Perioperative acute internal carotid thrombosis after general surgery

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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Increased Incidence of Proximal Aortic Atherosclerotic Disease in Patients with Internal Carotid Occlusion

The Heart Surgery Forum ◽

10.1532/hsf.604 ◽

2005 ◽

Vol 6 (1) ◽

pp. 55

Author(s):

David C. Charlesworth ◽

Christopher T. Maloney

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Internal Carotid ◽

Aortic Disease ◽

Carotid Occlusion ◽

Atherosclerotic Disease ◽

Internal Carotid Occlusion ◽

Group 2 ◽

Carotid Doppler ◽

Group 1

Background: Atherosclerotic involvement of the proximal aorta is a major cause of embolic operative stroke in cardiac surgery. Its incidence is less well known in patients with severe carotid disease. Methods: We reviewed the incidence of proximal atherosclerotic aortic disease in patients with internal carotid occlusion (group 1) and then compared it to a group of patients with normal carotids undergoing cardiac surgery (group 2). Both groups had preoperative carotid Doppler and epiaortic ultrasound analysis at the time of surgery. Results: Epiaortic ultrasound results showed that the degree of atherosclerosis in group 1 was normal in 9 patients (10.2%), mild in 34 (38.6%), moderate in 29 (33%), and severe in 16 (18.2%). In group 2, the degree of atherosclerosis was normal in 70 patients (9.3%), mild in 466 (61.8%), moderate in 150 (19.9%), and severe in 68 (9.0%). Stroke rate was higher in group 1 at 4.5% versus 1.1% for group 2 (P = .029). No difference in surgical mortality was found. Conclusions: Patients with internal carotid occlusions undergoing heart surgery have a higher incidence of proximal aortic atherosclerotic disease. Epiaortic ultrasound examination is strongly recommended.

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Duplex scanning criteria for selection of patients for internal carotid artery endarterectomy

VASA ◽

10.1024/0301-1526.34.1.36 ◽

2005 ◽

Vol 34 (1) ◽

pp. 36-40 ◽

Cited By ~ 3

Author(s):

Engelhardt ◽

Bruijnen ◽

Schnur ◽

Pfadenhauer ◽

Bohndorf ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stroke Prevention ◽

Internal Carotid ◽

Duplex Scanning ◽

Operating Characteristics ◽

Post Test ◽

Ica Stenosis ◽

Selection Of Patients ◽

Selection Of

Background: The value of carotid endarterectomy for stroke prevention depends on reliable identification of patients at higher risk for stroke from their internal carotid artery (ICA) occlusive disease than from surgery. This selection of patients is based on the degree of ICA stenosis. Therefore, preoperative diagnostic measures should strive for a prevalence independent probability for disease of 100%. Aim of this prospective study was to obtain clinically applicable duplex scanning criteria for ICA stenosis ≥70% with a probability for disease of 100%. Patients and methods: In 124 ICA in 62 patients (79% male) angiography and duplex scanning were performed. Degree of stenosis was classified in 4 categories: I < 50%; II 50%–69%; III 70%–99%; IV 100%. Cohen's kappa statistic was used to estimate agreement between both methods within categories. To improve accuracy post-test likelihood for disease was calculated for each point on the receiver operating characteristics (ROC)-curve for peak systolic (PSV) and end-diastolic velocity (EDV), and cut-off points for velocity criteria were set at a positive likelihood of 100%. Results: Diagnostic agreement was good with kappa = 0.77 (95% CI, 0.64–0.90; p < 0.001). For EDV a criterion of ≥150 cm/sec was associated with a post-test likelihood for disease of 100%. For PSV no appropriate criterion could be detected. Conclusions: A probability of 100% for ICA stenosis ≥70% can be achieved by mere preoperative duplex scanning. Vascular laboratory specific validation of duplex scanning criteria should consider prevalence independent post-test likelihood for disease to ensure the value of CEA for stroke prevention.

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SELECTION OF PATIENTS FOR CARDIAC SURGERY

Survey of Anesthesiology ◽

10.1097/00132586-195712000-00025 ◽

1957 ◽

Vol 1 (6) ◽

pp. 626

Author(s):

G. H. PRATT

Keyword(s):

Cardiac Surgery ◽

Selection Of Patients ◽

Selection Of

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Local Thrombolysis for Acute Ischemic Stroke Based on Findings of Diffusion and Perfusion MRI

Interventional Neuroradiology ◽

10.1177/15910199010070s130 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 193-196

Author(s):

N. Kitagawa ◽

M. Morikawa ◽

K. Hayashi ◽

H. Ishimaru ◽

T. Yoshioka ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Internal Carotid ◽

Cerebral Tissue ◽

Tissue Integrity ◽

Symptomatic Intracerebral Hemorrhage ◽

Complete Restoration ◽

Irreversible Brain Damage ◽

Local Thrombolytic Therapy ◽

Selection Of Patients ◽

Selection Of

Cerebral perfusion and cerebral tissue integrity were studied in 13 patients with acute embolic stroke in the territory of the internal carotid artery by diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) within six hours after onset. PWI/DWI mismatch lesion was depicted in six patients. MCA was occluded in five of six patients, who underwent local thrombolytic therapy. In three cases, complete restoration of the cerebral circulation was obtained and enlargement of irreversible brain damage compared to initial DWI lesion was prevented. Seven patients without PWI/DWI mismatch did not undergo thrombolytic therapy. Spontaneous reopening of occluded MCA was verified with subsequent cerebral angiography in one of seven patients. CT depicted symptomatic intracerebral hemorrhage in this patient. It is concluded that DWI and PWI in combination are useful in selection of patients for thrombolytic therapy.

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Watershed Infarct in Beta-Thalassemia Major Patient

Case Reports in Neurological Medicine ◽

10.1155/2017/2736402 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Behnaz Ansari ◽

Mohammad Saadatnia ◽

Ali Asghar Okhovat

Keyword(s):

High Risk ◽

Internal Carotid ◽

Thalassemia Major ◽

Carotid Occlusion ◽

Beta Thalassemia ◽

Severe Anemia ◽

Thalassemia Major Patient ◽

Risk Patients ◽

Internal Carotid Occlusion ◽

Acute Brain Ischemia

Background. The mechanism of stroke in beta-thalassemia was reported previously as cardioembolic and hypercoagulable state. However, there is no report of watershed infarct in beta-thalassemia anemia.Method. We present an adultβ-thalassemia major patient with manifest asymptomatic chronic left carotid occlusion who suffered watershed infarct.Result. In the presence of asymptomatic chronic left internal carotid occlusion, we assumed that severe anemia (hemoglobin = 3) at admission leads to watershed infarct.Conclusion. Watershed infarct seems to be the cause of stroke in cases ofβ-thalassemia major with severe anemia. Blood transfusion can be applied in the setting of acute brain ischemia in such high risk patients.

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