Association between gender and stoke recurrence in ischemic stroke patients with high-grade carotid artery stenosis

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

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CAROTID ARTERY STENOSIS; IN ISCHEMIC STROKE PATIENTS

The Professional Medical Journal ◽

10.17957/tpmj/17.4064 ◽

2017 ◽

Vol 24 (08) ◽

pp. 1126-1131

Author(s):

MUHAMMAD ISHAQ KHATTAK ◽

FARAMOZ KHAN ◽

ZAHID FIDA ◽

ADNAN ZAR

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Stroke Patients

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Investigation of Antiphosphatidyl-Serine Antibody and Antiphosphatidyl-Inositol Antibody in Ischemic Stroke Patients

Clinical and Developmental Immunology ◽

10.1155/2010/439230 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Hirohisa Okuma ◽

Yasuhisa Kitagawa ◽

Shigeharu Takagi

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Venous Thrombosis ◽

Antiphospholipid Syndrome ◽

Carotid Artery Stenosis ◽

Antiphospholipid Antibodies ◽

Antinuclear Antibody ◽

Artery Stenosis ◽

Stroke Patients ◽

Intimal Medial Thickness

Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the presence of antiphospholipid antibodies (aPL). We measured β2-GPI aCL, IgGaCL, LA, antiphosphatidyl-serine antibody (PS), and antiphosphatidyl-inositol antibody (PI) in each patient at one month after the onset of stroke. In addition, carotid artery echography was performed in patients positive for PI or PS. Among the 250 patients, 13.6% (34/250) were positive for either PI or PS, and 6.8% (17/250) were positive for both. Carotid artery echography performed on these 34 patients showed that the frequencies of increased intimal-medial thickness (IMT) of 1.1 mm or more, plaque, and carotid artery stenosis of 50% or more were all significantly higher in patients positive for antinuclear antibody than those negative for the antibody (P<.05). PI and PS are associated with antinuclear antibody and precipitation of atherosclerosis. Ischemic stroke patients with SLE frequently showed a variety of antiphospholipid-protein antibodies.

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Association of extracranial carotid artery stenosis in ischemic stroke in a Sri Lankan cohort of patients - An analytical cross-sectional study

10.21203/rs.3.rs-841918/v1 ◽

2021 ◽

Author(s):

Ishani Rajapakshe ◽

Devasmitha Wijesundara ◽

Amila Chandrakumara ◽

Bimsara Senanayake

Keyword(s):

Ischemic Stroke ◽

Sri Lanka ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Low Grade ◽

Ageing Population ◽

Sri Lankan ◽

Stroke Patients ◽

Extracranial Carotid Artery

Abstract Background and Objectives : The burden of stroke in Sri Lanka is on the increase with the current demographic transition toward an ageing population [1]. However, the association of symptomatic extracranial carotid artery stenosis (CAS) in ischemic stroke has not been prospectively evaluated in a Sri Lankan cohort of patients. Globally population-based studies have estimated about 15% of ischemic strokes are caused by large vessel occlusions. It is commonly believed that the prevalence of significant extracranial CAS is low in Sri Lanka compared to western populations [2, 3]. The purpose of the study is to systematically analyses and assess this long held notion and to search for other associated causative factors. Methods The study population comprised 164 acute ischemic stroke patients admitted to the National hospital of Sri Lanka over a period of 3 months. Carotid artery duplex scans were done by a single well-trained operator within 2 weeks of presentation and degree of CAS was classified as low (< 50%), moderate (50–69%), severe (> 70%) and complete occlusion according to NASCET criteria. Factors associated with CAS were identified by stepwise multiple logistic regression analysis. Results Out of 164 ischemic stroke patients 104 (63.4%) were male and 60 (36.6%) were female. The mean age of stroke patients was 62.2+- 14.21 years. 139 (84.8%) had low grade stenosis, 10 (6.1%) had moderate stenosis, 7 (4.2%) had severe stenosis and 8 (4.9%) had complete stenosis of carotid artery. Older age and presence of previous TIAs were significantly associated with CAS. Gender, hypertension, diabetes mellitus, hypercholesterolemia, IHD, previous stroke, previous TIA, previous use of antiplatelets, family history of stroke, previous use of statins and presence of carotid bruit were not significantly associated. Conclusion Extracranial carotid artery occlusion previously considered a rare cause of ischemic stroke in Sri Lanka was found to be having a prevalence similar to western populations in this study with over 15% having significant stenosis. Hence, we emphasize that early carotid doppler studies must be performed in all ischemic strokes at least within two weeks and necessary interventions carried out where it is deemed necessary.

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Cognitive Impairment: A Retrospective Study of Carotid Artery Stenosis

Brain and Neurological Disorders ◽

10.31579/2642-973x/007 ◽

2019 ◽

Vol 2 (1) ◽

pp. 01-03

Author(s):

M Gennaro

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Retrospective Study ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Carotid Artery Stenosis ◽

Vascular Cognitive Impairment ◽

Artery Stenosis ◽

Stroke Patients

Acute ischemic stroke has been recognized as one key cause of vascular cognitive impairment (VCI). The purpose of this study was to evaluate the correlation between carotid artery stenosis and post VCI in acute ischemic stroke patients.

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Relative Frequency and Characteristics of Carotid Artery Stenosis in Hospitalized Acute Ischemic Stroke Patients: A Retrospective Analysis

International Journal of Neurology and Neurosurgery ◽

10.21088/ijnns.0975.0223.9217.8 ◽

2017 ◽

Vol 9 (2) ◽

pp. 123-127

Author(s):

Mahendra Javali ◽

◽

Usha Holla ◽

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Retrospective Analysis ◽

Carotid Artery Stenosis ◽

Relative Frequency ◽

Artery Stenosis ◽

Stroke Patients

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Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis

European Neurology ◽

10.1159/000512407 ◽

2020 ◽

pp. 1-7

Author(s):

Ching-I Wu ◽

Chia-Lun Wu ◽

Feng-Chieh Su ◽

Shun-Wen Lin ◽

Wen-Yi Huang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Significant Risk ◽

Cox Proportional Hazards Model ◽

Artery Stenosis ◽

High Grade ◽

Increased Risk ◽

Artery Disease

Background: The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. Methods: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. Results: Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (p = 0.017, p < 0.001, p = 0.002, and p < 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35–3.79; p = 0.002). Conclusion: Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.

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Diagnostic dilemmas of multislice CT angiography in the evaluation of the degree of common carotid artery stenosis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1008494n ◽

2010 ◽

Vol 138 (7-8) ◽

pp. 494-497

Author(s):

Dragoslav Nenezic ◽

Slobodan Tanaskovic ◽

Predrag Gajin ◽

Nenad Ilijevski ◽

Goran Vucurevic

Keyword(s):

Carotid Artery ◽

Ct Angiography ◽

Common Carotid Artery ◽

Carotid Artery Stenosis ◽

Soft Tissues ◽

Multislice Ct ◽

Diagnostic Procedures ◽

Left Common Carotid Artery ◽

Artery Stenosis ◽

High Grade

Introduction. Multislice CT angiography (CTA) is a noninvasive and quick technique to image carotid artery stenosis, as well as intracerebral vasculature. Modern multidetector CTA produces images with a high resolution of, not only the contrast-filled lumen, but also of the vessel wall and the surrounding soft tissues. Multiple studies have verified the ability of CTA to provide an accurate representation of the degree of carotid stenosis in comparison to digital subtraction angiography, both for moderate and high-grade stenosis. Because of its fast and accurate vessel imaging, CT angiography is increasingly used in the assessment of carotid artery stenosis. Case Outline. A 37-year-old female patient was admitted at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, for angiography and endovascular procedure of a high-grade stenosis of the left common carotid artery based on Multislice CT findings brought by the patient. She complained of problems which we considered to be the result of cerebral circulation ischemia. After detailed diagnostic procedures, we concluded that no pathological lesions could be verified either on the left common carotid artery or other supraaortic branches. Therefore, the patient was discharged for further neurological examinations. Conclusion. Although Multislice CTA has many advantages over classical angiography, its validity should be taken with reserve, especially in younger patients.

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