Large artery occlusive disease of the anterior circulation

AbstractInadequate cerebral perfusion is a risk factor for cerebral ischemia in patients with large artery steno-occlusion. We investigated whether prefrontal oxyhemoglobin oscillation (ΔHbO2, 0.6–2 Hz) was associated with decreased vascular reserve in patients with steno-occlusion in the large anterior circulation arteries. Thirty-six patients with steno-occlusion in the anterior circulation arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery) were included and compared to thirty-six control subjects. Patients were categorized into two groups (deteriorated vascular reserve vs. preserved vascular reserve) based on the results of Diamox single- photon emission computed tomography imaging. HbO2 data were collected using functional near-infrared spectroscopy. The slope of ΔHbO2 and the ipsilateral/contralateral slope ratio of ΔHbO2 were analyzed. Among the included patients (n = 36), 25 (69.4%) had deteriorated vascular reserve. Patients with deteriorated vascular reserve had a significantly higher average slope of ΔHbO2 on the ipsilateral side (5.01 ± 2.14) and a higher ipsilateral/contralateral ratio (1.44 ± 0.62) compared to those with preserved vascular reserve (3.17 ± 1.36, P = 0.014; 0.93 ± 0.33, P = 0.016, respectively) or the controls (3.82 ± 1.69, P = 0.019; 0.94 ± 0.29, P = 0.001). The ipsilateral/contralateral ΔHbO2 ratio could be used as a surrogate for vascular reserve in patients with severe steno-occlusion in the anterior circulation arteries.

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Safety of Endovascular Therapy in Progressive Ischemic Stroke and Anterior Circulation Large Artery Occlusion

World Neurosurgery ◽

10.1016/j.wneu.2018.10.059 ◽

2019 ◽

Vol 122 ◽

pp. e383-e389 ◽

Cited By ~ 1

Author(s):

Wen-Huo Chen ◽

Ting-yu Yi ◽

Yan-Min Wu ◽

Mei-Fang Zhang ◽

Ding-lai Lin ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Therapy ◽

Artery Occlusion ◽

Large Artery ◽

Anterior Circulation

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Collateral circulation is a predictor for in-stent restenosis after cerebral anterior circulation large artery stenting

10.21203/rs.3.rs-177380/v1 ◽

2021 ◽

Author(s):

Luji Liu ◽

Xudong Su ◽

Zhongzhong Li ◽

Kailin Bu ◽

Si Yuan ◽

...

Keyword(s):

Risk Factors ◽

Drug Therapy ◽

Collateral Circulation ◽

Large Artery ◽

Anterior Circulation ◽

Standard Drug ◽

Residual Stenosis ◽

Stent Restenosis ◽

Stenosis Rate ◽

In Stent Restenosis

Abstract Background- In-stent restenosis (ISR) is a critical issue of endovascular therapy. The predictors for ISR are not fully explored. We aimed to investigate the predictors for ISR, especially the effect of collateral circulation on ISR after cerebral large artery stenting. Methods- From June, 2015 to June, 2018, a total of 312 patients, who performed stenting, with severe cerebral anterior circulation stenosis (≥ 70%), were enrolled. According to the flow velocity indicated by carotid artery ultrasound or Transcranial Doppler, the patients were divided into the ISR and no-ISR groups. Clinical data were collected, including age, sex, cerebrovascular risk factors, preoperative serum lipid, inflammatory markers, and platelet count, stent site, residual stenosis rate, drug therapy after stenting. The collateral circulation was graded according to digital subtraction angiography (DSA). Univariable and multivariable logistic regression analyses were performed to assess the potential risk factors related to restenosis in such patients. Results- Higher residual stenosis rate (median 11% vs 10%, p = 0.040), fewer patients received standard drug therapy ( 73.3% vs 89.4%, p = 0.001), more patients with poor collateral circulation (70.0% vs 41.0%, p = 0.007) were found in ISR group. Residual stenosis rate increased by 10% was associated with a 19.1% increase in restenosis risk. Good collateral circulation (OR 0.16, [95%CI, 0.04–0.49]; p = 0.002) and receiving standard drug therapy (OR 0.14, [95%CI, 0.05–0.58]; p = 0.002) were significantly related to the lower risk of ISR. Conclusion- Collateral circulation is an independent factor related with ISR after successful cerebral anterior circulation large artery stenting, and long-term standard drug therapy after stenting should be strictly carried out in such patients.

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Abstract WP39: Mechanical Embolectomy for Acute Ischemic Stroke Beyond Six Hours From Symptom Onset Using Advanced MR Imaging

Stroke ◽

10.1161/str.48.suppl_1.wp39 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ryan McTaggart ◽

Shadi Yaghi ◽

Daniel C Sacchetti ◽

Richard Haas ◽

Shawna Cutting ◽

...

Keyword(s):

Ischemic Stroke ◽

Mr Imaging ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Lesion Volume ◽

Large Artery ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Outcome

Background: There is very limited data on the use of advanced neuroimaging to select patients with acute ischemic stroke and large vessel occlusion for intraarterial therapy beyond 6 hours from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6 hours from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. Methods: This is a single institution retrospective study between December 1st, 2015, and July 30 th , 2016 with acute ischemic stroke and anterior circulation large vessel occlusion (LVO) with ASPECTS of 6 or more and beyond 6 hours from symptoms onset. Favorable imaging profile was defined as 1) DWI lesion volume (as defined as apparent diffusion coefficient < 620 X 10-6 mm2/s) of 70 mL or less AND 2) Penumbra volume (as defined by volume of tissue with Tmax >6 sec) of 15 mL or greater AND 3) A mismatch ratio of 1.8 or more AND 4) Volume of tissue with perfusion lesion with Tmax > 10 sec is less than 100 mL. Good outcome was defined as a 90 day mRS≤2. Results: In the study period, 41 patients met the inclusion criteria; 22 (53.6%) had favorable imaging profile and underwent mechanical embolectomy. The median age was 75 years (59-92), 68.2% were females; the median time from last known normal to groin puncture was 684.5 minutes (range 363-1628) and the median admission NIHSS score was 17.5 (range 4-28). The rate of good outcomes in this series was similar to that in a patient level pooled meta-analysis of the recent endovascular trials (68.2% vs. 46.0%, p=0.07). The rate of good outcome matches that of the EXTEND-IA trial that selected patients using perfusion imaging (68.2% vs. 71.0%, p = 1.00). None of the patients in our cohort had symptomatic intracereberal hemorrhage. Conclusion: Advanced MR imaging may help select patients with acute ischemic stroke and anterior circulation large vessel occlusion for embolectomy beyond the treatment window used in most endovascular trials.

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Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

Case Reports in Neurology ◽

10.1159/000507185 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 49-55

Author(s):

Huong Bich Thi Nguyen ◽

Thang Huy Nguyen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Time Window ◽

Recurrent Stroke ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Large Artery ◽

Limited Information ◽

Anterior Circulation ◽

Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

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Comment on: Mechanical Thrombectomy with the Solitaire AB Device in Large Artery Occlusions of the Anterior Circulation

Clinical Neuroradiology ◽

10.1007/s00062-010-0043-4 ◽

2010 ◽

Vol 20 (4) ◽

pp. 267-268 ◽

Cited By ~ 1

Author(s):

S. Stampfl ◽

S. Rohde

Keyword(s):

Mechanical Thrombectomy ◽

Large Artery ◽

Anterior Circulation

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Management of Bilateral Carotid Occlusive Disease

Interventional Neurology ◽

10.1159/000442530 ◽

2015 ◽

Vol 4 (3-4) ◽

pp. 96-103 ◽

Cited By ~ 2

Author(s):

Ashutosh P. Jadhav ◽

Andrew F. Ducruet ◽

Brian T. Jankowitz ◽

Tudor G. Jovin

Keyword(s):

Scale Score ◽

Internal Carotid ◽

Recurrent Stroke ◽

Carotid Stenting ◽

Occlusive Disease ◽

External Carotid ◽

Anterior Circulation ◽

Retrograde Filling ◽

Bilateral Carotid ◽

Carotid Occlusive Disease

Background: Symptomatic bilateral internal carotid occlusive disease is a rare but potentially devastating entity. Medical therapy alone is associated with high rates of mortality and recurrent stroke. The optimal management of this disease remains poorly understood. Methods: A retrospective review of a prospectively maintained database was conducted for patients who presented with an acute stroke in the setting of bilateral carotid occlusive disease between May and October 2013. Results: We identified 3 patients. The admission National Institutes of Health Stroke Scale score ranged from 4 to 7. All patients had small- to moderate-sized infarcts in the anterior circulation on presentation. Angiography confirmed bilateral internal carotid occlusions with collateral filling via the posterior communicating artery and retrograde filling via external carotid artery supply to the ophthalmic artery. All patients were initially managed with permissive hypertension and anticoagulation followed by carotid angioplasty and stenting. At 1-year follow-up, all patients demonstrated a modified Rankin scale score of 0-1. Conclusions: Carotid stenting may be a safe and effective therapy for patients presenting with symptomatic bilateral carotid occlusions.

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