Stenting of precerebral arteries in acute period of ischemic stroke

OBJECTIVE. The study aimed to raise an efficacy of motor functions after stenting of precerebral arteries in acute period of ischemic stroke in patients of elderly and senile age. MATERIAL AND METHODS. Treatment efficacy was assessed according to dynamics of neurological status, data of duplex scanning of brachiocephalic vessels, index of mobility «Rivermed», scale «Bartel» in 30 patients. RESULTS. Stenting of precerebral arteries in acute period of ischemic stroke facilitated to regress of motor disorders and normalized cerebral hemodynamics. CONCLUSIONS. Stenting is an alternative method to carotid endarterectomy. This approach should be applied in patients with expressed carotid stenosis in combination with accompanied diseases and high surgical risk.

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Early carotid endarterectomy in patients with symptomatic carotid stenosis in the acute period of ischemic stroke

Zhurnal nevrologii i psikhiatrii im S S Korsakova ◽

10.17116/jnevro201811809249 ◽

2018 ◽

Vol 118 (9) ◽

pp. 49

Author(s):

S. Sh. Zabirov ◽

P. V. Chechulov ◽

I. A. Voznyuk ◽

A. V. Polyakova ◽

A. V. Solovyev ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Acute Period ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis

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In-hospital outcomes of carotid endarterectomy in acute period of ischemic stroke: single-center register data

Kardiologiya i serdechno-sosudistaya khirurgiya ◽

10.17116/kardio20181105160 ◽

2018 ◽

Vol 11 (5) ◽

pp. 60 ◽

Cited By ~ 2

Author(s):

R. S. Tarasov ◽

A. N. Kazantsev ◽

I. V. Moldavskaya ◽

N. N. Burkov ◽

A. V. Mironov ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Single Center ◽

Hospital Outcomes ◽

Acute Period

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Outcomes of Carotid Artery Stenting in High-Risk Patients With Carotid Artery Stenosis

Neurosurgery ◽

10.1227/01.neu.0000365008.17803.ad ◽

2010 ◽

Vol 66 (3) ◽

pp. 448-454 ◽

Cited By ~ 13

Author(s):

Scott A. Meyer ◽

Chirag D. Gandhi ◽

David M. Johnson ◽

H. Richard Winn ◽

Aman B. Patel

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Neck Surgery ◽

Surgical Risk ◽

High Surgical Risk ◽

Risk Patients ◽

Ischemic Attack ◽

Major Stroke

Abstract OBJECTIVE Carotid artery angioplasty and carotid artery stenting (CAS) offer a viable alternative to carotid endarterectomy for symptomatic and asymptomatic patients; however, the complication rates associated with CAS may be higher than previously documented. We evaluated the safety and efficacy of CAS in high surgical risk patients in a single neurovascular center retrospective review. METHODS An institutional review board–approved retrospective review of the clinical variables and treatment outcomes of 101 consecutive patients (109 stents) from July 2001 to March 2007 with carotid stenosis were analyzed. Both symptomatic and asymptomatic stenoses were studied in high surgical risk patients as defined by the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial. Specifically, those patients with clinically significant cardiac disease (congestive heart failure, abnormal stress test, or need for open-heart surgery), severe pulmonary disease, contralateral carotid occlusion, contralateral laryngeal nerve palsy, recurrent stenosis after carotid endarterectomy, previous radical neck surgery, or radiation therapy to the neck, and an age older than 80. RESULTS Seventy-four percent of the patients were symptomatic (n = 81), and the mean stenosis in symptomatic patients was 83%. Reasons for stenting included cardiac/pulmonary/medical risk (60%), contralateral internal carotid artery occlusion (8%), recurrent stenosis after carotid endarterectomy (11%), carotid dissection (6%), age older than 80 (7%), previous radical neck surgery (7%), and previous neck radiation (1%). Stent deployment was achieved in 108 of 109 vessels (99%). Distal embolic protection devices were used in 72% of cases treated. The overall rate of in-hospital adverse events (transient ischemic attack, intracranial hemorrhage, minor stroke, major stroke, myocardial infarction, and death) was 8.3% (9 of 109). Of these events, 2 patients (1.8%) experienced a hemispheric transient ischemic attack (neurological symptoms that resolved within 24 hours), 2 others (1.8%) had transiently symptomatic acute reperfusion syndrome. The 30-day stroke/death/myocardial infarction risk was 4.6% (n = 5). Of these patients, 3 had minor strokes (2.7%) defined as a modified Rankin Scale score less than 3 at 1-year follow-up, 1 had a major stroke (0.9%) defined as a modified Rankin Scale score of 3 or more at 1-year follow-up, and 1 patient died after a periprocedural myocardial infarction (0.9%). CONCLUSION CAS can be performed with a low 30-day complication rate, even with a higher percentage of symptomatic lesions. The results support the use of CAS in high surgical risk patients with both significant symptomatic and asymptomatic carotid artery disease.

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The prognostic value of the serum inflammatory biomarkers in patients with carotid atherosclerosis

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001969 ◽

2021 ◽

pp. 26-33

Author(s):

Olga Dubenko ◽

Tetyana Litovchenko ◽

Victoria Anysienkova ◽

Maryna Nessonova ◽

Liudmyla Kovalenko

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Prognostic Value ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Operating Characteristics ◽

Asymptomatic Group ◽

Logistic Regression Models ◽

Asymptomatic Patients

20 % of ischemic stroke appear to originate from carotid artery atherosclerotic disease. Serum biomarkers reflecting the activity of atherosclerotic process and may help for estimate risk of acute cerebrovascular events. Several serum inflammatory markers have been proposed for risk assessment, but their prognostic role less known. The aim of this study is to clarify the prognostic value of biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 (Lp-PLA2) and E-selectin in patients with symptomatic and asymptomatic carotid stenosis. Materials and methods. The study involved 106 patients with atherosclerotic carotid stenosis >50 % (74 men and 32 women, mean age 62.6±0.9) from which 76 symptomatic (35 with acute ipsilateral atherothrombotic stroke and 41 after carotid endarterectomy) and 30 asymptomatic patients. The control group consisted of age- and sex-matched 20 healthy subjects. The level of serum Lp-PLA2 and E-selectin was determined using a commercially available enzyme-linked immunosorbent assay kit. Results. The level of Lp-PLA 2 was in general significantly higher (p<0.05) in patients groups than in the control group and most high Lp-PLA2 concentration was in groups of symptomatic patients who underwent carotid endarterectomy. The level of E-selectin in the study patients was significantly higher than in the control group (p<0.05). The correlation of Lp-PLA 2 with E-selectin was significant for total patients (R=0.365664, p=0.00085) and group after carotid endarterectomy (R=0.429143, p=0.01796), but not for asymptomatic group (p>0.05). Receiver Operating Characteristics curves of logistic regression models which takes into joint both indicators was specificity and sensitive for predicting the occurrence of ischemic stroke. Conclusion. Conducted study show that the levels of Lp-PLA 2 and E-selectin have a significant impact on the development of stroke in patients with atherosclerotic carotid stenosis and can be used to predict it. A multidimensional model of the dependence of the probability of stroke on a linear combination of Lp-PLA 2 and E-selectin allows to obtaining significantly higher characteristics of the accuracy of stroke prediction than models with each factor alone.

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Multicenter study: carotid endarterectomy in the first hours after ischemic stroke

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4316 ◽

2021 ◽

Vol 26 (6) ◽

pp. 4316

Author(s):

A. N. Kazantsev ◽

R. A. Vinogradov ◽

M. A. Chernyavsky ◽

V. N. Kravchuk ◽

V. V. Matusevich ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Multicenter Study ◽

Cardiovascular Events ◽

Academic Research ◽

Composite Endpoint ◽

National Guidelines ◽

Acute Period ◽

Ischemic Attack ◽

Research Consortium

Aim. To analyze inhospital outcomes of carotid endarterectomy (CE) in the acute period (within 3 days from the onset) of ischemic stroke.Material and methods. This retrospective multicenter study for the period from January 2008 to August 2020 included 357 patients who underwent CE in the acute period of stroke. An interdisciplinary commission defined the revascularization timing. There were following inclusion criteria: 1. Mild neurological disorders: NIHSS stroke of 3-8; modified Rankin Scale score <2; Bartel index >61; 2. Indications for CE according to the current national guidelines; 3. Brain ischemic focus <2,5 cm in diameter. There were following exclusion criteria: 1. Presence of contraindications to CE. The endpoints were such unfavorable cardiovascular events as death, myocardial infarction (MI), stroke/transient ischemic attack (TIA), silent stroke, silent hemorrhagic transformations, Bleeding Academic Research Consortium (BARC) type >3b bleeding, internal carotid artery thrombosis, composite endpoint (death + all strokes/TIA + MI). Silent strokes were those strokes, established according to control multi-slice computed tomography angiography, without symptoms.Results. During the in-hospital follow-up period, 8 deaths (2,24%), 5 MIs (1,4%), 6 strokes/TIAs (1,7%), 15 silent ischemic strokes (4,2%), 13 hemorrhagic transformations (3,6%), 26 silent hemorrhagic transformations (7,3%), and 6 BARC type >3b bleeding (1,7%) were recorded. Thus, the combined endpoint was 20,4% (n=73).Conclusion. Due to the high incidence of cardiovascular events, CE is not a safe operation for patients in the acute period of ischemic stroke. The stroke + mortality rate exceeding 3% demonstrates the ineffectiveness of this method of treatment.

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Comparative characteristics of atherogenesis factors in patients with symptomatic and asymptomatic atherosclerotic carotid stenosis

Problems of Uninterrupted Medical Training and Science ◽

10.31071/promedosvity2021.01.070 ◽

2021 ◽

Vol 41 (1) ◽

pp. 70-76

Author(s):

V. Ju. Anysienkova ◽

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Internal Carotid ◽

Clinical Manifestations ◽

Control Group ◽

Clinical Group ◽

Atherosclerotic Stenosis ◽

Group I ◽

Atherosclerotic Process

To study a comparative assessment of risk factors for atherogenesis in patients with different clinical manifestations of carotid atherosclerotic stenosis. The study included 106 patients (men — 74, women — 32) aged 39 to 79 years (mean age 62.6 ± 0.9), which devided to 3 clinical groups: Group I — 35 patients with acute atherothrombotic stroke with ipsilateral carotid stenosis, group II — 41 patients after acute cerebrovascular events and carotid endarterectomy, group III — 30 patients with asymptomatic atherosclerotic carotid stenosis and the control group, which consisted of 20 relatively healthy individuals. The degree of stenosis of the internal carotid arteries was highest (> 70 %) in the group of patients who underwent carotid endarterectomy. In addition in this group was prevalence younger men, compared with the group of asymptomatic stenosis and women (p = 0.00300), there was an older age of patients and moderate stenosis of 50–69 % (p = 0.00647). In patients with stenotic atherosclerosis of the internal carotid artery, there was a significant increase in the level of Lp-PLA2 compared with the control. This confirms that Lp-PLA2 can be considered as a marker of carotid atherosclerosis and influence the development of ischemic stroke. The highest level of Lp-PLA2 was observed in the clinical group of patients who underwent carotid endarterectomy after ischemic stroke and there was a tendency to a more significant increase in total cholesterol. This suggests a more aggressive course of the atherosclerotic process in patients in this group.

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Neuroprosthetic Technology «Bioness» (Exorobot) in the Process of Restoring Motor and Vegetative-Trophic Disorders in Central Paresis of the Upper Limb

Journal of restorative medicine and rehabilitation ◽

10.38025/2078-1962-2020-99-5-62-69 ◽

2020 ◽

Vol 99 (5) ◽

pp. 62-69

Author(s):

I.A. Vozniuk ◽

A.V. Polyakova ◽

D.V. Tokareva

Keyword(s):

Electrical Stimulation ◽

Ischemic Stroke ◽

Upper Limb ◽

Functional Electrical Stimulation ◽

Cognitive Abilities ◽

Positive Reinforcement ◽

Recovery Process ◽

General Level ◽

Motor Disorders ◽

Acute Period

Disability after a stroke or brain injury is most often associated with impaired movement, speech, swallowing, and reduced cognitive abilities. By the end of the acute period of stroke, paresis in the arm and leg of varying degrees is observed in 80-90 % of survivors.In case of severe paresis, it is advisable to support the function of the limb at the early stages of recovery using modern specialized modifiable devices and methods that provide functional and multimodal stimulation and partial prosthetics. Aim of the study: evaluation of the efficacy of functional electrical stimulation (FES) in a complex of multimodal effects in restoring movement in Stroke patients with upper limb paresis (palcy).Methods. Stimulation and neuroprosthetic methods (FES - “Bioness H200”, RTMs) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the upper limb after an ischemic stroke (n=140). The median period of stroke was 25 [13; 56] days, median age 52 [48; 69] years. The standard methods of diagnosis and treatment of patients with stroke in accordance to the protocol of the Ministry of health of the Russian Federation No. 928 n and 1705 n (2012) were used, as well as scales and questionnaires for assessing the loss of strength and volume of motor disorders, assessing depression and motivation for treatment (Motricity Index), Fugl-Meyer AR, Medical Research Council Weakness Scale, Modified Ashworth Scale (MAS), Beck Depression Inventory; Beck At, Recovery Locus of Control, Patridge C., Johnstone M. Results. The effectiveness of personalized therapy with the use of a neuroprosthesis (“Bioness H200”) in patients in the acute period of ischemic stroke was shown, with the Motrisight index, Fugle-Meier scale being the most sensitive scales. the results depend on thebasic disease characteristics, the most relevant of which were - focus, degree of neurological deficit, personal motivation. The addition using of botulinum toxin allowed eliminating the inhibitory effect of spasticity, which prepared patients for intensive methods of physical rehabilitation. During the follow-up period, no complications were revealed. In 90% of cases, an increase in daily activity was noted. Functional electrical stimulation has significantly increased their level of self-care. The disability complex was initially equally pronounced in all patients, but positive reinforcement in the form of movement of the paretic hand against the background of FES led to a decrease in the severity of depression. In 100%, there was a high motivation to continue the treatment program with neuroprosthetics. Conclusion. The use of a complex of stimulating personalized techniques in the acute period of stroke is justified and safe. The useof FES significantly increases the range of motion in the hand, helps to overcome power paresis, coordination disorders, increases the general level of physical activity of patients after a stroke, motivation for the recovery process and improves the quality of life.

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Сonstitucional features of ischemic stroke patients with concomitant cardiac pathology

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2010-4-148-151 ◽

2010 ◽

Vol 9 (4) ◽

pp. 148-151

Author(s):

N. V. Oleksyuk ◽

Yu. T. Kuryachenko

Keyword(s):

Ischemic Stroke ◽

Adverse Outcome ◽

Neurological Status ◽

Stroke Patients ◽

Cardiac Pathology ◽

Acute Period ◽

Positive Correlation ◽

Different Types

Identification of influence of cardiac pathology on the course of ischemic stroke in patients with different types of constitution, can play an important role in the tactics of treatment and prognosis. The assessment of neurological status in the acute period of stroke depending of the type of cardiac pathology and constitutional features, evaluation of hemostasis was performed. A positive correlation between the existed cardiac pathology with some anthropometric somatotype parameters and their influence on adverse outcome of stroke was revealed.

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