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1.
No Shinkei Geka ; 48(1): 33-38, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983686

RESUMO

INTRODUCTION: Non-bifurcating cervical carotid artery(NBCCA)is a rare carotid artery anomaly, occurring at a rate of only 0.2%. We report a case in which carotid artery stenting(CAS)was performed for NBCCA stenosis. CASE REPORT: In a 69-year-old man had noted bilateral carotid artery stenosis was noted by chance during treatment for myocardial infarction. Carotid angiography revealed stenosis in both cervical carotid arteries, and the right side did not bifurcate(i.e. it was an NBCCA). Silent ischemia was observed in the left cerebral hemispheres in an MRI, and CAS was performed. A subsequent ultrasound examination revealed an increase in the peak systolic velocity in the right carotid artery, and CAS was planned for the right side. As it was not possible to use a guide-wire to guide into the external carotid artery, we planned to introduce it directly, approaching from the right brachial artery using a 6Fr Simmons guiding sheath. Angiography during distal balloon occlusion revealed significant retrograde flow from the facial and maxillary arteries to the internal carotid artery via the ophthalmic artery. Considering this finding, we decided to perform CAS with a femoral artery approach and flow reversal using distal and proximal balloon occlusion. Intraoperative embolism was prevented, and a successful treatment outcome was obtained. CONCLUSION: There are few reports of NBCCA stenosis treated with carotid endarterectomy or CAS. As CAS to treat NBCCA stenosis has several drawbacks, such as the impossibility of anchoring the wire in the external carotid artery. It is important to take appropriate steps to prevent distal embolism.


Assuntos
Estenose das Carótidas , Stents , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Angiografia Cerebral , Humanos , Masculino , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(2): 104579, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31852598

RESUMO

OBJECTIVE: Vulnerable carotid plaque is associated with cerebrovascular events. Cholesterol crystals are often seen in the atherosclerotic plaques. However, the potential role of cholesterol crystals in carotid plaques destabilization is unknown. We aimed to identify the association between cholesterol crystals and carotid plaque vulnerability. METHODS: Optical coherence tomography assessment of carotid plaque was performed in 95 patients. Clinical characteristics and plaque morphology were examined. The differences in plaque characteristics (thrombus, calcification, neovascularization, and macrophage accumulations) and clinical parameters (age, symptom, coronary heart disease, total cholesterol, triglycerides, and C-reactive protein) between patients with or without cholesterol crystals were analyzed with multivariate logistic regression. RESULTS: Among 66 patients with acceptable carotid atherosclerotic optical coherence tomography images, 16 were with and 50 were without cholesterol crystals. 56.3% patients (9 of 16) with cholesterol crystals had cerebrovascular ischemic symptom related to ipsilateral internal carotid artery, whereas only 26.0% patients (13 of 50) without cholesterol crystals had symptom (OR, 3.66; 95% CI, 1.13-11.82; P = .025). 75.0% of the plaques with cholesterol crystals had concomitant macrophage accumulation (OR, 4.14; 95% CI, 1.17-14.65; P = .04). In segments with cholesterol crystals, a higher presence of calcification could be demonstrated compared to those without cholesterol crystals (62.5% versus 32.0%, P = .03). 70.0% plaques with cholesterol crystals and calcification were classified as symptomatic plaques (OR, 6.38; 95% CI, 1.46-27.91; P = .01). No association between plaque rupture and cholesterol crystals was identified. Multivariate logistic regression showed that age and macrophage accumulation were independently associated with cholesterol crystals. CONCLUSIONS: Carotid atherosclerotic plaques with cholesterol crystals were more likely to have concomitant macrophage and calcification accumulations. Patients with cholesterol crystals plaque experienced more cerebrovascular symptoms. Thus, cholesterol crystals, especially together with macrophage and calcification, may serve as an important component of venerable carotid plaques.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Colesterol/análise , Placa Aterosclerótica , Tomografia de Coerência Óptica , Idoso , Isquemia Encefálica/etiologia , Artéria Carótida Interna/química , Estenose das Carótidas/complicações , Estenose das Carótidas/metabolismo , Cristalização , Feminino , Humanos , Macrófagos/química , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença , Calcificação Vascular/diagnóstico por imagem
4.
Angiology ; 71(1): 56-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31416325

RESUMO

The SYNTAX score (SS) and SS II, which include additional clinical parameters, are widely used today for deciding revascularization following coronary angiography. We investigated the association between the presence and severity of carotid artery disease (CrAD) using the SS and SS II in 287 patients who underwent coronary artery bypass grafting. We based this investigation on the known association between coronary artery disease and CrAD. A significant association was observed between the groups with and without CrAD in terms of SS II values (28.4 ± 9.6 vs 21.4 ± 7.7, respectively; P < .001). A significant difference was also observed when stenosis was classified according to severity as <50%, 50% to 70%, and >70% (P < .001). The results indicated a positive correlation between the presence and severity of CrAD as SS II increased (r = 0.187, P = .005). According to the results of multivariate logistic regression analysis, the SS II was an independent predictor of CrAD.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Angiografia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Ultrassonografia Doppler em Cores , Idoso , Estenose das Carótidas/complicações , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Angiol Sosud Khir ; 25(4): 41-52, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855200

RESUMO

AIM: The study was aimed at demonstrating efficacy and feasibility of intravascular ultrasound during internal carotid artery stenting for assessment of atheromatous plaque protrusion through a stent. PATIENTS AND METHODS: Over the period from October to December 2018, the specialists of our Centre performed a total of 90 internal carotid artery stenting procedures in 83 patients (of these, 7 patients underwent bilateral staged stenting of both internal carotid arteries) using intravascular ultrasound in order to assess intraoperative protrusion of an atherosclerotic plaque through the implanted stent. The patients' age varied from 42 to 87 (mean 68.6±6.9) years. Symptomatic lesions of internal carotid arteries were revealed in 14 (16.9%) operated patients and asymptomatic lesions in 69 (83.1%). The degree of stenosis varied from 60% to 90% according to the findings of preliminary duplex ultrasonography and was subsequently confirmed by the results of multislice computed tomography or selective angiography. The assessment of the patients' neurological status, as well as duplex ultrasonography of brachiocephalic arteries were performed at a scheduled follow-up visit on day 30 after discharge from hospital. RESULTS: The technical success of stenting was achieved in 100% of patients. According to the findings of intravascular ultrasound, plaque protrusion was observed in eight (8.8%) stented patients. Among them, six (6.6%) were free from angiographic signs of protrusion and only two (2.2%) had apparent angiographic signs of protrusion. During the early postoperative period, transient ischaemic attack was identified in four (4.4%) cases. One (1.1%) patient was found to develop ST-segment elevation acute myocardial infarction 24 hours after internal carotid artery stenting, followed by large hemispheric stroke on the side of stenting revealed on postoperative day 3. Nine (10%) patients according to the findings of intravascular ultrasound were diagnosed as having incomplete stent apposition after postdilatation, with the absence of such signs on angiography. CONCLUSION: Intravascular ultrasound during carotid stenting provides a more accurate assessment of such an event as atherosclerotic plaque protrusion through a stent's cells. At the same time, IVUS-guided assessment of the intraoperative outcome may prevent the risk for the development of stroke in the early postoperative period. Besides, intravascular ultrasound allows a more detailed assessment of stent apposition and the degree of stent expansion in order to optimize and improve the remote results of the operation.


Assuntos
Implante de Prótese Vascular , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
6.
Angiol Sosud Khir ; 25(4): 64-75, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855202

RESUMO

AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.


Assuntos
Estenose das Carótidas/cirurgia , Stents , Implante de Prótese Vascular , Estenose das Carótidas/diagnóstico por imagem , Humanos , Resultado do Tratamento
7.
Angiol Sosud Khir ; 25(4): 83-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855204

RESUMO

The authors carried out a prospective study aimed at revealing predictors of acute embolic lesions of cerebral vessels during angioplasty with stenting of the internal carotid artery. The study enrolled a total of 54 patients who between May 2015 and December 2018 underwent carotid angioplasty with stenting performed at the Department of Vascular and Endovascular Surgery of the Research Centre of Neurology. The procedure of internal carotid artery stenting may be accompanied by intraoperative acute embolic lesions. In order to reveal intraoperative acute embolic lesions of cerebral vessels all patients before and 24 hours after the intervention were subjected to diffusion-weighted magnetic resonance imaging. Thirty-six patients received classical carotid stents (Xact and Acculink) and 18 patients received Casper stents. The patients of both groups were comparable by 24 characteristics studied, including the incidence of intraoperative acute cerebral embolic lesions (18/36 for the classical stents and 10/18 for the Casper stent), which made it possible to unite them into one group in order to increase the power of the study. All acute embolic lesions detected by the diffusion-weighted magnetic resonance imaging (prior to stenting and 24 hours thereafter) were clinically, asymptomatic with no perioperative stroke observed. In order to reveal predictors of intraoperative acute embolic lesions of cerebral vessels we analysed 22 characteristics of the patients, with the obtained findings demonstrating the following signs: a low-intensity (below 20 dB) ultrasonographic signal reflected from fragments of an atherosclerotic plaque during ultrasound examination prior to stenting (p=0.001) - a sign strongly associated with acute embolic lesions (sensitivity - 75%, specificity - 92%); symptomatic stenosis according to the anamnestic data (p=0.02) - a sign significantly associated with acute embolic lesions; female gender (p=0.06) - a sign moderately associated with acute embolic lesions; a history previously endured (according to the anamnestic data) operations on coronary and/or carotid arteries (p=0.09) - a sign weakly associated with acute embolic lesions. Based on the obtained findings we proposed a prognostic scale to assess the risk of acute embolic lesions of cerebral vessels during internal carotid artery stenting. Knowing the factors associated with intraoperative acute embolic lesions will allow the endovascular surgeon to single out the patients at increased risk of acute embolic lesions.


Assuntos
Angioplastia/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Embolia Intracraniana/etiologia , Stents/efeitos adversos , Doença Aguda , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Dispositivos de Proteção Embólica , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(52): e18526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876747

RESUMO

A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (Eartery) was calculated as a normalized signal using the following equation: Eartery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and Eartery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values <.05 were considered significant.We found a significant difference in SHenhance between the data obtained from the spiral flow tube (0.20 ±â€Š0.060) and the T-shaped tube (0.24 ±â€Š0.056) (P = .001). The Eartery values significantly increased by 15% (spiral flow tube, median 14.1 with interquartile range [IQR] 11.8-15.4 vs T-shaped tube, median 12.3 IQR 11.3-14.0, P = .02) using the spiral flow tube.These findings suggest that, by using the Spiral flow tube, the homogeneity of the contrast-enhanced signal intensity in the carotid artery was significantly improved without decreasing the signal intensity in CEMRA.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Angiografia por Ressonância Magnética/instrumentação , Pescoço/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Estudos Retrospectivos
9.
Braz J Cardiovasc Surg ; 34(5): 581-587, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719009

RESUMO

OBJECTIVE: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). METHODS: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. RESULTS: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). CONCLUSION: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Ponte de Artéria Coronária/métodos , Ultrassonografia Doppler Dupla/métodos , Idoso , Estenose das Carótidas/etiologia , Ponte de Artéria Coronária/efeitos adversos , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(44): e17785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689850

RESUMO

INTRODUCTION: Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS: A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS: Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS: After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES: Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS: Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.


Assuntos
Aneurisma Roto/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia
11.
Vasc Med ; 24(5): 431-438, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31543030

RESUMO

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69-3.19%). All CAS procedures were performed according to the 'tailored' algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/terapia , Ponte de Artéria Coronária , Procedimentos Endovasculares/instrumentação , Cardiopatias/cirurgia , Implante de Prótese de Valva Cardíaca , Stents , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Estudos de Viabilidade , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 28(11): 104353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31494013

RESUMO

OBJECTIVES: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening process in an undifferentiated emergency department (ED) suspected stroke population as well as identify predictors of successful EVT. METHODS: We identified a cohort of consecutive ED patients who received CT angiography and brain perfusion (CTA/P) imaging to determine candidacy for EVT during 2016. In keeping with the guidelines at that time, hospital protocol directed physicians to obtain CTA/P studies if time from the onset of symptoms was less than or equal to 6 hours, and the National Institute of Health Stroke Scale (NIHSS) more than or equal to 6 or if recommended by the consulting stroke neurologist. Final discharge diagnoses, EVT attempts, and successful reperfusion (TICI 2b or better) were recorded. Yield of CTA/P was compared among patients based on NIHSS and duration of symptoms. RESULTS: Over a 12-month period, 406 suspected stroke patients were screened with CTA/P; 273 (67%) received a final diagnosis of ischemic stroke. Among cases screened, 53 (13%) underwent attempted EVT; 35 (9%) achieved successful reperfusion. Only 1 of 113 (1%) patients with an NIHSS less than 6 was successfully treated with EVT compared to 34 of 285 (12%) with higher NIHSS (p = 0.001). The probability of successful EVT declined with increasing symptom duration (p = 0.009 for trend). In multivariable analysis, NIHSS more than or equal to 6 was associated with successful EVT (odds ratio [OR] 4.0 [1.6 to 9.9]) but presentation within 6 hours of onset was not (OR 2.3 [0.8 to 6.7]). CONCLUSIONS: EVT candidates were common among suspected stroke patients screened with CTA/P in the ED, however, patients with NIHSS less than 6 rarely received successful EVT.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Serviço Hospitalar de Emergência , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(33): e16758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415373

RESUMO

RATIONALE: Adverse drug reactions (ADRs) to iohexol occur infrequently and generally result in good outcomes. This report describes a 51-year-old man suffering from an ADR to iohexol (Omnipaque 300), which proved fatal. PATIENT CONCERNS: The patient was admitted to hospital due to intermittent dizziness over 2 years and transient numbness and weakness of the right limbs for 1 week. The patient was investigated using carotid artery angioplasty (CAA), during which the patient suffered a sudden disorder of consciousness and a tonic-clonic seizure leading to status epilepticus. After the CAA, the patient suffered from increasing cerebral edema volume. DIAGNOSES: Results of digital subtraction angiography and computed tomography angiography performed at another hospital before the CAA suggested severe stenosis of the left internal carotid artery at the spinal C1 level. In the processes of intraoperative and postoperative CAA, the patient developed severe allergic reactions to the contrast agent including epilepsy, brain tissue edema, and renal failure, which were typical according to the 10th edition of the American College of Radiology Manual on Contrast Media (ACR Manual on Contrast Media, Version 10.3, 2017). INTERVENTIONS: The patient was treated with antiepileptic, antianaphylactic therapy, and control of blood pressure. Due to rapid and severe brain edema, a decompressive craniectomy was performed on the left side, but it was unsuccessful in reducing brain edema. Subsequently, the patient was started on continuous renal replacement therapy for progressive renal dysfunction. OUTCOMES: Despite the use of a variety of medical and surgical interventions, it was not possible to control the patient's condition, which gradually declined leading to death, 7 days post-CAA. LESSONS: To the authors' knowledge, this represents the 1st case of fatal contrast-induced ADR to iohexol during CAA. Although a variety of preoperative tests for iohexol allergy were performed according to recommendations from the ACR Manual on Contrast Media (Version 10.3, 2017), severe complications related to iodized contrast agent still occurred. If the ADR had been recognized sooner and decompressive craniectomy and continuous renal replacement therapy were applied earlier, it would have improved the patients' prognosis.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Iohexol/efeitos adversos , Angiografia Digital , Estenose das Carótidas/complicações , Tontura/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
14.
Medicine (Baltimore) ; 98(32): e16781, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393403

RESUMO

In this single-center, retrospective study, we aimed to compare early and late outcomes after carotid endarterectomy (CEA) between younger and elderly patients and to investigate the impact of patient age on the overall incidence of cardiovascular events after CEA.A total of 613 patients with 675 CEAs between January 2007 and December 2014 were stratified by patient age into 2 groups: younger (≤60 years, n = 103 CEAs, 15.3%) and elderly (>60 years, n = 572 CEAs, 84.7%) groups. The study outcomes were defined as the occurrence of major adverse events (MAEs), including fatal or nonfatal stroke or myocardial infarction (MI), or any-cause mortality, and overall cardiovascular events (meaning the composite incidence of stroke or MI) during the perioperative period and within 4 years after CEA.Although there were no significant differences in the incidence of 30-day MAEs and any of the individual MAE manifestations between the 2 groups, the differences in the MAE incidence (P = .006) and any-cause mortality (P = .023) within 4 years after CEA were significantly greater in patients in the elderly group. For overall incidence of cardiovascular events, no significant difference was noted between the 2 groups (P = .096). On multivariate analysis, older age (>60 years) did not affect the incidence of perioperative MAEs and individual MAE manifestations; however, older age was significantly associated with an increased risk of 4-year MAEs (hazard ratio [HR], 3.68, 95% confidence interval [CI], 1.35-10.0; P = .011) and any-cause mortality (HR, 3.26, 95% CI, 1.02-10.5; P = .047). With regard to the 4-year overall incidence of cardiovascular events, older age was not an independent predictor of increased risk of these cardiovascular events.Our study indicates that the risks of perioperative MAEs and the 4-year overall incidence of cardiovascular events do not significantly differ between younger and elderly Korean patients undergoing CEA, although there was a higher risk of 4-year any-cause mortality in the elderly patients. Older age does not appear to be an independent risk factor for perioperative MAEs and overall cardiovascular events within 4 years after CEA.


Assuntos
Doenças Cardiovasculares/epidemiologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Estenose das Carótidas/diagnóstico por imagem , Reestenose Coronária/epidemiologia , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Tempo
15.
Surgery ; 166(4): 601-606, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31405580

RESUMO

BACKGROUND: Difficult cephalad exposure during carotid endarterectomy in patients with high plaque (HP) may lead to increased incidence of complications after carotid endarterectomy. We report on our experience of carotid endarterectomy in patients with HP. METHODS: This is a retrospective review of 1,233 consecutive patients who underwent carotid endarterectomy by a single surgeon at 2 teaching hospitals between January 1989 to December 2018. Group A consisted of patients with HP (n = 100) diagnosed by computed tomography angiography of the neck in 90, catheter-based arteriography in 8, and an unexpected finding during carotid endarterectomy in 2 patients. Group B consisted of 1,133 consecutive carotid endarterectomies with plaque ending in Zone 1 non-high plaque (nHP). RESULTS: Both groups were similar in age (70.9 ± 8.7 vs 70.3 ± 9.1, P = .53). There was a preponderance of male patients in the HP group (78.0% vs 66.1%, P = .02). Associated risk factors, including coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and hyperlipidemia, were similar in both groups. Indications for carotid endarterectomy in HP patients include recent stroke (<8 weeks) in 15 patients (15.0%), transient ischemic attack in 23 patients (23.0%), and asymptomatic in 62 patients (62.0%). Three patients (3.0%) with HP required shunt placement compared with 10.9% in the nHP group (P = .009). Completion carotid arteriogram was performed in 6 patients. Perioperative stroke and mortality were similar in both groups. The incidence of cranial nerve injury was higher in the HP group. CONCLUSION: Most patients with HP can be diagnosed with computed tomography angiography of the neck or catheter-based arteriography. Shunt requirement in patients with HP is significantly lower than in the nHP group. Perioperative stroke and mortality in patients with HP undergoing carotid endarterectomy is similar to the nHP group; however, there is a higher incidence of permanent cranial nerve injury. Carotid artery stenting should be considered in cases in which carotid endarterectomy may be challenging, such as in patients with HP. Overall, our results demonstrate that carotid endarterectomy can be safely performed in patients with HP, however, at an increased risk of permanent cranial nerve injury.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Endarterectomia das Carótidas/métodos , Segurança do Paciente , Placa Aterosclerótica/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Estenose das Carótidas/mortalidade , Estudos de Coortes , Endarterectomia das Carótidas/efeitos adversos , Feminino , Hospitais de Ensino , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Acidente Vascular Cerebral/prevenção & controle , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Estados Unidos
16.
J Stroke Cerebrovasc Dis ; 28(10): 104298, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371145

RESUMO

OBJECTIVES: Arterial branches and curvatures, such as the common carotid artery (CCA) origin and carotid bifurcation, are usual sites of atherosclerosis, which leads to carotid artery stenosis. Atherosclerosis may occur due to repetitive compression. Stenosis localized to the proximal segment away from the CCA origin and bifurcation is rare. Here, we describe the case of a patient with right proximal CCA stenosis induced by repetitive compression. METHODS: We studied an acute stroke patient who worked for a long time as a geographical surveyor carrying a tripod on his right shoulder. We found severe eccentric stenosis composed of thick plaque in the right proximal CCA, away from the right CCA origin. However, there was no finding of CCA dissection or vasculitis. RESULTS: The patient was diagnosed with ischemic stroke due to artery-to-artery embolization from the right CCA stenosis, which we believed was due to repetitive compression by the tripod. CONCLUSIONS: Repetitive mechanical stimuli can cause stenotic lesions at atypical vascular sites.


Assuntos
Isquemia Encefálica/etiologia , Artéria Carótida Primitiva , Estenose das Carótidas/etiologia , Remoção/efeitos adversos , Doenças Profissionais/etiologia , Acidente Vascular Cerebral/etiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Humanos , Descrição de Cargo , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico por imagem , Doenças Profissionais/fisiopatologia , Doenças Profissionais/terapia , Ocupações , Fluxo Sanguíneo Regional , Stents , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
17.
J Neurol Surg A Cent Eur Neurosurg ; 80(6): 441-453, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31466106

RESUMO

OBJECTIVE: To investigate the difference in treatment outcomes according to the method used to select the recipient artery in superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. METHODS: We retrospectively analyzed the cases of 35 patients who underwent an STA-MCA anastomosis for internal carotid artery/MCA occlusion or stenosis. Patients were divided into two groups based on whether the recipient artery was precisely targeted by single-photon emission computed tomography (SPECT group) or less precisely targeted by visual assessment (Visual group). Then the bypass results in both groups were evaluated postoperatively based on changes in the regional cerebral blood flow (rCBF) and clinical outcomes. RESULTS: The delineated recipient artery in magnetic resonance angiography (MRA) matched the intraoperatively selected artery in 87.6% of the SPECT group cases and 83.3% of the Visual group cases. The SPECT group's digital subtraction angiography (DSA) findings coincided with the intraoperative selection in 76.9% of cases, and the MRA findings corresponded with the DSA findings in 92.3%. The postoperative areas with increased rCBF matched the perfused areas of intraoperatively selected arteries in 80.0% of the SPECT group cases and 77.8% of the Visual group cases. Postoperatively increased rCBF areas matching totally or partially with preoperative low-perfusion areas were observed in all cases. CONCLUSIONS: The present results revealed no significant differences in the change in rCBF in the low-perfusion area between the patients whose recipient arteries were selected by SPECT or visual assessment.


Assuntos
Anastomose Cirúrgica/métodos , Estenose das Carótidas/cirurgia , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgia , Idoso , Angiografia Digital , Estenose das Carótidas/diagnóstico por imagem , Revascularização Cerebral/métodos , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Estudos Retrospectivos , Artérias Temporais/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
18.
Dtsch Med Wochenschr ; 144(17): 1209-1211, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31454843

RESUMO

HISTORY: An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS: The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE: A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION: After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.


Assuntos
Estenose das Carótidas , Pneumopatias , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Eletrocardiografia , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Marca-Passo Artificial
19.
BMC Med Imaging ; 19(1): 74, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443643

RESUMO

BACKGROUND: This study evaluates carotid vulnerable plaques using contrast-enhanced ultrasound (CEUS) and explores the relationship between vulnerable plaques and leukocytes. METHODS: Sixty-two symptomatic and 54 asymptomatic patients underwent CEUS. The images were analyzed using time-intensity and fitting curves, and peak (PTIC), mean (MTIC), peak (PFC), sharpness (SFC), and area under the curve (AUCFC) were obtained. The relations between CEUS parameters and leukocytes were analyzed. RESULTS: In the symptomatic group, total leukocytes and neutrophils were higher, while lymphocyte was decreased; PTIC, MTIC, PFC, SFC, and AUCFC were significantly higher; MTIC and AUCFC were negatively correlated with lymphocytes, and MTIC was positively correlated with neutrophils. Classification and regression tree analysis showed that MTIC at a cutoff of 20.8 and AUCFC at a cutoff of 8.8 resulted in a predictive of acute cerebral infarction, accuracy of 84.3%, sensitivity of 87.1%, and specificity of 81.5%. CONCLUSIONS: The variation in the perivascular leucocyte is significantly related to intraplaque inflammatory activities, CEUS is a feasible monitor of intraplaque neovascularization, so CEUS combined with perivascular leucocyte could be helpful as a warning for vulnerable plaques.


Assuntos
Infarto Encefálico/diagnóstico por imagem , Estenose das Carótidas/sangue , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Meios de Contraste , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
20.
Zhonghua Nei Ke Za Zhi ; 58(8): 599-601, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365983

RESUMO

Carotid web is a rare risk factor of ischemic stroke. A total of 32 (0.54%) patients with carotid web were finally diagnosed in 5 943 patients who underwent carotid computerized tomography angiography (CTA) in two hospitals. Only one patient received carotid endarterectomy that pathological findings were fibrous tissue hyperplasia of vascular wall with mucinous degeneration. Stent implantation was administrated in two cases. Among 13 asymptomatic patients, the observational follow-up period was (20.9±12.4) months without strokes. Carotid web is a rare aberration. Asymptomatic patients with carotid web are usually silent. Large sized cohort and long-term follow-up are further needed.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Stents/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Estudos de Coortes , Endarterectomia das Carótidas/métodos , Displasia Fibromuscular/complicações , Seguimentos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
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