Endovascular treatment in patients with acute ischemic stroke and apparent occlusion of the extracranial internal carotid artery on CTA

2014 ◽  
Vol 7 (10) ◽  
pp. 709-714 ◽  
Author(s):  
Hanneke M Duijsens ◽  
Fianne Spaander ◽  
Lukas C van Dijk ◽  
Frank E Treurniet ◽  
Rudolf W Keunen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Extracranial Internal Carotid Artery

scholarly journals Recanalization of Extracranial Internal Carotid Artery Occlusion after i.v. Thrombolysis for Acute Ischemic Stroke

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e55318 ◽  
Author(s):  
Raimund Pechlaner ◽  
Michael Knoflach ◽  
Benjamin Matosevic ◽  
Michael Ruecker ◽  
Christoph Schmidauer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Extracranial Internal Carotid Artery

scholarly journals Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

Stroke ◽  
2019 ◽  
Vol 50 (8) ◽  
pp. 2057-2064 ◽  
Author(s):  
Bruna G. Dutra ◽  
Manon L. Tolhuisen ◽  
Heitor C.B.R. Alves ◽  
Kilian M. Treurniet ◽  
Manon Kappelhof ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Internal Carotid ◽  
Common Odds Ratio ◽  
Imaging Characteristics

Background and Purpose— Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment. Methods— The MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, and observational study in all centers performing endovascular treatment in the Netherlands. We evaluated associations of thrombus imaging characteristics with the functional outcome (modified Rankin Scale at 90 days), mortality, reperfusion, duration of endovascular treatment, and symptomatic intracranial hemorrhage using univariable and multivariable regression models. Thrombus characteristics included location, clot burden score (CBS), length, relative and absolute attenuation, perviousness, and distance from the internal carotid artery terminus to the thrombus. All characteristics were assessed on thin-slice (≤2.5 mm) noncontrast computed tomography and computed tomography angiography, acquired within 30 minutes from each other. Results— In total, 408 patients were analyzed. Thrombus with distal location, higher CBS, and shorter length were associated with better functional outcome (adjusted common odds ratio, 3.3; 95% CI, 2.0–5.3 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted common odds ratio, 1.15; 95% CI, 1.07–1.24 per CBS point; and adjusted common odds ratio, 0.96; 95% CI, 0.94–0.99 per mm, respectively) and reduced duration of endovascular procedure (adjusted coefficient B, −14.7; 95% CI, −24.2 to −5.1 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted coefficient B, −8.5; 95% CI, −14.5 to −2.4 per CBS point; and adjusted coefficient B, 7.3; 95% CI, 2.9–11.8 per mm, respectively). Thrombus perviousness was associated with better functional outcome (adjusted common odds ratio, 1.01; 95% CI, 1.00–1.02 per Hounsfield units increase). Distal thrombi were associated with successful reperfusion (adjusted odds ratio, 2.6; 95% CI, 1.4–4.9 for proximal M1 occlusion compared with internal carotid artery occlusion). Conclusions— Distal location, higher CBS, and shorter length are associated with better functional outcome and faster endovascular procedure. Distal thrombus is strongly associated with successful reperfusion, and a pervious thrombus is associated with better functional outcome.

scholarly journals Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

2021 ◽  
Author(s):  
Luigi Cirillo ◽  
Daniele Giuseppe Romano ◽  
Gianfranco Vornetti ◽  
Giulia Frauenfelder ◽  
Chiara Tamburrano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Poor Response ◽  
Response To Treatment ◽  
Vessel Occlusion

Abstract Background Occlusions of internal carotid artery (ICA), whether isolated or in tandem lesions (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies ​​have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to ICA occlusion, whether isolated or in TL. Methods we assessed the association between 90-day outcome and clinical, demographic, imaging and procedure data in 51 consecutive patients with acute isolated ICA or TL occlusion who underwent endovascular treatment (EVT). We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, procedural therapy and complications. Results A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67%) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8% Conclusions EVT in the treatment of AIS due to ICA occlusion is safe and effective; mortality rates are in agreement with the current literature. The use of the stent is safe and promotes good angiographic results, as well as therapy with a GpIIb / IIIa inhibitor immediately after stent release which is also associated with better 3-month outcome and good revascularization.

Direct PTA for Acute Ischemic Stroke

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 47-50 ◽  
Author(s):  
J. Uno
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Fibrinolytic Therapy ◽  
Extracranial Internal Carotid Artery ◽  
Extracranial Vertebral Artery ◽  
Extracranial Ica

We have performed direct PTA for 23 patients with acute ischemic stroke. Occlusion was identified at extracranial internal carotid artery (ICA) in 6 patients, at extracranial vertebral artery (VA) in 1, at intracranial ICA in 3, at middle cerebral artery (MCA) in 12, and at basilar artery (BA) in 1. Stenosis was identified at extracranial VA in 1 patient. In 4 of 6 patients of extracranial ICA, 1 of 1 patient of extracranial VA, 1 of 3 patients of intracranial ICA, 7 of 12 patients of MCA and 1 of 1 patient of BA, recanalization was observed. Fourteen of 22 occluded arteries (64%) were recanalized. The recanalization rate approximated that of local intraarterial fibrinolytic therapy. We have not experienced complications with this procedure. Direct PTA is promising and might be a novel recanalization technique.

scholarly journals Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system

2020 ◽  
Vol 4 (9) ◽  
pp. 539-543
Author(s):  
D.T. Chipova ◽  
◽  
L.V. Santikova ◽  
A.Ch. Zhemukhov ◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Inflammatory Markers ◽  
Internal Carotid ◽  
Fatal Outcome ◽  
Group 2 ◽  
Group 1

Aim: to study the stroke-associated pneumonia (SAP) effect on the outcome of ischemic stroke (IS) in the internal carotid artery system. Patients and Methods: 87 patients with IS underwent the follow-up study, of which 75 had no inflammatory bronchopulmonary complications (group 1), and 12 had pneumonia manifestation (group 2). The study was performed on days 1, 5, and 9 after IS, and 6 months and 12 months after discharge from the hospital. Neurological deficit severity (NIHSS, Barthel index) and inflammatory markers (peripheral blood leukocyte composition, C-reactive protein (CRP), ESR) were studied. Results: it was found that the presence of SAP was associated with increased mortality during the acute IS period (4 (33.1%) patients died in group 1 and 10 (13.3%) — in group 2, p<0.05), greater severity of neurological deficits (63.3±5.3 and 71.5±4.0 points on the NIHSS scale, respectively, p<0.05) and incapacitation (Barthel index — 63.3±5.3 and 71.5±4.0 points, respectively, p<0.05) at the end of the inpatient treatment period. In group 2, signs of an inflammatory response were detected on day 5, and the values of the white blood cell shift index, ESR and CRP significantly (p<0.05) differed from the initial values. During examination at 6 months and 12 months, there were no significant differences in these indicators between the groups. An association was established between the probability of SAP occurrence and the presence of swallowing disorders (r=0.672; p<0.05), the age of patients (r=0.572; p<0.05) and the presence of diabetes mellitus (r=0.522; p<0.05). The studied laboratory inflammatory markers allow us to timely assume the occurrence of pulmonary pathology. Conclusion: timely diagnosis and prevention of SAP can reduce the risk of fatal outcome, facilitate rehabilitation measures, and improve early IS outcomes. KEYWORDS: ischemic stroke, cardioembolic stroke, atherothrombotic stroke, complications, acute period, inflammatory markers, strokeassociated pneumonia, long-term outcomes. FOR CITATION: Chipova D.T., Santikova L.V., Zhemukhov A.Ch. Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system. Russian Medical Inquiry. 2020;4(9):539–543. DOI: 10.32364/2587-6821-2020-4-9-539-543.

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