Analysis of Clinical and Demographic Variables in the Treatment of Carotid Stenosis by Endarterectomy and Stent Angioplasty

Introduction: Carotid stenosis plays a major role in the etiology of cerebral ischemic events. We evaluated the variables that impact the evolution of these patients. Methods: Data were retrospectively checked from the medical records of patients treated in the period between 2008 and 2015. Different variables were evaluated to determine the factors that influence the patients clinically. Results: The analysis was conducted based on a sample of 63 patients with carotid stenosis who underwent surgery. Regarding the factors that influenced the outcome, there was significant association with age ≥70 years, smoking and previous ischemic stroke. Although hypertension was the most prevalent comorbidity, no significant association as clinical worsening factor was found, as well as the isolated analysis of each surgery showed no significant difference. Conclusions: The clinical profile and lifestyle habits associated with certain comorbidities are variables that influence the clinical outcome of patients with carotid stenosis.

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Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Cerebrovascular Diseases ◽

10.1159/000506826 ◽

2020 ◽

Vol 49 (2) ◽

pp. 200-205

Author(s):

Juha-Pekka Pienimäki ◽

Niko Sillanpää ◽

Pasi Jolma ◽

Sara Protto

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Clinical Outcome ◽

Acute Stroke ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Collateral Circulation ◽

Artery Stenosis ◽

Stroke Patients ◽

Significant Difference

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

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Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

Brain Sciences ◽

10.3390/brainsci11040504 ◽

2021 ◽

Vol 11 (4) ◽

pp. 504

Author(s):

Dalibor Sila ◽

Markus Lenski ◽

Maria Vojtková ◽

Mustafa Elgharbawy ◽

František Charvát ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Binary Logistic Regression ◽

Stent Retriever ◽

Good Clinical Outcome ◽

Significant Difference ◽

Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

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Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽

10.1161/str.52.suppl_1.p426 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sachin M Bhagavan ◽

Ammad Ishfaq ◽

Muhammad F Ishfaq ◽

Mukaish Kumar ◽

Shruthi Pulimamidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Carotid Stenosis ◽

Transient Ischemic Attack ◽

Stent Placement ◽

Severe Disability ◽

Platelet Glycoprotein ◽

Carotid Stent ◽

Significant Difference ◽

Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

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A Simple Geometric Assessment of Perfusion Lesion Volume at Hyperacute Stage of Ischemic Stroke in Patients with Symptomatic Steno-Occlusion of Major Cerebral Arteries and Risk of Subsequent Cerebral Ischemic Events

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2015.05.025 ◽

2015 ◽

Vol 24 (12) ◽

pp. 2669-2675

Author(s):

Jihoon Kang ◽

Cheolkyu Jung ◽

Nayoung Kim ◽

Yoo Ri Son ◽

Byungse Choi ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Arteries ◽

Lesion Volume ◽

Cerebral Ischemic ◽

Ischemic Events

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Association Between Carotid atherosclerosis And High Factor VIII Activity In Ischemic stroke

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v30i1.57358 ◽

2014 ◽

Vol 30 (1) ◽

pp. 1-10

Author(s):

Sukumar Majumder ◽

Anis Ahmed ◽

- Md Shahidullah ◽

Md Rafiqul Islam ◽

Md Rezaul Karim Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Factor Viii ◽

Carotid Stenosis ◽

Carotid Atherosclerosis ◽

Coagulation Factors ◽

Population Based ◽

Factor Viii Activity ◽

Chi Square ◽

Cross Sectional ◽

Significant Difference

Background: A sample of 60 subjects from population based study participated in a study on carotid color duplex ultrasonography that aimed to assess the relations of coagulation factors to stroke and carotid atherosclerosis. The association between severity of carotid atherosclerosis and high factor viii activity in ischemic stroke is still not clear. Objective: The present study was conducted to find out the association between carotid atherosclerosis and high factor viii activity in ischemic stroke. Methodology: This was a cross sectional analytical study carried out in the department of neurology,BSMMU during the period of july’2009 to june’2011.A total 60 subjects with ischemic stroke were included in this study and data were collected purposively. Chi square test was done and probability value <0.05 were considered as level of significance and 95% confidence limit were taken. Result: In patients with e”50% carotid stenosis, 7(23.33%) had high factor VIII activity and 23(76.67%) had normal factor VIII activity. In patients with <50% carotid stenosis, 2(6.67%) had high factor VIII activity and 28(93.33%) had normal factor VIII activity. No significant difference (P>0.05%) was found between the high factor VIII activity and normal factor VIII activity related to severity of carotid stenosis. Conclusion: The roles of hypertension, hypercholesterolemia, and hypertriglyceridemia have been implicated in the pathogenesis of the carotid atherosclerosis but in the present study did not find any association between the severity of the carotid atherosclerosis with high factor viii activity in ischemic stroke. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 1-10

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Abstract TMP119: Early Cerebral Ischemic Events in Symptomatic Carotid Stenosis are Related to Plaque Inflammation

Stroke ◽

10.1161/str.48.suppl_1.tmp119 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Prakash R Paliwal ◽

Arvind K Sinha ◽

Hock L Teoh ◽

James Hallinan ◽

Zhengdao Du ◽

...

Keyword(s):

Cerebral Ischemia ◽

Carotid Stenosis ◽

Fdg Pet ◽

Carotid Plaque ◽

Stroke Recurrence ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis ◽

Plaque Inflammation ◽

Cerebral Ischemic ◽

Ischemic Events

Background and aims: Symptomatic carotid stenosis is associated with an increased risk of early stroke recurrence. Severity of the stenosis, current basis of revascularization, explains only the cerebral ischemic mechanism of regional hypoperfusion. Plaque inflammation, the initiating event for plaque rupture and thromboembolism (artery-to-artery embolism), is not evaluated routinely. Using 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography (CT) and high resolution magnetic resonance imaging (HR-MRI), we investigated the role of plaque imaging and stroke recurrence in our cohort of stroke patients with recently symptomatic carotid stenosis. Methods: This ongoing prospective study included consecutive patients within 30-days of recent stroke and ipsilateral carotid stenosis (≥50%). FDG uptake was quantified as mean standardized uptake values (SUV, g/ml). The ratio of T1 hyperintensity of carotid plaque to the ipsilateral sternocleidomastoid muscle (SCM) was recorded on T1-weighted fat suppressed images. Patients were followed prospectively for stroke recurrence within 90-days. Embolic potential of carotid plaque is estimated by presence of spontaneous microembolic signals (MES) on extended transcranial Doppler monitoring of ipsilateral middle cerebral artery. Results: Of the 33 patients included in the study, 6 (18%) suffered from recurrent cerebral ischemic event in the same vascular territory within 90-days. Compared to patients without subsequent cerebral ischemic events, patients with recurrent cerebral ischemia showed higher mean T1 carotid-SCM ratio (2.49 versus 1.53; p<0.0001) and higher mean SUV value in the carotid plaque (3.52g/ml versus 1.51g/ml; p<0.0001). Higher T1 carotid-SCM ratio on HR-MRI (OR 4.249, 95%CI 1.818-5.18; p<0.0001), higher mean SUV on FDG-PET (OR 3.050, 95%CI 5.586-28.571; p=0.005) and MES on TCD (OR 2.186, 95%CI 1.652-47.619;p=0.037) were independent predictors of recurrent cerebral ischemia. Conclusions: FDG-PET/CT and HR-MRI imaging of carotid stenosis helps in identification of patients at higher risk of subsequent cerebral ischemic events and may aid in better therapeutic decision-making.

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Abstract T P64: Cerebral Ischemic Events Associated with Intravenous Thrombolytic Administration in International Joint Efficacy Comparison of Thrombolytics (INJECT) Trial.

Stroke ◽

10.1161/str.45.suppl_1.tp64 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nudrat Tasneem ◽

Malik M Adil ◽

M Fareed K Suri ◽

Adnan I Qureshi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Double Blind ◽

Intravenous Heparin ◽

Acute Mi ◽

Cardiac Shock ◽

Cerebral Ischemic ◽

Post Hoc ◽

Ischemic Events

Background: Platelet activation can be seen subsequent to thrombolytic administration leading to re-occlusion within coronary arteries. However, the occurrence of cerebral ischemic events secondary to thrombolytic administration is not well studied. Objective: To study the rate and outcome of patients with acute myocardial infarction [MI] who develop cerebral ischemic events within 48 hours of thrombolytic administration. Methods: A post-hoc analysis of the INJECT trial data was performed. Patients from 208 centers in nine countries (n = 6010) with acute myocardial infarction (<12 hr after symptom onset) were randomized to receive double-blind either streptokinase 1.5 MU intravenously over 60 min or reteplase two boluses of 10 MU given 30 min apart. All patients received intravenous heparin for at least 24 h. Ascertainment of ischemic stroke during hospitalization was performed throughout the study. Results: A total of 81 in-hospital strokes were observed in 6010 acute MI patients of which 47 were classified as ischemic events. A total of 29 (62%) suffered ischemic events within 48 hours of thrombolytic administration; 23 were ischemic stroke and 06 were transient ischemic attacks. The mean age (±SD) of the 29 patients was 70± (10) ; 20 were men. None of the patients had pre-existing or new onset atrial fibrillation. Underlying cardiac shock and heart failure was seen in 2 and 5 patients, respectively. IV heparin was continued for 24-72 hours in 11 patients. Survival was 66% (n=19) at 35 days and 55% (n=16) at 6 months. Conclusions: Most cerebral ischemic events occur in the immediate post-thrombolytic period and result in disproportionately low survival over 6 months.

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Abstract T P160: Are Severity and Outcome of Ischemic Stroke With Paroxysmal Atrial Fiblliration Different From Those With Chronic Atrial Fibrillation?

Stroke ◽

10.1161/str.45.suppl_1.tp160 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Seiji Miura ◽

Masahiro Yasaka ◽

Koichiro Maeda ◽

Takeshi Uwatoko ◽

Takahiro Kuwashiro ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Paroxysmal Atrial Fibrillation ◽

Medical Records ◽

Chronic Atrial Fibrillation ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Significant Difference ◽

Scale Scores

Background and Purpose: Previous studies indicated that incidence of ischemic stroke did not differ between patients with paroxysmal atrial fibrillation (PAF) and those with chronic atrial fibrillation (CAF). However, it has been under dispute whether severity and outcome of ischemic stroke in patients with PAF differ from those with CAF. Then, we compared them between ischemic stroke patients with PAF and those with CAF. Methods: We obtained data from the medical records of 372 consecutive patients admitted to our hospital, who had acute ischemic stroke with atrial fibrillation, from January, 2008, to December, 2012.We compared neurological severities (NIH stroke scale scores) on admission and discharge, functional outcome evaluated by modified Rankin scale, (mRS) on discharge between patients with PAF and those with CAF. Results: Of 372 patients, 123 patients had PAF (men 62.6%, 78.0 +- 10.0 years old) and 249 patients (men 62.1%, 77.9 +- 9.5 years old) had CAF. There were no significant differences in NIH stroke scale on admission between the PAF group (media 5 with IQR 2-14) and the CAF group (6, 2-16)(P=0.2772). NIH stroke scale scores (1, 0-8.75, vs. 2, 0-10, p=0.1549) and mRS(2, 1-4, vs. 3, 1-4, p=0.2105) on discharge did not differ between the two groups, either. After adjustment for age, sex, modified Rankin scale before admission, diabetes, hypertension, dyslipidemia, there was no significant difference in mRS at discharge between the two groups. (P=0.1416). Conclusion: It seems that the severity and outcome of ischemic stroke with PAF are not different from those with CAF.

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