Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

Pacheco, Felipe Torres; Littig, Ingrid Aguiar; Gagliardi, Rubens José; Rocha, Antônio José da

doi:10.1590/0004-282x20150034

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…The same was observed in the study of Pacheco et al. ( 18 ) , in which 34% of the patients had stenosis that was not considered relevant and 59% of those patients had vulnerable plaques. Therefore, 20% of their patients would not have received adequate treatment if only the criterion of indirect stenosis were considered.…”

Section: Discussionsupporting

confidence: 81%

“…In the present study, the most common diagnosis was stroke of undetermined etiology, followed by stroke attributed to large-vessel atherosclerosis. In the patient samples evaluated by Pacheco et al ( 18 ) and Silva et al ( 20 ) , atherosclerosis was the main etiology, identified in 50% and 41% of the cases, respectively. However, other authors have reported large proportions of patients diagnosed with stroke of undetermined etiology, thus highlighting one of the limitations of the TOAST classification system, which includes many heterogeneous conditions in this category, resulting in an overestimation of its incidence ( 25 - 27 ) .…”

Section: Discussionmentioning

confidence: 90%

“…The plaque surface was classified as regular or irregular and as ulcerated or not. Plaques were thereby divided into two categories ( 18 ) : stable (calcified with a regular surface); and vulnerable (mixed or fatty-fibrous, with an irregular surface and with or without ulceration).…”

Section: Methodsmentioning

confidence: 99%

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Importance of computed tomography angiography in acute/hyperacute ischemic stroke

Dias

Bezerra

et al. 2021

Radiol Bras

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Objective: To evaluate the importance of computed tomography and computed tomography angiography (CTA) in stroke protocols, as well as their impact on endovascular treatment and on the determination of the etiology. Materials and Methods Were evaluated 28 patients with acute/hyperacute stroke in the anterior circulation who underwent intracranial and cervical CTA between April 2018 and August 2019. The parameters evaluated were the degree of stenosis, plaque characteristics, type of infarct, treatment, etiology, and the Alberta Stroke Program Early CT Score (ASPECTS). Results: Of the 28 patients evaluated, 16 (57.1%) had an ASPECTS of 10 (the maximum score, indicative of normality). Four patients (14.3%) underwent thrombolytic treatment, and seven (25.0%) underwent mechanical thrombectomy. The etiology was atherosclerosis in 32.1% of the patients, cerebral small-vessel disease in 7.1%, cardioembolic in 7.1%, and undetermined in 53.6%. Regarding plaque, 17.9% of the patients presented stenosis ≥ 50%, 21.4% presented stable plaques, and 42.9% presented vulnerable plaques. Patients with a lower ASPECTS were more likely to have relevant stenosis and were more likely to have a total infarct. Conclusion: In the evaluation of patients with acute/hyperacute strokes, CTA provides important information, identifying occlusion, as well as helping define the etiology and inform decisions regarding treatment.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 90%

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Importance of computed tomography angiography in acute/hyperacute ischemic stroke

Dias

Bezerra

et al. 2021

Radiol Bras

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“…Os fatores de risco modificáveis como: estresse, hipertensão, diabetes, tabagismo, etilismo, obesidade e doenças cardiovasculares, são descritos pela literatura como comorbidades favoráveis para o acometimento de doenças cerebrovasculares, principalmente o AVC 25,27,28 . No entanto, estudos apontam que aderir a um estilo de vida saudável como uma boa alimentação e práticas de atividades físicas contribui de forma significativa para manter os níveis adequados de autonomia motora, melhora da saúde física, mental e socialização 19,29 . Portanto, a reincidência da doença diminui assim como a incidência de novos casos.…”

Section: Discussionunclassified

Qualidade de vida de pacientes acometidos por acidente vascular cerebral

Silva

Oliveira²,

Brito³

et al. 2021

Rev. Atenção Saúde

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O Acidente Vascular Cerebral (AVC) é uma doença grave, suas sequelas podem comprometer a qualidade de vida das pessoas acometidas. Objetivo: Analisar a qualidade de vida de pacientes acometidos por AVC. Metodologia: Trata-se de um estudo descritivo, exploratório do tipo transversal, com amostra composta por pacientes acometidos por AVC de ambos os sexos, com idade acima de 21 anos. Foram aplicados os questionários: Mini-Exame do estado mental (MEEM), Sociodemográfico e o Medical Outcomes Short-Form 36-item Health Survey (SF-36). Resultados: 20 pacientes estavam em atendimento, desses apenas 15 atingiram a pontuação necessária no MEEM para entrar na pesquisa. 9 (60,0%) eram do sexo masculino e 6 (40,0%) do sexo feminino, com idade igual ou superior a 60 anos, com faixas etárias de 60 a 69 anos 6 (40,0%) e 71 a 79 anos 2 (13,3%), em relação à raça, a branca e a parda se igualaram com 7 (46,7%), ao tipo de AVC observou-se que 11 (73,3%) dos pacientes sofreram AVC Isquêmico e 4 (26,7%) AVC Hemorrágico. Sobre o tempo de ocorrido do AVC, 12 (80%) tinham tido há mais de 1 ano. Foram observados baixos escores em todos os domínios da SF-36, principalmente nos aspectos físicos (26,66), capacidade funcional (43,33), e aspectos emocionais (41,93). Conclusão: Foi observado o comprometimento na percepção da Qualidade de Vida (QV) com valores baixos de todos os domínios, principalmente nos aspectos físicos, emocionais e capacidade funcional, com maior frequência em pacientes com diagnóstico clínico de AVC do tipo isquêmico, com igual ou superior a 60 anos de gênero masculino

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“…A detailed investigation into the characteristics of the artery involved in the stroke would also be elucidating, since atherothrombosis with unstable and/or complex plaques carries a higher risk of hemorrhage compared to embolisms. A study of the arteries using the multidetector computed tomography angiography method, which has proven useful for this purpose 12 may, in future investigations, contribute to better etiological and physiopathological definition. Akin to all retrospective studies, the investigation by Ducci et al 10 has some inherent bias, such as the fact that some patients may not have been included due to missing data.…”

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confidence: 99%

Could side of middle cerebral artery obstruction be a prognostic factor for mortality in thrombolysed patients?

Gagliardi¹

2015

Arq. Neuro-Psiquiatr.

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T reatment with thrombolytic therapy in ischemic stroke is effective and safe but data on its safety and efficacy in different stroke subtypes and etiologies is lacking. Different parameters can influence the effectiveness and risk of thrombolysis in stroke patients and knowledge of these factors can be useful to inform therapeutic decisions, often involving actions outside the general consensus or decisions based on risk/benefit. This information may also be useful as a prognostic element and help guide rehabilitation conduct. Among the numerous parameters that can be analyzed, laterality of the arterial territory affected represents a favorable element which is readily and quickly assessed. Cerebrovascular events often cause neuropsychological deficits that are related to the side of the stroke, for example, aphasia in the left cerebral hemisphere (LCH) and neglect in the right cerebral hemisphere (RCH).RCH strokes are often underestimated by clinical rating scales 1,2 because deficits such as language disorders (typical of the LCH) are more easily recognized than neglect or agnosias, typical of the RCH 2,3 . Imaging studies show that RCH stroke patients can be rated lower by the NIH scale, despite having a large cerebral infarct area 3,4 . Stroke severity, as measured by the NIH scale, an internationally accepted instrument, is one of the criteria used for patient selection. The scale could be adjusted by hemisphere affected for a more accurate assessment of patient hemorrhage risk 1 , should the hypothesis of a relationship between laterality and severity be proven. These factors may contribute to less frequent thrombolysis of RCH stroke patients who consequently do not receive adequate treatment. Difficulties detecting symptoms of RCH stroke are challenges which must be overcome in order to optimize conduct, particularly during the acute phase of stroke.The topographic relationship regarding the side of the middle cerebral artery affected (right or left) can represent a further element contributing to risk assessment and quantification of prognosis. The issue remains controversial in the literature 1,5,6,7 and warrants further analyses. Brain hemorrhage after thrombolysis is the most feared complication of the procedure 2,8 and studies analyzing possible predictors of risk are of great clinical interest.Sato et al. 5, in a study analyzing a large casuistic (2708 patients with supratentorial hemorrhage) found a higher death rate in right-sided stroke but no effect of laterality on severity of sequelae among survivors. Audebert et al.1 stated that the higher hemorrhage rates in RCH stroke reported were due to bias introduced by the scales employed.Brott et al. 9 found a 15% higher incidence of silent infarction in RCH compared to LCH; patients with previous silent stroke may have poorer prognosis after thrombolysis, a finding which, if confirmed, can be used as an auxiliary criteria to guide patient conduct.The study of Ducci et al. 10, "Does the side of middle cerebral artery compromise matters in the mortal...

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Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

Cited by 4 publications

References 31 publications

Importance of computed tomography angiography in acute/hyperacute ischemic stroke

Importance of computed tomography angiography in acute/hyperacute ischemic stroke

Qualidade de vida de pacientes acometidos por acidente vascular cerebral

Could side of middle cerebral artery obstruction be a prognostic factor for mortality in thrombolysed patients?

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