INTERNAL CAROTID ARTERY STENTING WITH SIMULTANEOUS THROMBECTOMY IN TANDEM OCCLUSION WITH ACUTE ISCHEMIC STROKE

Vestnik ◽  
2021 ◽  
pp. 126-130
Author(s):  
Р.М. Кастей ◽  
Е.К. Дюсембеков ◽  
Е.С. Жуков ◽  
С.Т. Калдыбаев ◽  
К.А. Никатов
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Circulation ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
Large Vessels

Механическая тромбэктомия в настоящее время является золотым стандартом в лечении острого ишемического инсульта при окклюзии крупных сосудов передней циркуляции мозгового кровообращения. Однако проблема лечения так называемой тандемной окклюзии - это одновременная окклюзия или критический стенозэкстракраниальной части внутренней сонной артерии (ВСА) в комбинации с окклюзией крупныхвнутримозговых сосудов передней циркуляции мозгового кровообращения в настоящее времяостается актуальной. В данной статье представлен клинический случай успешного лечения тандемной окклюзии внутренней сонной артерии и средней мозговой артерии путем проведения механической тромбэктомии с одномоментным стентированием внутренней сонной артерии. Однако для разработки единого стандарта лечения тандемных окклюзийнеобходимо проведение дальнейших исследований. Mechanical thrombectomy is currently the gold standard in the treatment of acute ischemic stroke with occlusion of large vessels of the anterior circulation of cerebral circulation. However, the problem of treating the so-called tandem occlusion is simultaneous occlusion or extracranial part of the internal carotid artery (ICA) critical stenosis in combination with occlusion of large intracerebral vessels of the anterior cerebral circulation currently remains relevant. This article presents a clinical case of successful treatment of tandem occlusion of the internal carotid artery and middle cerebral artery by mechanical thrombectomy with simultaneous ICA stenting. However, further research is needed to develop a unified standard for the tandem occlusions treatment.

Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol

2020 ◽  
pp. 174749302092994 ◽  
Author(s):  
François Zhu ◽  
Gabriela Hossu ◽  
Marc Soudant ◽  
Sébastien Richard ◽  
Hamza Achit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Anterior Circulation ◽  
Tandem Occlusion

Background and hypothesis There is no consensus on the optimal endovascular management of the extracranial internal carotid artery steno-occlusive lesion in patients with acute ischemic stroke due to tandem occlusion. We hypothesized that intracranial mechanical thrombectomy plus emergent internal carotid artery stenting (and at least one antiplatelet therapy) is superior to intracranial mechanical thrombectomy alone in patients with acute tandem occlusion. Study design TITAN is an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Eligibility requires a diagnosis of acute ischemic stroke, pre-stroke modified Rankin Scale (mRS)≤2 (no upper age limit), National Institutes of Health Stroke Scale (NIHSS)≥6, Alberta Stroke Program Early Computed Tomography Score (ASPECTS)≥6, and tandem occlusion on the initial catheter angiogram. Tandem occlusion is defined as large vessel occlusion (intracranial internal carotid artery , M1 and/or M2 segment) and extracranial severe internal carotid artery stenosis ≥90% (NASCET) or complete occlusion. Patients are randomized in two balanced parallel groups (1:1) to receive either intracranial mechanical thrombectomy plus internal carotid artery stenting (and at least one antiplatelet therapy) or intracranial mechanical thrombectomy alone within 8 h of stroke onset. Up to 432 patients are randomized after tandem occlusion confirmation on angiogram. Study outcomes The primary outcome measure is complete reperfusion rate at the end of endovascular procedure, assessed as a modified Thrombolysis in Cerebral Infarction (mTICI) 3, and ≥4 point decrease in NIHSS at 24 h. Secondary outcomes include infarct growth, recurrent clinical ischemic event in the ipsilateral carotid territory, type and dose of antiplatelet therapy used, mRS at 90 (±15) days and 12 (±1) months. Safety outcomes are procedural complications, stent patency, intracerebral hemorrhage, and death. Economics analysis includes health-related quality of life, and costs utility comparison, especially with the need or not of endarterectomy. Discussion TITAN is the first randomized trial directly comparing two types of treatment in patients with acute ischemic stroke due to anterior circulation tandem occlusion, and especially assessing the safety and efficacy of emergent internal carotid artery stenting associated with at least one antiplatelet therapy in the acute phase of stroke reperfusion. Trial registration ClinicalTrials.gov NCT03978988

scholarly journals Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2558-2562
Author(s):  
Jai Ho Choi ◽  
Jinhee Jang ◽  
Jaseong Koo ◽  
Kook-Jin Ahn ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Diagnostic Value ◽  
Fisher Exact Test ◽  
Anterior Circulation

Background and Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value. Methods: Thirty patients with nonvisualization of the proximal ICA were included. Diagnosis of pseudo- or true occlusion of the ICA was made based on digital subtraction angiography. Diagnostic performances of multiphasic computed tomography angiography findings—(1) a flame-shaped stump and (2) delayed contrast filling at the cervical ICA— were evaluated and compared. The Fisher exact test, χ 2 test, or Wilcoxon rank-sum test and McNemar test were used in the data analysis. Results: Twelve patients had true proximal ICA occlusion and 18 had pseudo-occlusion. Delayed contrast filling at the cervical ICA on multiphasic computed tomography angiography was found in all patients with pseudo-occlusion of the ICA, while 1 case of true occlusion showed delayed contrast filling ( P <0.001). The presence of a flame-shaped stump was not significantly different between the pseudo- and true occlusion groups. The sensitivity of delayed contrast filling (0.94 [95% CI, 0.73–1]) was significantly higher than that of flame-shaped stump (0.75 [95% CI, 0.36–0.83]). Conclusions: We demonstrated that the delayed filling sign on multiphasic computed tomography angiography could be a useful and readily available finding for differentiating proximal ICA pseudo-occlusion from true occlusion.

Abstract T P68: Outcome of Cervical Internal Carotid Artery Occlusions After Intravenous Thrombolysis in Acute Ischemic Stroke Patients With Tandem Occlusions

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Héctor Avellón-Liaño ◽  
Ana I Calleja ◽  
Elisa Cortijo ◽  
Pablo García-Bermejo ◽  
Luis López-Mesonero ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Infarct Volume ◽  
Lower Mortality ◽  
Carotid Revascularization ◽  
Mca Occlusion ◽  
Tandem Occlusion

Background and Objective: Acute ischemic stroke (AIS) associated with tandem extracranial internal carotid artery (EICA) - middle cerebral artery (MCA) occlusion is burdened with a poor clinical outcome. The recanalization rate of extracranial ICA occlusion after i.v. thrombolysis and its prognostic significance in this group of patients remain largely unknown. Methods: Retrospective analysis of a prospectively collected database including consecutive AIS patients treated with i.v. thrombolysis. All patients underwent urgent assessment of extracranial and intracranial large arteries with either computed tomography angiography (CTA) or echo-Doppler ultrasound to document an acute EICA-MCA tandem occlusion prior to thrombolysis. EICA was monitored by control carotid ultrasound and/or CTA in order to detect transition from occlusion to relevant stenosis. Outcome variables: carotid revascularization, in-hospital mortality, Rankin 0-2 at three months, and infarct volume. Results: From January 2008 to December 2013, 606 AIS patients received i.v. thrombolysis, of whom 53 (9%) had a documented EICA-MCA tandem occlusion. Four of them died within first 24 hours and EICA could not be monitored. Occluded EICA evolved towards a severe stenosis in 14/49 (29%) after thrombolysis. Angiographic confirmation was obtained in 11 of them, who underwent carotid endarterectomy. EICA recanalization was more frequent among active smokers and was associated with carotid revascularization (79% vs. 0%, p<0.001), lower mortality (0% vs. 26%, p=0.03) and a smaller infarct volume (27 vs. 89 cc, p=0.04). Conclusion: Around 30% of AIS patients with tandem EICA-MCA occlusion treated with i.v. thrombolysis experience transition from initially occluded to severely stenosed EICA that can be rescued for revascularization. This evolution is associated with a lower mortality and smaller infarct volume.

scholarly journals Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke

2017 ◽  
Vol 23 (6) ◽  
pp. 583-588 ◽  
Author(s):  
ZO Kaymaz ◽  
O Nikoubashman ◽  
MA Brockmann ◽  
M Wiesmann ◽  
C Brockmann
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Left Common Carotid Artery ◽  
Access Time ◽  
Vessel Tortuosity

Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding recanalization time and radiographic result. Results ICA-AT was significantly influenced by vessel tortuosity. Take-off angle of the left common carotid artery ( p = 0.001) and the brachiocephalic trunk ( p = 0.002) as well as the tortuosity of the common carotid artery ( p = 0.002) had highest impact on ICA-AT. For recanalization time, however, we found only the take-off angle of the left common carotid artery to be of significance ( p = 0.020). There was a tendency for ICA-AT to correlate with successful (mTICI ≥ 2 b) revascularization (average time of successful results was 24.3 minutes, of unsuccessful was 35.6 minutes; p = 0.065). Every evaluated segment with less carotid tortuosity showed a carotid AT below 25 minutes. Conclusion Supraaortic vessel tortuosity significantly influences ICA-AT in mechanical thrombectomy for an acute large vessel. There furthermore was a trend for lower successful recanalization rates with increasing ICA-AT.

scholarly journals Recanalization of Extracranial Internal Carotid Artery Occlusion after i.v. Thrombolysis for Acute Ischemic Stroke

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e55318 ◽  
Author(s):  
Raimund Pechlaner ◽  
Michael Knoflach ◽  
Benjamin Matosevic ◽  
Michael Ruecker ◽  
Christoph Schmidauer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Extracranial Internal Carotid Artery

scholarly journals Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system

2020 ◽  
Vol 4 (9) ◽  
pp. 539-543
Author(s):  
D.T. Chipova ◽  
◽  
L.V. Santikova ◽  
A.Ch. Zhemukhov ◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Inflammatory Markers ◽  
Internal Carotid ◽  
Fatal Outcome ◽  
Group 2 ◽  
Group 1

Aim: to study the stroke-associated pneumonia (SAP) effect on the outcome of ischemic stroke (IS) in the internal carotid artery system. Patients and Methods: 87 patients with IS underwent the follow-up study, of which 75 had no inflammatory bronchopulmonary complications (group 1), and 12 had pneumonia manifestation (group 2). The study was performed on days 1, 5, and 9 after IS, and 6 months and 12 months after discharge from the hospital. Neurological deficit severity (NIHSS, Barthel index) and inflammatory markers (peripheral blood leukocyte composition, C-reactive protein (CRP), ESR) were studied. Results: it was found that the presence of SAP was associated with increased mortality during the acute IS period (4 (33.1%) patients died in group 1 and 10 (13.3%) — in group 2, p<0.05), greater severity of neurological deficits (63.3±5.3 and 71.5±4.0 points on the NIHSS scale, respectively, p<0.05) and incapacitation (Barthel index — 63.3±5.3 and 71.5±4.0 points, respectively, p<0.05) at the end of the inpatient treatment period. In group 2, signs of an inflammatory response were detected on day 5, and the values of the white blood cell shift index, ESR and CRP significantly (p<0.05) differed from the initial values. During examination at 6 months and 12 months, there were no significant differences in these indicators between the groups. An association was established between the probability of SAP occurrence and the presence of swallowing disorders (r=0.672; p<0.05), the age of patients (r=0.572; p<0.05) and the presence of diabetes mellitus (r=0.522; p<0.05). The studied laboratory inflammatory markers allow us to timely assume the occurrence of pulmonary pathology. Conclusion: timely diagnosis and prevention of SAP can reduce the risk of fatal outcome, facilitate rehabilitation measures, and improve early IS outcomes. KEYWORDS: ischemic stroke, cardioembolic stroke, atherothrombotic stroke, complications, acute period, inflammatory markers, strokeassociated pneumonia, long-term outcomes. FOR CITATION: Chipova D.T., Santikova L.V., Zhemukhov A.Ch. Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system. Russian Medical Inquiry. 2020;4(9):539–543. DOI: 10.32364/2587-6821-2020-4-9-539-543.

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