A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke

Abstract: Acute ischemic stroke (AIS) has been reported in patients with coronavirus disease 2019 (COVID-19). The cause of AIS in COVID-19 patients has not been fully understood, but COVID-19 is known to cause hypercoagulation characterized by increased d-dimer levels, and cytokine storms. Some AIS patients with COVID-19 require intensive care. This study was aimed to determine the description of AIS patients with COVID-19 admitted to the intensive care unit. This was a literature review study using three databases, as follows: Pubmed, ClinicalKey, and Science Direct. The keywords used were acute ischemic stroke AND COVID-19 AND intensive care unit. The results showed that after being selected based on inclusion and exclusion criteria, 10 literatures were obtained. There were 20 subjects and most were female (55%) and age group of 60-69 years old (35%). The most common cardiovascular risk factor was hypertension (80%, n=10). There were some increases in the levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen. On radiological examination performed, there were cases with bilateral pulmonary infiltrate (33%) and ground-glass opacities (67%) (n = 6). In conclusion, the characteristics of AIS patients with COVID-19 admitted to the intensive care room were mostly female, age group 60-69 years, had cardiovascular risk factors for hypertension, had elevated levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen, and had ground-glass opacity on radiological imaging.Keywords: acute ischemic stroke, COVID-19, intensive care unit Abstrak: Stroke iskemik akut telah dilaporkan pada pasien dengan coronavirus disease 2019 (COVID-19). Penyebab stroke iskemik akut pada COVID-19 belum diketahui secara menyeluruh, tetapi COVID-19 dapat menyebabkan kejadian hiperkoagulasi ditandai dengan peningkatan kadar d-dimer serta menyebabkan badai sitokin. Beberapa pasien stroke iskemik akut dengan COVID-19 membutuhkan perawatan di ruang perawatan intensif. Penelitian ini bertujuan untuk mengetahui gambaran pasien stroke iskemik akut dengan COVID-19 yang masuk di ruang perawatan intensif. Jenis penelitian ialah literature review dengan pencarian data menggunakan tiga database yaitu Pubmed, ClinicalKey dan Science Direct dengan kata kunci acute ischemic stroke AND COVID-19 AND intensive care unit. Hasil penelitian mendapatkan 10 literatur dengan jumlah subyek penelitian sebanyak 20 orang, jenis kelamin terbanyak ialah perempuan (55%) dengan kelompok usia terbanyak ialah 60-69 tahun (35%). Faktor risiko kardiovaskular yang paling banyak dimiliki subyek penelitian ialah hipertensi (80%, n=10). Terdapat peningkatan kadar LDH, CRP, d-dimer, ferritinin, dan fibrinogen. Pada pemeriksaan radiologi ditemukan bilateral pulmonary infiltrate (33%) dan ground-glass opacitiy (67%) (n=6). Simpulan penelitian ini ialah karakteristik pasien stroke iskemik akut dengan COVID-19 yang masuk ruang perawatan intensif paling banyak ialah perempuan, usia 60-69 tahun, memiliki faktor risiko kardiovaskular hipertensi, mengalami peningkatan kadar LDH, CRP, d-dimer, ferritinin, fibrinogen, dan ditemukan ground-glass opacitiy pada gambaran radiologi.Kata kunci: Stroke iskemik akut, COVID-19, ruang perawatan intensif

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Penanganan Stroke Iskemik Akut di Masa Pandemi COVID-19

e-CliniC ◽

10.35790/ecl.v9i1.32421 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Erlika Lengkong ◽

Finny Warouw ◽

Mieke A. H. N. Kembuan

Keyword(s):

Ischemic Stroke ◽

Literature Review ◽

Acute Ischemic Stroke ◽

Personal Protective Equipment ◽

Virus Disease ◽

Google Scholar ◽

Protective Equipment ◽

Team Approach ◽

Long Distance ◽

Corona Virus

Abstract: When the pandemic corona virus disease (COVID-19) occurs, emergency services and hospitals are finally disrupted. One of the medical emergencies which can cause death and disability as well as other problems if being ignored, especially in productive age patients is stroke. This study was aimed to obtain the management of ischemic stroke during COVID-19 pandemic. This was a literature review study using three databases, namely Clinical Key, PubMed and Google Scholar. The keywords used in data search were acute AND stroke AND pandemic. The results showed that the treatment of acute ischemic stroke during COVID-19 pandemic consisted of three stages, namely pre-hospitalization (public education, contacting medical assistance, use of personal protective equipment, pre-notification), hospitalization (emergency room, imaging room, neuroradiology unit, ICU and IMCU), and post hospitalali-zation (integrated team approach). In conclusion, the management of acute ischemic stroke during COVID-19 pandemic begins before the medical personnel take action until the action is carried out. The main things in the management of acute ischemic stroke during COVID-19 pandemic are handling fast and precisely, using adequate personal protective equipment (PPE), and using communication tools or long-distance medical care (telemedicine).Keywords: acute ischemic stroke, COVID-19, pandemic Abstrak: Saat terjadi pandemi corona virus disease (COVID-19), layanan kegawatdaruratan dan rumah sakit megalami perubahan. Salah satu kasus kegawatdaruratan medik yang menjadi penyebab kematian dan kecacatan serta dapat menimbulkan masalah lainnya jika diabaikan terutama pada pasien usia produktif ialah stroke. Penelitian ini bertujuan untuk mengetahui penanganan stroke pada masa pandemic COVID-19. Jenis penelitian ialah literature review yang menggunakan tiga database yaitu Clinikal key, PubMed dan Google Scholar. Kata kunci yang digunakan dalam pencarian data ialah acute AND stroke AND pandemic. Hasil penelitian mendapatkan penanganan stroke iskemik akut di masa pandemi COVID-19 terdiri dari 3 tahapan yakni prahospitalisasi (edukasi masyarakat, menghubungi bantuan medis, penggunaan alat pelindung diri, pranotifikasi rumah sakit), hospitalisasi (ruang gawat darurat, ruang pencitraan, unit neuroradiologi, ICU dan IMCU), dan pasca hospitalisasi (pendekatan tim terpadu). Simpulan penelitian ini ialah penanganan stroke iskemik akut di masa pandemi COVID-19 dimulai dari sebelum tenaga medis melakukan tindakan sampai setelah tindakan dilaksanakan. Hal utama dalam penanganan stroke iskemik akut di masa pandemi COVID-19 ialah penanganan yang cepat dan tepat, penggunaan alat pelindung diri (APD) yang memadai, dan pemanfaatan alat komunikasi atau perawatan medis jarak jauh.Kata kunci: stroke iskemik akut, pandemi, COVID-19

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A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.021907 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2872-2876 ◽

Cited By ~ 25

Author(s):

Andrew J. Zhang ◽

Parth Dhruv ◽

Philip Choi ◽

Caitlin Bakker ◽

Jonathan Koffel ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Literature Review ◽

Systematic Literature Review ◽

Stroke Risk ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Carotid Revascularization ◽

Stroke Risk Factors ◽

Patient Level

Background and Purpose— Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods— Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results— Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16–85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0–97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions— CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

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Abstract 207: A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.207 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Parth Dhruv ◽

Jae Kim ◽

Jonathan Koffel ◽

David Anderson ◽

Christopher Streib

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Literature Review ◽

Systematic Literature Review ◽

Recurrent Stroke ◽

Fibrous Tissue ◽

Definitive Treatment ◽

Stroke Recurrence ◽

Prevention Measures ◽

Carotid Revascularization

Introduction: Carotid Web (CW) is a rare form of focal fibromuscular dysplasia that results in an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. There is uncertainty in diagnosis, prognosis, and optimal management of this uncommon entity. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods: Our literature search for CW and related terms yielded 1017 results. After a preliminary assessment of all 1017 retrieved manuscripts; 72 manuscripts were reviewed in detail. A total of 31 manuscripts met entry criteria and were included in our SLR. We present the demographics, cardiovascular (CV) risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality of CW patients. Results: Our SLR resulted in 104 patients with CW, (median age at presentation: 45.7 [IQR 45-57], 52.3% female). The majority (68.3%) of CW patients did not have CV risk factors, however, 22.2% of patients were smokers. 47.8% of patients suffered recurrent stroke. The majority of patients were ultimately treated with antiplatelet therapy (94.4%) and 21.2% underwent carotid revascularization (4.8% carotid stenting, 16.3% carotid endarterectomy). None of the patients who underwent revascularization had a reported stroke recurrence. See Table. Conclusions: CW is a rare disease leading to ischemic stroke in younger patients without typical CV risk factors. CW patients in our SLR were at extremely high risk for recurrent stroke (47.8%). Aggressive secondary stroke prevention measures are indicated in this patient population, however, the optimal treatment strategies remain unclear. Carotid revascularization may be the definitive treatment for certain patients with CW, but further studies are needed as incomplete reporting and potential publication bias limit our findings.

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