Carotid surgery in acute symptomatic patients

Huber, Rita; Müller, Bárbara; Seitz, Rüdiger J.; Siebler, Mario; Mödder, Ulrich; Sandmann, W.

doi:10.1053/ejvs.2002.1774

Cited by 55 publications

(40 citation statements)

References 33 publications

(10 reference statements)

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“…However, some surgeons report encouraging results from emergency operations for patients with severe stenosis or occlusion of the internal carotid artery existing for Յ24 hours. 324,386,[451][452][453][454][455][456][457][458][459][460] In general, improvement after surgery was found among patients with mild to moderate neurological impairments. Still, the data are limited, and the usefulness of urgent surgery among patients with severe neurological deficits is even less clear.…”

Section: A Carotid Endarterectomymentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,102

480

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods-Members of the panel were appointed

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Section: A Carotid Endarterectomymentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,102

480

View full text Add to dashboard Cite

show abstract

“…In another study of 67 patients, emergency carotid endarterectomy achieved recanalization in all but 5 cases. 54 The patients who were selected for surgery had normal preoperative flow in the middle cerebral artery. The aim was to avoid performing surgery on the internal carotid artery if an ipsilateral embolic occlusion of the middle cerebral artery had already occurred.…”

Section: Surgical and Endovascular Proceduresmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Ischemic Stroke

Adams¹,

Adams²,

Zoppo³

et al. 2005

Stroke

401

161

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“…Moreover, ADC lesions were shown to normalize more often within three hours after stroke onset as compared to the three-to six-hour time window, particularly when they were accompanied by a smaller perfusion lesion (15,21). However, there are acute patients with a persisting perfusion-diffusion mismatch who benefit from immediate carotid artery surgery both clinically and in terms of cerebral perfusion (46,47). Similarly, Desmoteplase was shown to be an effective thrombolytic treatment during the three-to six-hour window in patients with acute stroke and a perfusion-diffusion mismatch (48).…”

Section: Discussionmentioning

confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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Purpose: To determine whether the perfusion deficit could predict brain infarction in patients with chronic cerebral ischemia who experienced recurring episodes of neurological symptoms and showed a perfusion-diffusion mismatch on magnetic resonance (MR) images. Materials and Methods:In 53 consecutive patients (38 males and 15 females, 62 Ϯ 13 years old) with ischemia in the middle cerebral artery (MCA) territory, lesion volumetry was performed on parametric maps of the time-to-peak, the cerebral blood volume, and diffusion-weighted (DW) images. The infarct lesions were assessed on follow-up T2-weighted (T2W) MR images after eight days. Cerebrovascular changes were determined by time-of-flight (TOF) MR angiography (MRA). Inferential and correlation statistics were used. Results:Patients with chronic ischemic brain disease (N ϭ 39) who presented with a severe perfusion-diffusion mismatch in the presence of a normal cerebral blood volume had no or small brain infarctions as found on follow-up T2W images. MRA revealed widespread abnormalities of the basal cerebral arteries compatible with brain perfusion abnormalities. In contrast, in acute stroke patients (N ϭ 14) the deficit of cerebral perfusion predicted the infarct lesion in the T2W images. Conclusion:Our results suggest that in chronic cerebral ischemia the normal blood volume was maintained despite the depression of cerebral perfusion and recurring minor insults.

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Carotid surgery in acute symptomatic patients

Abstract: clinical decision-making based on stratified diagnostic workup by means of extra- and intracranial as well as intracerebral hemodynamics using new imaging techniques may select patients who will benefit more from urgent surgery than from conservative management.

Cited by 55 publications

References 33 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Patients With Ischemic Stroke

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

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