Abstract WP65: Relationship Between Neurological Severity and CBF Grade of Mr Perfusion in Acute Stroke Patients With the Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yuji Takahashi ◽  
Kazuhiro Yoshioka ◽  
Shigen Kasakura ◽  
Yuhei Tanno ◽  
Tomonori Iwata ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Mr Perfusion ◽  
Stroke Patients ◽  
Statistical Significant Difference ◽  
Time To Peak ◽  
Significant Difference ◽  
Grade Groups

Introduction: It remains unclear how strongly perfusion findings are related to neurological severity (NS) and MR-DW images (DWI). Hypothesis: CBF grade based on MR perfusion (MRp) is related to NS or DWI and can identify candidates for endovascular therapy (ET). Methods: Included in our retrospective analysis were acute ischemic stroke patients 1) who were admitted to our stroke center within 24 hours of the onset between Jan 2004 and May 2015, 2) who presented NIHSS as NS of 0 or more, 3) who underwent MRA, displaying complete occlusion of the affected carotid artery. We evaluated patients’ baseline features, NIHSS, DWI-ASPECTS (ACT) at arrival and CBF grade, which was calculated by using bilateral time-intensity curves (TICs) of MR perfusion. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we regarded the affected-sided PSa divided by TPa as possible CBFa and the contralateral-sided PSc divided by TPc as possible CBFc. CBF grade 1 was defined as CBFa divided by CBFc (CBF%) less than 0.2, grade 2 as CBF% of 0.2 or more and CBF% less than 0.7 and grade 3 as CBF% of 0.7 or more. Results: During the study period, 176 patients matched our criteria for analysis. Median NIHSS was 18, and median ACT was 6. There were 30 patients with CBF grade1, 81 with grade2 and 65 with grade3. Median NIHSS in grade1, 2, and 3 patients was 23, 19, and 7 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Median ACT in grade1, 2, and 3 was 1, 5, and 8 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Among 32 patients with NIHSS of 7 or less and ACT of 8 or more, there were 28 (87.5%) in grade3. Among 10 patients with NIHSS of 23 or more and ACT of 1 or less, there were 9 (90%) in grade1. Among 40 patients with NIHSS of 8 or more and ACT of 8 or more, there was 22 (55%) in grade2 and 18 (45%) in grade3. Conclusion: CBF grade defined by MRp had strong relation to NIHSS and ACT. Patients with lower NIHSS score but higher ACT score were probable candidates for ET and many among them belonged to CBF grade2.

Abstract WP150: BeamSAT MRI Help to Identify Patients at Risk for Intolerance to Temporary Internal Carotid Artery Occlusion During CEA and CAS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jun Tanaka ◽  
Kohkichi Hosoda ◽  
Yusuke Yamamoto ◽  
Taichiro Imahori ◽  
Atsushi Fujita ◽  
...  
Keyword(s):  
At Risk ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Preoperative Assessment ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Patients At Risk

Introduction: Pencil Beam type presaturation (BeamSAT) pulse on a major cervical vessel enables selective suppression of blood flow signal of the applied vessel in MR angiography (MRA). By subtracting the BeamSAT pulse-added MRA of an internal carotid artery (ICA) from conventional MRA, only the contralateral ICA image (SubBeamSAT image) can be obtained (Figure A, B). In this way, an ICA-selective MRA with more physiologial flow pattern can be obtained, because it requires no powerful injection of contrast medium. Purpose: The aim of this study was to investigate whether preoperative assessment of the flow of Acom/A1 by SubBeamSAT image and posterior communicating artery (Pcom) by conventional MRA could identify patients at risk for intolerance to intraoperative temporary ICA occlusion. Method: 29 patients who underwent carotid endarterectomy (CEA) (n = 17) or carotid artery stenting (CAS) (n = 12) were enrolled in the current study. All patients underwent the SubBeamSAT images and conventional MRA pre- and post-operatively. Response to ICA temporally occlusion was recorded during the revascularization procedure. Results: Among twenty-nine patients, 4 patients who demonstrate neither the Acom/A1 flow on SubBeamSAT image (Figure. B) nor Pcom flow on MRA showed intolerance. In contrast, the remaining 25 patients who demonstrated Acom/A1 (Figure. A) and/or Pcom flow showed tolerance. Intolerance to ICA occlusion was excellently predicted by visualization of collateral flow via Acom and Pcom (specificity: 100%, sensitivity: 100%, p=0.00004). Conclusions: SubBeamSAT image is useful for evaluating the flow of Acom from A1 portion of the healthy side to A2 portion of the contralateral side, which is often difficult to evaluate with conventional MRA. With the SubBeamSAT image, it is feasible to evaluate the Acom/A1 flow accurately. In conclusion, SubBeamSAT image enables excellent prediction for the intolerance to temporary ICA occlusion.

Neurosurgical applications of ocular pneumoplethysmography

1981 ◽  
Vol 54 (5) ◽  
pp. 588-595 ◽  
Author(s):  
William F. Bingham
Keyword(s):  
Standard Deviation ◽  
Carotid Artery ◽  
Intracranial Aneurysm ◽  
Carotid Endarterectomy ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Content Type ◽  
Final Adjustment ◽  
Fine Print

✓ Ocular pneumoplethysmography (OPG), a semiautomated form of suction ophthalmodynamometry, was used to evaluate and follow 15 patients who underwent carotid endarterectomy and two patients in whom gradual carotid artery occlusion was performed for inoperable intracranial aneurysm. Postoperative corrected ophthalmic arterial pressures (COAP's) on the operated side in the carotid endarterectomy patients averaged 12.5 mm Hg higher than before surgery, the standard deviation being 4.9 mm Hg for clinically stable patients. There was no significant change in COAP on the contralateral side. Several problems were encountered in closing down carotid clamps, the most potentially serious being a precipitous fall in COAP with the final adjustment. The current uses of OPG and similar techniques are reviewed, and potential neurosurgical applications are discussed.

Abstract TP53: Simple And Easy Way Using Time-Intensity Curve of Perfusion-Weighted Images to Find Penumbra In Stroke Patients Within 4.5 Hours Of Onset Due To The Carotid Artery Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yuichi Miyazaki ◽  
Masahito Nakazaki ◽  
Yoichiro Takahashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Hospital Death ◽  
Emergency Setting ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve

[Purpose] It is not clear how to find penumbra from MR-PWI for reperfusion therapy (RT). The aim of our retrospective study was to investigate whether or not a simple way using time-intensity curve (TIC) of PWI can find penumbra in stroke patients admitted within 4.5 hours from sudden onset due to acute carotid artery occlusion. [Subjects and Methods] Included for analysis were stroke patients 1) who were admitted within 4.5 hours of onset between Jan 2006 and January 2011, 2) who presented NIHSS score of 6 or more on admission, and 3) who underwent emergency MR imaging , which suggested the affected carotid artery occlusion. We assessed, NIHSS on admission (NIH adm), DWI-ASPECT score, TIC types, successful recanalization (SR), NIHSS on the 7th day (NIH 7 th ), and in-hospital death. Early neurological improvement (ENI) was defined as NIH adm - NIH 7 th >0. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we classified TIC pattern into four types and defined type 1 as TPa>TPc and PSa<PSc/2, type2 as TPa>TPc and PSc/2≦PSa<PSc, type 3 as TPa >TPc and PSa≧PSc, and type 4 as TPa=TPc. Relationship between TIC types, in-hospital death and ENI were assessed. [Result] Eighty-seven patients were analyzed. There were 36, 39, 12 and 0 patients in TIC type 1, 2, 3 and 4, 39 patients (44.8%: 39/87) underwent RT and SR was achieved in 18 patients (46.2%), and 29 patients died. Among variables, TIC type 1 was the only determinant of in-hospital death (p<0.01) and SR coupled with TIC type 2 was the determinant of ENI (p<0.01). [Conclusion] TIC type 1 predetermines poor clinical outcome and type 2 means penumbra, where SR may early improve neurological symptoms. TIC is an easy way to find penumbra in an emergency setting.

scholarly journals Case of “Slow” Stroke from Carotid Artery Occlusion Treated by Delayed but Cautious Endovascular Intervention

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Kachi Illoh ◽  
Emilio Supsupin ◽  
Hashem M. Shaltoni ◽  
Edwin D. Cacayorin
Keyword(s):  
Carotid Artery ◽  
Brain Imaging ◽  
Multimodal Imaging ◽  
Imaging Techniques ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Carotid Occlusion ◽  
Mr Perfusion ◽  
Residual Stenosis ◽  
Endovascular Revascularization

In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present “slow” strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement across the residual stenosis, enabled revascularization of the occluded artery without overt in-hospital complications.

scholarly journals Thrombectomy for acute ischemic stroke patients with isolated distal internal carotid artery occlusion: a retrospective observational study

2020 ◽  
Author(s):  
Jan W. Hoving ◽  
◽  
Manon Kappelhof ◽  
Mark Schembri ◽  
Bart J. Emmer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Choroid Plexus ◽  
Internal Carotid ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Patients ◽  
Distal Internal Carotid Artery ◽  
Mr Clean

Abstract Purpose Acute stroke patients presenting with a distal internal carotid artery occlusion and patent carotid terminus, allowing for collateral flow via the circle of Willis, may have a more favorable natural history. Therefore, benefit of endovascular treatment (EVT) is less evident. We performed an exploratory analysis of EVT results compared to conservative treatment in patients with ‘carotid-I’ occlusions. Methods We report on EVT-treated and non-EVT-treated patients with carotid-I occlusions from the MR CLEAN Registry, MR CLEAN trial, and our comprehensive stroke center. CT-angiography was reviewed on primary collateral patency and choroid plexus enhancement. Perfusion deficits were assessed on CT-perfusion (CTP). Clot migration was assessed by comparing clot location on baseline CTA to its location on periprocedural digital subtraction angiography. Outcomes included 90-day functional independence (mRS 0–2), successful reperfusion and mortality. Results We included 51 patients. Forty-one patients received EVT, ten patients did not. Intravenous thrombolysis was administered in 32 (78%) EVT-treated patients and 6 (60%) non-EVT-treated patients. CTP, available for 17 patients, showed hypoperfusion on cerebral blood flow maps in 13 (76%) patients. Successful reperfusion after EVT occurred in 23 (56%), and clot migration in 8 patients (20%). Functional independence was achieved in 54% (21/39) of EVT-treated and in 10% (1/10) of non-EVT-treated patients. Mortality was 26% (10/39) and 30% (3/10), respectively. Anterior choroidal artery patency and choroid plexus enhancement were positively associated with functional independence. Conclusion In our population, data suggest improved outcomes after EVT in carotid-I occlusion patients and provide no arguments to withhold EVT in these patients.

Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions

Neurosurgery ◽  
2019 ◽  
Vol 86 (2) ◽  
pp. 213-220 ◽  
Author(s):  
Byungjun Kim ◽  
Byung Moon Kim ◽  
Oh Young Bang ◽  
Jang-Hyun Baek ◽  
Ji Hoe Heo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Efficacy And Safety ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage

Abstract BACKGROUND It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO). OBJECTIVE To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone). METHODS We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success. RESULTS Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187). CONCLUSION CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.

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