Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion

Oka, Fumiaki; Ishihara, Hideyuki; Kato, Shoichi; Oku, Takayuki; Yamane, Akiko; Kunitugu, Ichiro; Suzuki, Michiyasu

doi:10.1016/j.jvs.2013.05.103

Cited by 28 publications

(25 citation statements)

References 30 publications

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“…1,2,4,6,[9][10][11][12][13][14][15][16][17][18][19][20]28,31,45,[47][48][49][50][51]55,59,60,62,64,68,69,71,72 Pseudo-Occlusion. The term "pseudo-occlusion" was used for cases with raised intracranial pressure by Newton and Couch in 1960.…”

Section: Figmentioning

confidence: 99%

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Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Johansson

Fox

2015

AJNR Am J Neuroradiol

105

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SUMMARY:Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis. ABBREVIATION: ECA ϭ external carotid artery

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Section: Figmentioning

confidence: 99%

“…28,35 It seems that these measured criteria transfer the diagnosis of near-occlusion from a skilled interpretation to synthesized numbers applied without the same skill.…”

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confidence: 99%

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Johansson

Fox

2015

AJNR Am J Neuroradiol

105

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confidence: 96%

“…15 Before carotid stenting, 20% (3/15) of those with near-occlusions had Ͼ10% blood flow increase with acetazolamide; after carotid stenting, 100% (15/15) had Ͼ10% increase. 15 Some studies included measurements of intracerebral hemodynamics, without analyzing them in detail. [16][17][18][19] • Near-occlusion with full collapse (diagnosed with low-flow velocities on sonography) and high-grade stenosis cause similar infarction patterns with approximately half of patients having infarctions in watershed areas, though occlusions often have large territorial infarctions.…”

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confidence: 96%

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Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Johansson¹,

Fox²

2015

AJNR Am J Neuroradiol

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SUMMARY:In Part 1 of this review, the definition, terminology, and diagnosis of carotid near-occlusion were presented. Carotid nearocclusions (all types) showed a lower risk of stroke than other severe stenoses. However, emerging evidence suggests that the nearocclusion prognosis with full collapse (higher risk) differs from that without full collapse (lower risk). This systematic review presents what is known about carotid near-occlusion. In this second part, the foci are prognosis and treatment, pathophysiology, the current confusion about near-occlusion, and areas in need of future improvement.ABBREVIATIONS: ARR ϭ absolute risk reduction; CCA ϭ common carotid artery; ECA ϭ external carotid artery; PCA ϭ posterior cerebral artery; ECST ϭ European

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Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

Meershoek¹,

Vries²,

Veen

et al. 2019

British Journal of Surgery

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Background Guidelines recommend treating patients with an internal carotid artery near occlusion (ICANO) with best medical therapy (BMT) based on weak evidence. Consequently, patients with ICANO were excluded from randomized trials. The aim of this individual‐patient data (IPD) meta‐analysis was to determine the optimal treatment approach. Methods A systematic search was performed in MEDLINE, EMBASE and the Cochrane Library databases in January 2018. The primary outcome was the occurrence of any stroke or death within the first 30 days of treatment, analysed by multivariable mixed‐effect logistic regression. The secondary outcome was the occurrence of any stroke or death beyond 30 days up to 1 year after treatment, evaluated by Kaplan–Meier survival analysis. Results The search yielded 1526 articles, of which 61 were retrieved for full‐text review. Some 32 studies met the inclusion criteria and pooled IPD were available from 11 studies, including some 703 patients with ICANO. Within 30 days, any stroke or death was reported in six patients (1·8 per cent) in the carotid endarterectomy (CEA) group, five (2·2 per cent) in the carotid artery stenting (CAS) group and seven (4·9 per cent) in the BMT group. This resulted in a higher 30‐day stroke or death rate after BMT than after CEA (odds ratio 5·63, 95 per cent c.i. 1·30 to 24·45; P = 0·021). No differences were found between CEA and CAS. The 1‐year any stroke‐ or death‐free survival rate was 96·1 per cent for CEA, 94·4 per cent for CAS and 81·2 per cent for BMT. Conclusion These data suggest that BMT alone is not superior to CEA or CAS with respect to 30‐day or 1‐year stroke or death prevention in patients with ICANO. These patients do not appear to constitute a high‐risk group for surgery, and consideration should made to including them in future RCTs of internal carotid artery interventions.

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Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion

Abstract: Before CAS, patients with NO were more hemodynamically compromised than those with severe stenosis without NO. After CAS, significant cerebral hemodynamic improvement and normalization occurred long-term. Thus, from a hemodynamic perspective, CAS was effective in patients with NO.

Cited by 28 publications

References 30 publications

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion

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