, 12 mo and closeout based on the presence of impaired perfusion at baseline (p<0.001). After more modest (mean MoCA change = 0.5 increase from baseline, p=0.80) early improved cognitive function at 4 mo, those with impaired perfusion had cognitive decline at 12 mo (mean MoCA change, p<0.01) unlike the continued improvement in other subjects. Cognitive changes in those with impaired perfusion were associated with a higher frequency of subsequent stroke in the territory. Conclusions: Impaired perfusion in the symptomatic arterial territory of ICAD predicts cognitive outcomes that may precede recurrent ischemia. Future studies may define the role of noninvasive perfusion imaging in ICAD to predict cognitive trajectories and recurrent stroke.

Increased incidence and treatment of intracranial atherosclerotic disease during mechanical thrombectomy is safe, even with an increased number of passes

2021 ◽  
pp. neurintsurg-2020-017114
Author(s):  
Marlon Carl Monayao ◽  
Ahmed A Malik ◽  
Laurie Preston ◽  
Marlon Carl Monayao Sr ◽  
Wondwossen Tekle ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Atherosclerotic Disease ◽  
Vessel Occlusion ◽  
Intracranial Atherosclerotic Disease ◽  
Significant Difference ◽  
Artery Disease ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Angioplasty And Stenting ◽  
Number Of Passes

BackgroundThe incidence of intracranial atherosclerotic disease (ICAD) in acute ischemic stroke treated with mechanical thrombectomy (MT) is not well defined, and its description may lead to improved stroke devices and rates of first pass success.MethodsA retrospective study was performed on MT patients from 2012 to 2019 at a comprehensive stroke center using chart review and angiogram analysis. Angiograms at the time of MT were reviewed for ICAD, and location and severity were recorded. Patients with ICAD were divided according to ICAD location relative to the large vessel occlusion (LVO) site. Statistical analyses were performed on baseline demographics, comorbidities, MT procedure variables, outcome variables, and their association with ICAD.ResultsOf the 533 patients (mean age 70.4 (SD 13.20) years, 43.5% women), 131 (24.6%) had ICAD. There was no significant difference in favorable discharge outcomes (modified Rankin Scale score of 0–2; 23.8% ICAD vs 27.0% non-ICAD; p=0.82) or groin puncture to recanalization times (average 43.5 (range 8–181) min for ICAD vs 40.2 (4–204) min for non-ICAD; p=0.42). Patients with ICAD experienced a significantly higher number of passes (average 1.8 (range 1–7) passes for ICAD vs 1.6 (1–5) passes for non-ICAD; p=0.0059). Adjusting for age, ≥3 device passes, baseline National Institutes of Health Stroke Scale, rates of angioplasty only, rates of concurrent angioplasty and stenting, coronary artery disease and atrial fibrillation incidences, and time from emergency department arrival to recanalization, yielded no significant difference in rates of favorable outcomes between the two groups.ConclusionPatients who underwent MT with underlying ICAD had similar rates of favorable outcomes as those without, but required a higher number of device passes.

scholarly journals Genome sequencing reveals the role of rare genomic variants in Chinese patients with symptomatic intracranial atherosclerotic disease

2021 ◽  
pp. svn-2021-001157
Author(s):  
Mengmeng Shi ◽  
Xinyi Leng ◽  
Ying Li ◽  
Zihan Chen ◽  
Ye Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Candidate Genes ◽  
Genome Sequencing ◽  
Atherosclerotic Disease ◽  
Chinese Patients ◽  
Genomic Variants ◽  
Stroke Subtypes ◽  
Intracranial Atherosclerotic Disease ◽  
Shared Risk

ObjectivesThe predisposition of intracranial atherosclerotic disease (ICAD) to East Asians over Caucasians infers a genetic basis which, however, remains largely unknown. Higher prevalence of vascular risk factors (VRFs) in Chinese over Caucasian patients who had a stroke, and shared risk factors of ICAD with other stroke subtypes indicate genes related to VRFs and/or other stroke subtypes may also contribute to ICAD.MethodsUnrelated symptomatic patients with ICAD were recruited for genome sequencing (GS, 60-fold). Rare and potentially deleterious single-nucleotide variants (SNVs) and small insertions/deletions (InDels) were detected in genome-wide and correlated to genes related to VRFs and/or other stroke subtypes. Rare aneuploidies, copy number variants (CNVs) and chromosomal structural rearrangements were also investigated. Lastly, candidate genes were used for pathway and gene ontology enrichment analysis.ResultsAmong 92 patients (mean age at stroke onset 61.0±9.3 years), GS identified likely ICAD-associated rare genomic variants in 54.3% (50/92) of patients. Forty-eight patients (52.2%, 48/92) had 59 rare SNVs/InDels reported or predicted to be deleterious in genes related to VRFs and/or other stroke subtypes. None of the 59 rare variants were identified in local subjects without ICAD (n=126). 31 SNVs/InDels were related to conventional VRFs, and 28 were discovered in genes related to other stroke subtypes. Our study also showed that rare CNVs (n=7) and structural rearrangement (a balanced translocation) were potentially related to ICAD in 8.7% (8/92) of patients. Lastly, candidate genes were significantly enriched in pathways related to lipoprotein metabolism and cellular lipid catabolic process.ConclusionsOur GS study suggests a role of rare genomic variants with various variant types contributing to the development of ICAD in Chinese patients.

scholarly journals Role of Balloon-Expandable Stents in Intracranial Atherosclerotic Disease in a Series of 182 Patients

Stroke ◽  
2013 ◽  
Vol 44 (7) ◽  
pp. 2000-2003 ◽  
Author(s):  
Anand Alurkar ◽  
Lakshmi Sudha Prasanna Karanam ◽  
Sagar Oak ◽  
Suresh Nayak ◽  
Sandeep Sorte
Keyword(s):  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease

Intracranial Stenting for Cerebrovascular Pathology

2003 ◽  
Vol 16 (1) ◽  
pp. 139-148 ◽  
Author(s):  
E.I. Levy ◽  
A.S. Boulos ◽  
B.R. Bendok ◽  
M.B. Horowitz ◽  
S.H. Kim ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Present Status ◽  
Intracranial Aneurysms ◽  
Atherosclerotic Disease ◽  
Arteriovenous Fistulae ◽  
Intracranial Stenting ◽  
Technical Aspects ◽  
Cerebrovascular Pathology ◽  
Intracranial Atherosclerotic Disease

After reading this article, the participant should be able to: Describe the use of stent-assisted angioplasty for intracranial atherosclerotic disease. Recall the present status of stent-assisted managment of intracranial aneurysms. Describe the role of stenting and its technical aspects in the treatment of arteriovenous fistulae and acute stroke.

Sign in / Sign up

Export Citation Format

Share Document