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Carotid stenosis, acute stroke,

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https://www.readbyqxmd.com/read/28631982/carotid-intraplaque-hemorrhage-on-vessel-wall-mri-does-not-correlate-with-tcd-emboli-monitoring-in-patients-with-recently-symptomatic-carotid-atherosclerosis
#1
Adam de Havenon, David Tirschwell, Jennifer J Majersik, Scott McNally, Gregory Stoddard, Anne Moore, Mahmud Mossa-Basha
Background Carotid intraplaque hemorrhage (IPH) seen on vessel wall MRI is associated with an increased risk of stroke or transient ischemic attack, as are microembolic signals (MES) detected by transcranial Doppler (TCD). We sought to examine the association between IPH and MES in acute stroke patients with symptomatic carotid atherosclerosis. Methods Through a retrospective chart review, we included patients from 2011 to 2013 with acute ischemic stroke due to carotid atherosclerosis of varying stenosis who had both 3D volumetric MRI of the neck and TCD emboli monitoring...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28623378/carotid-stenting-in-neuroradiology-a%C3%A2-short-journey-from-the-past-to-current-debates
#2
REVIEW
Joachim Berkefeld, Marlies Wagner, Richard du Mesnil
After a period of stagnation due to negative results of randomized trials for patients with symptomatic stenosis, the relevance of carotid artery stenting (CAS) is increasing again. CAS has become an important and evidence-based part of interventional stroke treatment. Our ability to manage acute recanalization of carotid occlusions and other niche indications properly led some skeptical neurologists to trust in carotid intervention for elective cases as well. The evolution of CAS from initial euphoria to more realistic views under consideration of trial results and guidelines is reviewed...
June 16, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28611828/heads-up-a-novel-provocative-maneuver-to-guide-acute-ischemic-stroke-management
#3
Latisha K Ali, Julius K Weng, Sidney Starkman, Jeffrey L Saver, Doojin Kim, Bruce Ovbiagele, Brian H Buck, Nerses Sanossian, Paul Vespa, Oh Young Bang, Reza Jahan, Gary R Duckwiler, Fernando Viñuela, David S Liebeskind
BACKGROUND: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. METHODS: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28599258/prognostic-impact-of-subclinical-or-manifest-extracoronary-artery-diseases-after-acute-myocardial-infarction
#4
Maja Eriksson Östman, Fredrik Calais, Andreas Rosenblad, Ole Fröbert, Jerzy Leppert, Pär Hedberg
BACKGROUND AND AIMS: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI). METHODS: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta...
May 26, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28549916/utility-of-carotid-ultrasonography-in-management-of-an-atypical-high-vascular-risk-patient-with-recurrent-calcified-cerebral-embolic-stroke
#5
John W Liang, Jesse Weinberger, Aaron Tansy
OBJECTIVE: To describe a case of recurrent calcified cerebral emboli (CCE)-related acute ischemic stroke (AIS) and the diagnostic utility of plaque morphology characterization on carotid ultrasound. BACKGROUND: CCE are a rare cause of AIS. CCE-related AIS has been previously reported only in high vascular-risk patients such as those with severe carotid stenosis, widespread atheromatous disease, or cardiac valvular disease. CCE-related AIS from a carotid origin has not been reported in patients without carotid stenosis...
May 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28531910/extracranial-carotid-disease-and-effect-of-intra-arterial-treatment-in-patients-with-proximal-anterior-circulation-stroke-in-mr-clean
#6
Olvert A Berkhemer, Jordi Borst, Manon Kappelhof, Albert J Yoo, Lucie A van den Berg, Puck S S Fransen, Debbie Beumer, Wouter J Schonewille, Paul J Nederkoorn, Marieke J H Wermer, Henk A Marquering, Hester F Lingsma, Yvo B W E M Roos, Robert J van Oostenbrugge, Diederik W J Dippel, Wim H van Zwam, Charles B L M Majoie, Bart J Emmer, Aad van der Lugt
Background: The presence of extracranial carotid disease (ECD) is associated with less favorable clinical outcomes a in patients with acute ischemic stroke caused by intracranial proximal occlusion. Acute intra-arterial treatment (IAT) in the setting of extracranial and intracranial lesions is considered challenging, and whether it yields improved outcomes remains uncertain. Objective: To examine whether the presence of ECD modified the effect of IAT for intracranial proximal anterior circulation occlusion...
May 23, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28511475/colour-doppler-evaluation-of-extracranial-carotid-artery-in-patients-presenting-with-acute-ischemic-stroke-and-correlation-with-various-risk-factors
#7
Samrin Haq, Manoj Mathur, Jasvir Singh, Navkiran Kaur, Raminderpal Singh Sibia, Rajesh Badhan
INTRODUCTION: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28504077/routine-shunting-during-carotid-endarterectomy-in-patients-with-acute-watershed-stroke
#8
Paolo Perini, Domenico Marco Bonifati, Sebastiano Tasselli, Filippo Sogaro
AIM: To evaluate the protective role of routine shunting in patients with acute watershed stroke (WS) undergoing carotid endarterectomy (CEA). METHODS: A total of 138 patients with symptomatic carotid stenosis (SCS) who underwent CEA after acute ischemic stroke from March 2008 to March 2015 were included in this study. Transient ischemic attacks were excluded. These patients were divided into 2 groups according to the topographic pattern of the stroke on magnetic resonance imaging: group 1, territorial strokes (TS) caused by emboli of carotid origin, and group 2, WS caused by a hemodynamic mechanism related to an SCS...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28497668/potential-brain-dead-organ-donation-in-neurocritical-care-mortality
#9
Vera Spatenkova, Ondrej Bradac, Petr Suchomel
BACKGROUND: Mortality is a marker of quality in neurocritical care, but it also provides potential for donors after brain death (DBD) following irreversible acute brain damage. The aim of this study was to analyse the neurointensive care unit (NICU) mortality rate and recovery of potential DBD. METHODS: We performed a 10-year prospective observational cohort computer database analysis of 6138 acute neurological and neurosurgical patients (pts, 58.2% male, mean: age 55...
May 11, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28487337/haptoglobin-hp2-variant-promotes-premature-cardiovascular-death-in-stroke-survivors
#10
Petra Ijäs, Susanna Melkas, Jani Saksi, Antti Jula, Matti Jauhiainen, Niku Oksala, Tarja Pohjasvaara, Markku Kaste, Pekka J Karhunen, Perttu Lindsberg, Timo Erkinjuntti
BACKGROUND AND PURPOSE: Haptoglobin (Hp) is an acute phase plasma protein protecting tissues from oxidative damage. It exists in 2 variant alleles (hp1/hp2) giving rise to 3 protein isoforms with different biochemical properties and efficiency to limit oxidative stress. We previously found that hp2 variant is associated with stroke risk in the patients with carotid stenosis and the risk of ischemic cardiovascular events in a general population cohort. This study examined the hypothesis that Hp genotype is associated with general cardiovascular risk in patients with stroke...
May 9, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28481312/carotid-artery-stenting-and-blood-brain-barrier-permeability-in-subjects-with-chronic-carotid-artery-stenosis
#11
Arkadiusz Szarmach, Grzegorz Halena, Mariusz Kaszubowski, Maciej Piskunowicz, Michal Studniarek, Piotr Lass, Edyta Szurowska, Pawel J Winklewski
Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population...
May 8, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28479465/safety-of-early-carotid-endarterectomy-after-intravenous-thrombolysis-in-acute-ischemic-stroke
#12
Igor Gunka, Dagmar Krajickova, Michal Lesko, Ondrej Renc, Jan Raupach, Stanislav Jiska, Miroslav Lojik, Vendelin Chovanec, Radovan Maly
BACKGROUND: The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. MATERIAL AND METHODS: A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28479455/safety-of-carotid-revascularization-during-the-acute-period-of-neurological-symptom-onset-in-women
#13
Paola De Rango, Gioele Simonte, Virginia J Howard, Luca Farchioni, Enrico Cieri, Valeria Caso, Selena Pelliccia, Massimo Lenti
BACKGROUND: Benefit from carotid revascularization is supposed to be lower in women due to increased periprocedural risks. The aim of this study was to investigate the risk of stroke/death after carotid intervention in women treated within 15 days from last neurological event. METHODS: Data from 282 consecutive patients treated during 2009-2015 by carotid endarterectomy (CEA) or carotid stenting (CAS) within 15 days from neurological symptoms were analyzed by sex and stratified according to treatment delay towards symptoms onset...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28465268/intracranial-blood-flow-changes-in-patients-with-high-grade-severe-carotid-artery-stenosis-after-stenting
#14
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. MATERIALS AND 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 changes (rCBF) (measured by whole-brain computed tomography [CT] perfusion) pre- and poststenting in patients with high-grade severe stenosis (HGSS 90%-99%) versus patients with low-grade severe stenosis (LGSS 70%-89%)...
April 29, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28458385/recent-trends-in-neuro-endovascular-treatment-for-acute-ischemic-stroke-cerebral-aneurysms-carotid-stenosis-and-brain-arteriovenous-malformations
#15
Yuji Matsumaru, Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura
The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms...
May 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28439614/internal-carotid-artery-stenosis-and-collateral-recruitment-in-stroke-patients
#16
Jan W Dankbaar, Kelly G P Kerckhoffs, Alexander D Horsch, Irene C van der Schaaf, L Jaap Kappelle, Birgitta K Velthuis
PURPOSE: Leptomeningeal collaterals improve outcome in stroke patients. There is great individual variability in their extent. Internal carotid artery (ICA) stenosis may lead to more extensive recruitment of leptomeningeal collaterals. The purpose of this study was to evaluate the association of pre-existing ICA stenosis with leptomeningeal collateral filling visualized with computed tomography perfusion (CTP). METHODS: From a prospective acute ischemic stroke cohort, patients were included with an M1 middle cerebral artery (MCA) occlusion and absent ipsilateral, extracranial ICA occlusion...
April 24, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28431600/assessment-of-on-treatment-platelet-reactivity-and-relationship-with-cerebral-micro-embolic-signals-in-asymptomatic-and-symptomatic-carotid-stenosis
#17
Justin A Kinsella, Oliver Tobin, Sean Tierney, Timothy M Feeley, Bridget Egan, Tara Coughlan, D Ronan Collins, Desmond O'Neill, Joseph A Harbison, Colin P Doherty, Prakash Madhavan, Dermot J Moore, Sean M O'Neill, Mary-Paula Colgan, Maher Saqqur, Raymond P Murphy, Niamh Moran, George Hamilton, Dominick J H McCabe
INTRODUCTION: The relationship between on-treatment platelet reactivity and cerebral micro-embolic signals (MES) is unknown, and has not been previously simultaneously assessed in asymptomatic and symptomatic carotid stenosis patients. METHODS: Consecutive eligible patients with ≥50% asymptomatic or recently symptomatic carotid stenosis (≤4weeks following TIA/ischaemic stroke) were recruited to this pilot study. Symptomatic patients were followed up to the 'late' phase (≥3months) following symptom onset or carotid intervention; longitudinal data were analysed from symptomatic patients with data available at both time-points...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28400904/extensive-mobile-thrombus-of-the-internal-carotid-discovered-after-intravenous-thrombolysis-what-do-i-do-now
#18
Eugene L Scharf, Jennifer E Fugate, Sara E Hocker
This case report describes a rare presentation of ischemic stroke secondary to an extensive internal carotid artery thrombus, subsequent therapeutic dilemma, and clinical management. A 58-year-old man was administered intravenous (IV) thrombolysis for right middle cerebral artery territory ischemic stroke symptoms. A computed tomography angiogram of the head and neck following thrombolysis showed a longitudinally extensive internal carotid artery thrombus originating at the region of high-grade calcific stenosis...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28388675/impact-of-mca-stenosis-on-the-early-outcome-in-acute-ischemic-stroke-patients
#19
Jiann-Shing Jeng, Fang-I Hsieh, Hsu-Ling Yeh, Wei-Hung Chen, Hou-Chang Chiu, Sung-Chun Tang, Chung-Hsiang Liu, Huey-Juan Lin, Shih-Pin Hsu, Yuk-Keung Lo, Lung Chan, Chih-Hung Chen, Ruey-Tay Lin, Yu-Wei Chen, Jiunn-Tay Lee, Chung-Hsin Yeh, Ming-Hui Sun, Ta-Chang Lai, Yu Sun, Mu-Chien Sun, Po-Lin Chen, Tsuey-Ru Chiang, Shinn-Kuang Lin, Bak-Sau Yip, Chin-I Chen, Chi-Huey Bai, Sien-Tsong Chen, Hung-Yi Chiou, Li-Ming Lien, Chung Y Hsu
BACKGROUND: Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). METHODS: Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively...
2017: PloS One
https://www.readbyqxmd.com/read/28386036/silent-brain-infarctions-and-leukoaraiosis-in-patients-with-retinal-ischemia-a-prospective-single-center-observational-study
#20
Amir Golsari, Diana Bittersohl, Bastian Cheng, Pia Griem, Christoph Beck, Andrea Hassenstein, Max Nedelmann, Tim Magnus, Jens Fiehler, Christian Gerloff, Götz Thomalla
BACKGROUND AND PURPOSE: We aimed to determine the incidence of co-occurring cerebral ischemia, extent of cerebral small vessel disease, and vascular risk profile of patients with acute retinal ischemia. METHODS: RETIS (Frequency of Acute Silent Brain Infarction and Systematic Evaluation of Stroke Risk in Retinal Ischemia) was a single-center, prospective, observational study comprising ophthalmologic examination, brain magnetic resonance imaging, and extensive diagnostic work-up of vascular risk factors and stroke cause...
May 2017: Stroke; a Journal of Cerebral Circulation
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