Early Carotid Artery Stenting and Angioplasty in Patients with Acute Ischemic Stroke

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1237-1243 ◽  
Author(s):  
Osama O. Zaidat ◽  
Michael J. Alexander ◽  
Jose I. Suarez ◽  
Robert W. Tarr ◽  
Warren R. Selman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
University Hospitals ◽  
Radiological Data ◽  
The Mean ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
Mean Time

Abstract OBJECTIVE: To determine the safety of early percutaneous endovascular carotid angioplasty and stenting (CAS) after an ischemic stroke. METHODS: The neurointerventional database was reviewed for patients who underwent CAS after an acute ischemic stroke in two university hospitals. Clinical and radiological data were reviewed. Outcomes were worsening stroke, new stroke, or stroke-related death up to 30 days after the procedure. Procedure-related complications were also documented. RESULTS: A total of 38 patients with 39 procedures were identified. The mean age was 67 ± 15 years; 31 of 38 patients were Caucasian and 24 were female. Hypertension was found in 21 patients, peripheral vascular disease in 12, diabetes in 13, and coronary artery disease in 18. The median initial National Institutes of Health Stroke Scale score was 8. The carotid artery showed severe to high-grade stenosis in 28 patients, dissection was present in 6, and the rest had an acute occlusion treated with thrombolysis followed by CAS. The mean time from stroke onset to CAS was 55 ± 34 hours. The mean degree of stenosis at baseline was 86 ± 11%. In 37 procedures, complete recanalization was achieved, defined as less than 10% residual narrowing; in 2 procedures, the residual stenosis was mild (10–20%). Neurological deterioration occurred after three procedures (7.7%), with minor nondisabling stroke in two and death from intracranial hemorrhage in one. CONCLUSION: If deemed necessary and in certain circumstances, early CAS seems to be safe after acute ischemic stroke if infarction volume is small and neurological deficit is mild.

Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S83-S91 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Akshal Patel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

Monocyte to high-density lipoprotein cholesterol ratio is associated with the presence of carotid artery disease in acute ischemic stroke

2021 ◽  
Author(s):  
Timor Omar ◽  
Muammer Karakayalı ◽  
Mahmut Yesin ◽  
Halil Can Alaydın ◽  
Yavuz Karabağ ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
High Density Lipoprotein ◽  
Acute Ischemic Stroke ◽  
High Density Lipoprotein Cholesterol ◽  
Independent Predictor ◽  
Carotid Artery Disease ◽  
Density Lipoprotein ◽  
Cholesterol Ratio ◽  
Artery Disease

Aim: Monocyte to high-density lipoprotein cholesterol ratio (MHR) has recently emerged as a predictor of cardio-cerebrovascular diseases. Since around one-fifth of strokes are linked to atherosclerosis carotid artery, we aimed to present the relationship between carotid artery disease (CAD) and MHR value in acute ischemic stroke (AIS). Materials & methods: A total of 209 adult AIS patients analyzed. Patients divided into two groups in respect to the existence of CAD. MHR was compared between the two groups. Results: MHR with a cut off of 17.23 predicted the presence of disease in the carotid artery, with a sensitivity of 91.9% and specificity of 66.7. MHR was the independent predictor for the presence of disease in the carotid artery. Conclusion: MHR was found to be an independent predictor for the CAD in AIS. Therefore, in AIS patients with high MHR value, CAD should be examined more carefully.

Hemodynamic Compromise During Carotid Angioplasty and Stenting

2011 ◽  
Author(s):  
A. G. Lynch ◽  
M. T. Walsh
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Disease ◽  
Arterial Disease ◽  
Neurological Deficits ◽  
Carotid Angioplasty ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Modern surgical treatment of arterial disease is moving towards minimally invasive procedures, as the benefits are numerous. However, one area that is resisting this trend is the treatment of carotid artery disease. For the past number of decades carotid endarterectomy surgery has been referred to as the “gold standard” in the treatment of carotid artery disease. However, in recent year’s carotid angioplasty and stenting (CAS) has emerged to challenge carotid endarterectomy surgery (CES) as a viable alternative for the prevention of strokes. However uptake of this procedure has been hindered due to the peri-operative complications associated with the treatment. During this procedure blood flow in one of the internal carotid arteries supplying blood to the brain is interrupted for a period of time. However, it has been shown that not all patients can accommodate this interruption. Qureshi et al. suggests that ischemic neurological deficits occur in 3 to 13% of patients as a result of hemodynamic compromise.

scholarly journals Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

2016 ◽  
Vol 7 (01) ◽  
pp. 55-60 ◽  
Author(s):  
Lekhjung Thapa ◽  
Shikher Shrestha ◽  
Pratyush Shrestha ◽  
Suman Bhattarai ◽  
D. N. Gongal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Demographic Profiles ◽  
Intracranial Bleed ◽  
Treatment Complication ◽  
Clinical Profiles ◽  
The Mean ◽  
Mean Time

ABSTRACT Background: Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1st time in our country. Materials and Methods: In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed. Results: A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed. Conclusion: This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.

Cerebral Blood Flow Change before and after Carotid Angioplasty and Stenting (CAS) in Cases with Contralateral Carotid Artery Occlusion

1995 ◽  
Vol 8 (6) ◽  
pp. 201-204
Author(s):  
T. Kataoka ◽  
T. Hyogo ◽  
K. Hayase ◽  
H. Nakamura
Keyword(s):  
Carotid Artery ◽  
Cross Flow ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Anterior Communicating Artery ◽  
Carotid Angioplasty ◽  
Before And After ◽  
The Mean ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined. 123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side. This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.

Technique and clinical evidence of neuroprotection in carotid artery stenting

VASA ◽  
2014 ◽  
Vol 43 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Rainer Knur
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Clinical Evidence ◽  
Carotid Artery Disease ◽  
Balloon Occlusion ◽  
Protection Devices ◽  
Artery Disease ◽  
Distal Filter ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid artery stenting has been advocated as an effective alternative to carotid endarterectomy. Periprocedural embolization of debris during endovascular treatment of carotid artery disease may result in neurological deficit. Different strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. Distal filter devices, proximal and distal balloon occlusion systems are increasingly used in carotid artery stenting, because they seem to be safe and effective in preventing distal embolization, according to several uncontrolled studies. However the use of embolic protection devices is a subject of controversy and no data on their benefit are available from randomized controlled multi-center trials. The technique and clinical evidence of cerebral protection systems during carotid angioplasty and stenting for stroke prevention are reviewed.

scholarly journals Cerebral Blood Flow Change before and after Carotid Angioplasty and Stenting (CAS) in Cases with Contralateral Carotid Artery Occlusion

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 201-204 ◽  
Author(s):  
T. Kataoka ◽  
T. Hyogo ◽  
K. Hayase ◽  
H. Nakamura
Keyword(s):  
Carotid Artery ◽  
Cross Flow ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Anterior Communicating Artery ◽  
Carotid Angioplasty ◽  
Before And After ◽  
The Mean ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined. 123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side. This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.

Transradial access in acute ischemic stroke intervention

2015 ◽  
Vol 8 (3) ◽  
pp. 247-250 ◽  
Author(s):  
Diogo C Haussen ◽  
Raul G Nogueira ◽  
Keith G DeSousa ◽  
Ryan N Pafford ◽  
Nazli Janjua ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Innominate Artery ◽  
Artery Occlusion ◽  
Anterior Circulation ◽  
Transradial Access ◽  
Intravenous Tissue Plasminogen Activator ◽  
The Mean ◽  
Mean Time

ObjectiveTo describe the feasibility and safety of transradial access (TRA) in the interventional management of acute ischemic stroke (AIS).MethodsA retrospective review of the local institutional AIS interventional databases of three tertiary academic centers was performed and the use of TRA identified.ResultsTRA was attempted in 15 (1.5%) of 1001 patients; it was used in 12 cases due to transfemoral access (TFA) failure and in 3 as the primary strategy. The mean age was 72.3±8.6 and 46% were male. Baseline National Institutes of Health Stroke Scale score was 19.5±8.7, two patients (14%) received intravenous tissue plasminogen activator, and mean time from last known normal to intra-arterial therapy was 17.0±20.1 h. Five patients had anterior circulation occlusive disease and 10 had vertebrobasilar occlusions. TRA was effective in allowing clot engagement in 13 of 15 cases: one patient had a hypoplastic radial artery that precluded sheath advancement and one had chronic innominate artery occlusion that could not be crossed. Mean time to switch from TFA to TRA was 1.9±1.3 h and the mean time from radial puncture to reperfusion was 2.2±1.0 h. Modified Thrombolysis In Cerebral Infarction 2b–3 reperfusion via TRA was achieved in 9 of 15 patients (60%). No radial puncture site complications were noted. At 90 days, two patients (13%) had a good clinical outcome and seven (50%) had died.ConclusionsFailure of TFA in the endovascular treatment of AIS is uncommon but leads to unacceptable delays in reperfusion and poor outcomes. Standardization of benchmarks for access switch could serve as a guide for neurointerventionalists. TRA is a valid approach for the endovascular treatment of AIS.

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