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Carotid stenosis, acute stroke,

Satoshi Namitome, Seigo Shindo, Kuniyasu Wada, Tadashi Terasaki, Makoto Nakajima, Yukio Ando
A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/μl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T1 -weighted imaging) revealed enhancement of the vessel walls at the stenotic lesions...
February 28, 2018: Rinshō Shinkeigaku, Clinical Neurology
Taylor Wapshott, Brice Blum, Williams Kelsey, Thomas I Nathaniel
Background: Many studies have reported that women who survive stroke have less favorable outcomes than men in the use of rtPA, while others reported worse outcomes in men than women. The gender difference in the exclusion criteria in a diabetic stroke population is not fully understood. This issue was investigated in this study. Method: In a diabetic stroke population from a stroke registry of data collected between January 2010 to June 30, 2016, the gender difference was determined using demographics and clinical factors...
December 2017: Journal of Vascular and Interventional Neurology
Payam Sasannejad, Fateme Rezaei, Reza Bidaki, Ehsan Zarepur
Moyamoya disease is a chronic progressive vascular disease of brain characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. We introduce here a patient with Moyamoya who was misdiagnosed. She was a 16-yr-old female from north east of Iran who complained left hemiparesis and was diagnosed Moyamoya disease by brain and cervical CT-Angiography. There was still great difficulty in the diagnosis of diffuse white matter lesions. The CT-Angiography showed bilateral internal carotid stenosis with "puff of smoke" collateralization arising from the circle of Willis, therefore Moyamoya disease was raised...
2018: Iranian Journal of Child Neurology
Andreia Coelho, Miguel Lobo, Ricardo Gouveia, Diogo Silveira, Jacinta Campos, Rita Augusto, Nuno Coelho, Alexandra Canedo
INTRODUCTION: Endovascular intracranial thrombectomy (IT) has established itself as the standard of care in treating large-vessel anterior circulation acute ischemic stroke (AIS). However, internal carotid artery (ICA) stenosis/occlusion hampers distal access and controversy about simultaneous emergency ICA stenting ensues. The purpose of this review was to evaluate the safety of emergency ICA stenting in combination with IT for AIS with tandem occlusions. To our knowledge this is the first meta-analysis to evaluate emergency ICA stenting in tandem occlusions, combining results from studies with a control group...
January 23, 2018: Journal of Cardiovascular Surgery
Keju Ju, Lingling Zhong, Xiaoyu Ni, Hua Cao, Guanliang Cheng, Lianshu Ding
OBJECTIVE: To investigate the relationship between cerebral vasomotor reactivity (VMR) and acute stroke in patients with internal carotid artery stenosis. METHODS: 54 patients with internal carotid artery stenosis were enrolled. VMR was calculated by transcranial Doppler monitoring of the velocity of blood flow. 3-Dimensional dynamic contrast enhanced magnetic resonance angiography was used to detect stenosis, and diffusion weighted imaging was used to detect infarction...
January 8, 2018: Neurologia i Neurochirurgia Polska
Jacek Gacoń, Rafał Badacz, Ewa Stępień, Izabela Karch, Francisco J Enguita, Krzysztof Żmudka, Tadeusz Przewłocki, Anna Kabłak-Ziembicka
BACKGROUND: Circulating microRNAs (miRs) levels are potentially important diagnostic and prognostic biomarkers in acute coronary syndrome (ACS) or cerebral ischemic event (CIE) resulting from internal carotid artery stenosis (ICAS). AIM: This 4-year prospective study aimed to compare the levels of circulating miRs in ACS vs CIE patients, and investigate miRs potentially associated with risk of recurrent cardiovascular event. METHODS: The circulating miRs levels (miR-1-3p, miR-16-5p, miR-34a-5p, mir-122-5p, miR-124-3p, miR-133a-3p, miR-133b, miR-134-5p, miR-208b-3p, miR-375 and miR-499-5p) were compared in 43 (34M, 57...
January 19, 2018: Kardiologia Polska
Runming Sun, Lixia Wang, Cuiling Guan, Wenyuan Cao, Bing Tian
OBJECTIVE: To investigate the carotid atherosclerotic plaque features in patients with acute ischemic stroke (AIS). METHODS: A total of 288 patients meeting the included criteria were enrolled and divided into ulcer plaque group (n = 139) and none ulcer plaque group (n = 149). Patients in ulcer plaque group were further subdivided into < and ≥ 50% stenosis group. Carotid plaque components characteristics including luminal stenosis, carotid plaque volume, hypoechoic plaque volume and hyperechoic plaque volume were analyzed by color Doppler ultrasound measurement...
January 8, 2018: World Neurosurgery
Tammy Slater, Julie Stanik-Hutt, Patricia Davidson
BACKGROUND: Strokes following adult cardiac surgery contribute to burdensome neurocognitive complications, which are often difficult to detect during the perioperative period. Fluctuations in regional cerebral perfusion and co-morbid conditions, such as hypertension, diabetes, prior stroke, symptomatic carotid stenosis, aortic atherosclerotic disease, and peripheral vascular disease are associated with perioperative strokes. Approaches to achieve optimal cerebral perfusion remain elusive and traditional strategies for perioperative monitoring are not always sufficiently sensitive to detect acute changes in cerebral perfusion...
December 28, 2017: Contemporary Nurse
Takao Hoshino, Leila Sissani, Julien Labreuche, Gregory Ducrocq, Philippa C Lavallée, Elena Meseguer, Céline Guidoux, Lucie Cabrejo, Cristina Hobeanu, Fernando Gongora-Rivera, Pierre-Jean Touboul, Philippe Gabriel Steg, Pierre Amarenco
Importance: Patients who have experienced stroke with intracranial atherosclerotic disease (ICAD) may also have concomitant atherosclerosis in different arterial beds and other possible causes for ischemic stroke. However, little is known about the frequency and prognostic effect of such overlapping diseases. Objectives: To describe the prevalence of systemic atherosclerotic burdens and overlapping stroke etiologies and their contributions to long-term prognoses among patients who have experienced stroke with ICAD...
December 26, 2017: JAMA Neurology
Tian Xu, Peng Zuo, Lin Cao, Zhiwei Gao, Kaifu Ke
AIMS: Omentin-1 was proved to be associated with ischemic stroke clinical functional outcome. It also predicted carotid atherosclerosis among metabolic syndrome subjects and type 2 diabetes patients. Our aim was to examine the association of omentin-1 levels with carotid plaque instability and stenosis degree among ischemic stroke patients. METHODS: A total of 173 acute ischemic stroke patients were included in this study. Serum omentin-1 levels were assayed. Carotid ultrasound examinations were performed to evaluate the carotid plaque instability and stenosis degree...
December 9, 2017: Journal of Atherosclerosis and Thrombosis
Caroline Bund, Céline Heimburger, Valérie Wolff, Izzie Jacques Namer
An 84-year-old man, who presented lower limbs limb-shaking syndrome at orthostatism lasting a few seconds, was referred in our stroke unit. Magnetic resonance imaging showed an acute infarction in the right thalamus and the insular cortex, left extracranial carotid stenosis at 80%, and low flow in the right middle cerebral artery but did not explain limb-shaking syndrome symptomatology. We performed comparative positional brain perfusion single-photon emission computed tomography (SPECT), in the upright and in the supine position, to explore and localize hypoperfusion-endangered brain structures that may be involved in the presenting symptoms...
December 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Volker Maus, Daniel Behme, Jan Borggrefe, Christoph Kabbasch, Fatih Seker, Cicek Hüseyin, Utako Birgit Barnikol, Leonard Leong Litt Yeo, Patrick Brouwer, Michael Söderman, Markus Möhlenbruch, Marios Nikos Psychogios, Thomas Liebig, Christian Dohmen, Gereon Rudolf Fink, Anastasios Mpotsaris
BACKGROUND AND PURPOSE: Cerebral ischemic strokes due to extra-/intracranial tandem occlusions (TO) of the anterior circulation are responsible for causing mechanical thrombectomy (MT). The impact of concomitant contralateral carotid stenosis (CCS) upon outcome remains unclear in this stroke subtype. METHODS: Retrospective analysis of prospectively collected data of 4 international stroke centers between 2011 and 2017. One hundred ninety-seven consecutive patients with anterior TO were treated with MT and acute carotid artery stenting (CAS)...
November 24, 2017: Cerebrovascular Diseases
Filippo Farina, Anna Palmieri, Silvia Favaretto, Federica Viaro, Giacomo Cester, Francesco Causin, Claudio Baracchini
BACKGROUND: Endovascular treatment (EVT) is an effective therapy for acute ischemic stroke due to large artery occlusion of the anterior circulation. Yet some patients do not experience clinical improvement despite successful recanalization and reperfusion. The reasons are unknown, but one possible explanation is microvessel obstruction downstream. The aim of this study was to assess the presence of microembolic signals (MES) with transcranial Doppler and define their role as predictors of clinical outcome in stroke patients after EVT...
February 2018: World Neurosurgery
Agata Buonacera, Benedetta Stancanelli, Lorenzo Malatino
Stroke as a cause of long-term disability is a growing public health burden. Therefore, focusing on prevention is important. The most prominent aim of this strategy is to treat modifiable risk factors, such as arterial hypertension, the leading modifiable contributor to stroke. Thus, efforts to adequately reduce blood pressure (BP) among hypertensives are mandatory. In this respect, although safety and benefits of BP control related to long-term outcome have been largely demonstrated, there are open questions that remain to be addressed, such as optimal timing to initiate BP reduction and BP goals to be targeted...
November 16, 2017: Current Vascular Pharmacology
Ananth K Vellimana, Chad W Washington, Chester K Yarbrough, Thomas K Pilgram, Brian L Hoh, Colin P Derdeyn, Gregory J Zipfel
BACKGROUND: Thrombolysis is the standard of care for acute ischemic stroke patients presenting in the appropriate time window. Studies suggest that the risk of recurrent ischemia is lower if carotid revascularization is performed early after the index event. The safety of early carotid revascularization in this patient population is unclear. OBJECTIVE: To evaluate the safety of carotid revascularization in patients who received thrombolysis for acute ischemic stroke...
November 10, 2017: Neurosurgery
Barbara Goeggel Simonetti, Justine Hulliger, Etienne Mathier, Simon Jung, Urs Fischer, Hakan Sarikaya, Johannes Slotboom, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Marcel Arnold
PURPOSE: Knowledge about the localization and outcome of iatrogenic dissection (ID) during endovascular treatment of acute ischemic stroke (AIS) is limited. We aimed to determine the frequency, clinical aspects and morphology of ID in endovascular AIS treatment and to identify predictors of this complication. METHODS: Digital subtraction angiography (DSA) of ID carried out during endovascular treatment between January 2000 and March 2012 have been re-evaluated. The ID localization and morphology were analyzed and related to the interventional techniques...
November 2, 2017: Clinical Neuroradiology
Yun Zhang, Zhonglun Chen, Yufeng Tang, Wanying Shan, Ling Wang, Jian Shi, Qian Luo, Jinfeng Duan, Gelin Xu
BACKGROUND AND PURPOSES: Procalcitonin has been suggested as a new risk factor in atherosclerotic disease. However, whether procalcitonin levels are associated with the risk of carotid atherosclerosis remains unclear. This study aimed to investigate the relationship between procalcitonin levels and carotid atherosclerosis among patients with first-ever acute ischemic stroke. METHODS: Two hundred and thirty consecutive patients were prospectively enrolled in this study...
November 3, 2017: International Journal of Neuroscience
Renato Casana, Valerio Tolva, Andrea Odero, Chiara Malloggi, Aldo Paolucci, Fabio Triulzi, Vincenzo Silani
OBJECTIVE/BACKGROUND: Plaque protrusion through stent struts represents one of the principal causes of cerebral embolisation during carotid artery stenting (CAS) and the stent healing period. The aim of this study was to evaluate the safety (technical success) and efficacy (clinical success) of the CGuard stent system - a new nitinol stent covered by a closed-cell polyethylene terephthalate mesh designed to prevent embolic events. METHODS: Eighty-two consecutive patients who underwent CAS with CGuard from June 2015 were included in this study...
December 2017: European Journal of Vascular and Endovascular Surgery
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
Fadar Oliver Otite, Nicholas Liaw, Priyank Khandelwal, Amer M Malik, Jose G Romano, Tatjana Rundek, Ralph L Sacco, Seemant Chaturvedi
OBJECTIVE: To evaluate trends in prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and drug abuse) and cardiovascular diseases (carotid stenosis, chronic renal failure [CRF], and coronary artery disease [CAD]) in acute ischemic stroke (AIS) in the United States. METHODS: We used the 2004-2014 National Inpatient Sample to compute weighted prevalence of each risk factor in hospitalized patients with AIS and used joinpoint regression to evaluate change in prevalence over time...
November 7, 2017: Neurology
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