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Acute carotid artery stenting in high grade

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https://www.readbyqxmd.com/read/29204036/flow-diverting-stent-assisted-coil-embolization-of-a-ruptured-internal-carotid-artery-blister-aneurysm-with-the-pipeline-flex-embolization-device
#1
Dale Ding, Robert M Starke, Ayton Hope, Stefan Brew
Internal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm...
October 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29032862/endovascular-treatment-of-acute-tandem-occlusion-strokes-and-stenting-first-experience
#2
Süha Akpınar, Pınar Gelener
This study demonstrates the radiologic and clinical findings, etiologies and intervention strategy in 8 acute ischemic stroke patients with tandem occlusions. The mean age was 57 and mean NIHSS score was 19. Stent-assisted thrombectomy (SAT) was performed on all of the patients. Additionally, 6 patients underwent carotid artery stenting before SAT. Recanalization with TICI≥2b was attained in 7/8 patients. The 90thday median mRS was 2 and mortality was 1/8. The etiologies of the tandem occlusions were either extracranial high grade ICA stenosis/occlusion or cervical ICA dissection...
October 9, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28465268/intracranial-blood-flow-changes-in-patients-with-high-grade-severe-carotid-artery-stenosis-after-stenting
#3
Lei Huang, Wenjie Cao, Liang Ge, Gang Lu, Xiaolong Zhang, Daoying Geng
OBJECTIVE: We investigated whether the cerebral hemodynamic changes of pre- and poststenting in patients with severe carotid stenosis differ by stenosis grades. METHODS: We prospectively recruited patients who underwent carotid artery stenting (CAS) after acute ischemic stroke from June 2014 to December 2015. We compared the mean relative cerebral blood flow (rCBF) changes (measured by whole-brain computed tomography perfusion) pre- and poststenting in patients with high-grade severe stenosis (HGSS) (90%-99%) versus patients with low-grade severe stenosis (LGSS) (70%-89%)...
August 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28366065/management-of-acute-ischemic-stroke-due-to-tandem-occlusion-should-endovascular-recanalization-of-the-extracranial-or-intracranial-occlusive-lesion-be-done-first
#4
Leonardo Rangel-Castilla, Gary B Rajah, Hakeem J Shakir, Hussain Shallwani, Sirin Gandhi, Jason M Davies, Kenneth V Snyder, Elad I Levy, Adnan H Siddiqui
OBJECTIVE Acute tandem occlusions of the cervical internal carotid artery and an intracranial large vessel present treatment challenges. Controversy exists regarding which lesion should be addressed first. The authors sought to evaluate the endovascular approach for revascularization of these lesions at Gates Vascular Institute. METHODS The authors performed a retrospective review of a prospectively maintained, single-institution database. They analyzed demographic, procedural, radiological, and clinical outcome data for patients who underwent endovascular treatment for tandem occlusions...
April 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28304205/stenting-of-the-cervical-internal-carotid-artery-in-acute-stroke-management-the-karolinska-experience
#5
Anastasios Mpotsaris, Christoph Kabbasch, Jan Borggrefe, Vamsi Gontu, Michael Soderman
Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28162027/retriever-wire-supported-carotid-artery-revascularization-rewised-care-in-acute-ischemic-stroke-with-underlying-tandem-occlusion-caused-by-an-internal-carotid-artery-dissection-technical-note
#6
Daniel Behme, Michael Knauth, Marios-Nikos Psychogios
We hereby report a novel technical approach for the treatment of acute stroke with underlying tandem occlusion. The so-called retriever wire supported carotid artery revascularization (ReWiSed CARe) technique, utilizing the wire of a stent-retriever as a guiding wire for carotid artery stenting, is technically feasible in tandem occlusions caused by an internal carotid artery (ICA) dissection or high grade ICA stenosis. This technique eliminates the need to use a long microwire in order to maintain the position inside the true lumen of a dissection...
June 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27995806/aetiologies-of-internal-carotid-artery-pseudo-occlusions-in-acute-stroke-patients-what-neurointerventionalists-can-expect
#7
REVIEW
Süha Akpınar, Pınar Gelener, Güliz Yilmaz
In cases of acute stroke, differentiation between an occluded and a patent internal carotid artery (ICA) is crucial for diagnosis and management. Although CT angiography (CTA) can be highly accurate in defining high-grade stenosis and ICA occlusions, misleading ICA occlusion patterns are not rare in patients with acute stroke. We investigated the underlying causes of ICA pseudo-occlusions with CTA with respect to digital subtraction angiography. 11 out of 72 patients had pseudo-occlusion on CTA. Of these, there were three cases of tandem occlusions accompanying high-grade ICA stenosis, five cases of Distal ICA bifurcation occlusion as a result of atrial fibrillation, two cases of cervical ICA dissection and one acute thrombosis of the stent...
February 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/27118378/acute-carotid-artery-stenting-in-symptomatic-high-grade-cervical-carotid-artery-stenosis
#8
Kazuhide Adachi, Akiyo Sadato, Motoharu Hayakawa, Shingo Maeda, Yuichi Hirose
The safety and efficacy of emergency carotid artery stenting (CAS) for patients with acute ischemic stroke resulting from internal carotid artery stenosis are not established. In this retrospective study, we evaluated outcomes for CAS performed within 2 weeks of acute ischemic stroke for 16 patients treated between December 2009 and February 2014. Cases of internal carotid artery occlusion, internal carotid dissection, or intracranial major arterial trunk occlusion were excluded. Five patients were treated with CAS during the hyperacute phase (within 24 h of stroke onset), three in the advanced phase (within 24 h of stroke-in-evolution after admission), and eight in the acute phase (24 h to 2 weeks after onset)...
January 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/26492430/endovascular-management-vs-intravenous-thrombolysis-for-acute-stroke-secondary-to-carotid-artery-dissection-local-experience-and-systematic-review
#9
REVIEW
Diogo C Haussen, Ashutosh Jadhav, Tudor Jovin, Jonathan A Grossberg, Mikayel Grigoryan, Fadi Nahab, Mahmoud Obideen, Andrey Lima, Amin Aghaebrahim, Deepak Gulati, Raul G Nogueira
BACKGROUND: Little is known regarding the endovascular management of acute ischemic stroke (AIS) related to carotid artery dissection (CAD). OBJECTIVE: To report our interventional experience in AIS from CAD and to compare it with conservative treatment of CAD with intravenous thrombolysis (IVT) via systematic review. METHODS: Retrospective analysis of consecutive high-grade steno-occlusive CAD with National Institutes of Health Stroke Scale (NIHSS) >5 and ≤12 hours of last seen normal from 2 tertiary centers...
May 2016: Neurosurgery
https://www.readbyqxmd.com/read/26345413/thrombectomy-assisted-by-carotid-stenting-in-acute-ischemic-stroke-management-benefits-and-harms
#10
Henrik Steglich-Arnholm, Markus Holtmannspötter, Daniel Kondziella, Aase Wagner, Trine Stavngaard, Mats E Cronqvist, Klaus Hansen, Joan Højgaard, Sarah Taudorf, Derk Wolfgang Krieger
Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky because of procedural complexities and necessity of potent platelet inhibition-in particular following IVT. This study assesses the benefits and harms of thrombectomy assisted by carotid stenting and identifies factors associated with clinical outcome and procedural complications...
December 2015: Journal of Neurology
https://www.readbyqxmd.com/read/25547082/acute-stroke-and-obstruction-of-the-extracranial-carotid-artery-combined-with-intracranial-tandem-occlusion-results-of-interventional-revascularization
#11
Stephanie Lescher, Katja Czeppan, Luciana Porto, Oliver C Singer, Joachim Berkefeld
PURPOSE: Due to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy-often in combination with acute stenting of underlying atherosclerotic stenosis or dissection-is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes...
April 2015: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/25492900/asymptomatic-moderate-carotid-artery-stenosis-with-intraplaque-hemorrhage-onset-of-new-ischemic-stroke
#12
Kiyofumi Yamada, Masanori Kawasaki, Shinichi Yoshimura, Yuichi Sasaki, Shigehiro Nakahara, Yoshikazu Sato
BACKGROUND: The degree of stenosis of carotid arteries is recognized as an important risk factor for ischemic stroke. However, high-grade stenosis does not always cause cerebrovascular events, whereas low- to moderate-grade stenosis may often cause strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new brain ischemic events. CASE PRESENTATION: We present three patients with asymptomatic moderate carotid artery stenosis and carotid IPH who underwent both neurological and MRI at baseline and after at least 1 year's follow-up...
February 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/24988990/two-in-one-endovascular-treatment-of-acute-tandem-occlusions-in-the-anterior-circulation
#13
C J Maurer, F Joachimski, A Berlis
PURPOSE: Acute major stroke with high-grade stenosis or occlusion of the extracranial internal carotid artery (ICA) and additional intracranial large artery occlusion is increasingly treated with a mechanical endovascular approach by extracranial stenting and intracranial thrombectomy due to poor response to systemic thrombolysis with recombinant tissue plasminogen activator (rtPA). This article presents a single centre cohort of this challenging subtype of stroke, describing the technical procedure and analysing the angiographic and clinical outcome...
December 2015: Clinical Neuroradiology
https://www.readbyqxmd.com/read/24491271/treatment-of-ruptured-blood-blister-like-aneurysms-with-flow-diverter-silk-stents
#14
Kubilay Aydin, Anil Arat, Serra Sencer, Bahattin Hakyemez, Mehmet Barburoglu, Altay Sencer, Nail İzgi
INTRODUCTION: Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endovascular treatment methods, such as clipping, clip wrapping, primary coiling, or stent assisted coiling, have relatively high morbidity and mortality rates. In this study, we report clinical and angiographic results for treatment of ruptured BBAs using flow diverter stents. METHODS: We retrospectively reviewed patients who presented with subarachnoid hemorrhages caused by rupture of BBAs and who were treated using flow diverter stents at three neurointervention centers between January 2009 and January 2013...
March 2015: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/23703034/outcome-of-mechanical-thrombectomy-with-solitaire-stent-as-first-line-intra-arterial-treatment-in-intracranial-internal-carotid-artery-occlusion
#15
Yeon Hong Yoon, Woong Yoon, Min Young Jung, Nam Yeol Yim, Byeong Chae Kim, Heoung Keun Kang
INTRODUCTION: Acute stroke from occlusion of the intracranial internal carotid artery (ICA) is associated with a poor clinical outcome despite a thrombolytic treatment. The purpose of this study was to evaluate the outcome of mechanical thrombectomy using the Solitaire stent for the treatment of acute stroke patients with intracranial ICA occlusion. METHODS: A total of 104 consecutive patients with acute stroke were treated with mechanical thrombectomy using the Solitaire stent as a first-line intra-arterial treatment...
August 2013: Neuroradiology
https://www.readbyqxmd.com/read/23423939/-diagnostic-and-treatment-of-acute-ischemic-stroke
#16
REVIEW
C Weimar, R Weber, M Schlamann, K Hajjar, T Buck, H C Diener
The incidence of first stroke in Germany is about 200.000, most of which are ischemic. The benefit of stroke unit treatment and systemic thrombolysis has been shown in large randomized trials. Diagnostic work-up besides neurologic examination includes cerebral imaging by CT or MR imaging including angiography, ultrasound of brain supplying arteries, ECG and Holter ECG and - if indicated - transesophageal echocardiography. Aspirin is the cornerstone of early secondary prevention in the acute phase, thereafter secondary prevention is determined by stroke etiology...
March 2013: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/23296417/carotid-artery-stenting-in-recently-symptomatic-patients
#17
REVIEW
C Setacci, G de Donato, F Setacci, P Sirignano, G Galzerano, M P Borrelli, A Cappelli
Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period...
February 2013: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/22818387/efficacy-and-limitations-of-multimodal-endovascular-revascularization-other-than-clot-retrieval-for-acute-stroke-caused-by-large-vessel-occlusion
#18
Yusuke Egashira, Shinichi Yoshimura, Yukiko Enomoto, Mitsunori Ishiguro, Kiyofumi Yamada, Yoshitaka Tanaka, Toru Iwama
BACKGROUND: The purpose of this study was to evaluate the efficacy of multimodal endovascular treatment (EVT) other than clot retrieval for acute large-vessel occlusion (LVO). METHODS: Fifty-six consecutive patients with a median National Institutes of Health Stroke Scale (NIHSS) score of 15 were included this study. In all cases, intravenous administration of recombinant tissue plasminogen activator had failed (n = 23) or was contraindicated (n = 33). The modes of EVT performed included intra-arterial thrombolysis, mechanical clot disruption including balloon angioplasty, and stent placement...
August 2013: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/22518244/spontaneous-recanalization-after-complete-occlusion-of-the-common-carotid-artery-with-subsequent-embolic-ischemic-stroke
#19
Qaisar A Shah
INTRODUCTION: Acute carotid artery occlusion carries a high morbidity and mortality. Acute angioplasty and stenting is a feasible option with little known about the long term outcome. Limiting factor for this approach is hyperperfusion syndrome or hemorrhagic infarction. Spontaneous early or late recanalization for extracranial vessel is in the range of 5% -30%, with no well defined clinical outcome data. We describe a case of spontaneous common carotid recanalization. CASE REPORT: An 88 year old man presented with right sided weakness, global aphasia and visual field loss and was discovered to have common carotid occlusion at its origin...
January 2009: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/22422184/unprotected-carotid-artery-stenting-in-symptomatic-patients-with-high-grade-stenosis-results-and-long-term-follow-up-in-a-single-center-experience
#20
R Oteros, E Jimenez-Gomez, F Bravo-Rodriguez, J J Ochoa, R Guerrero, F Delgado
BACKGROUND AND PURPOSE: The use of cerebral protection during CAS is an extended practice. Paradoxically it is open to question because it can lead to potential embolic complications. The aim of this study was to evaluate the safety and efficacy of CASWPD in patients with severe symptomatic carotid artery stenosis. MATERIALS AND METHODS: A prospective study was performed including 210 consecutive patients (201 symptomatic and 9 asymptomatic) with carotid artery stenosis >70%...
August 2012: AJNR. American Journal of Neuroradiology
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