Clinical and hemodynamic aspects of low-flow infarcts.

Weiller, Cornelius; Ringelstein, E. B.; Reiche, W.; Buell, Udalrich

doi:10.1161/01.str.22.9.1117

Cited by 115 publications

(90 citation statements)

References 27 publications

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“…40 However, in patients with ICA occlusion and contralateral ICA stenosis, cerebral hemodynamics may be more disturbed, and higher risks of ischemic stroke have been reported for both symptomatic and asymptomatic patients. 2,3,41,42 A number of studies have shown that contralateral CEA in patients with ICA occlusion has a long-term effect on prevention of stroke on the side of endarterectomy and on the side of ICA occlusion, which is explained by improvement of cerebral hemodynamics on the side of ICA occlusion; however, among these studies, only the NASCET study was a randomized trial. 5,6,41,43,44 After CAS, a similar improvement was seen in our patients and in previous studies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Oka

Ishihara

Kato

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:CEA contralateral to an ICA occlusion is considered a surgical risk, and CAS may be an alternative for these patients. Our goal was to examine whether CAS improves cerebral hemodynamics on the treated side and on the side of the ICA occlusion, on the basis of measurement of CBF and CVR by using SPECT. The subjects were 8 patients who underwent contralateral CAS. Resting CBF and CVR to acetazolamide were measured by using 123 I-IMP SPECT before and chronically (3-6 months) after CAS. Resting CBF was also measured immediately (Ͻ2 hours) after CAS by using 123 I-IMP SPECT. There were no significant differences in resting CBF in both hemispheres

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Section: Discussionmentioning

confidence: 99%

“…1 Severe stenosis in contralateral ICA occlusion may further impair cerebral hemodynamics and increase the risk of cerebral ischemic attack. 2,3 CEA of the carotid stenosis is often performed in such patients, and this procedure may have hemodynamic benefits. [4][5][6] However, CEA for patients with contralateral ICA occlusion also has a high surgical risk.…”

mentioning

confidence: 99%

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Oka

Ishihara

Kato

et al. 2012

AJNR Am J Neuroradiol

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“…16 Decrease in CBF has been implicated in the pathogenesis of neurodegenerative disorders such as dementia and certain cerebrovascular events such as low-flow infarcts. 17,18 A recent study showed that lower total CBF is an independent risk factor for mortality and adverse clinical outcomes in patients with heart failure. 19 However, little is known about the independent role of CBF in the maintenance of health and survival in older people.…”

Section: Resultsmentioning

confidence: 99%

Total cerebral blood flow and mortality in old age

et al. 2013

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Objective: To examine the association of total cerebral blood flow (CBF) with all-cause, noncardiovascular, and cardiovascular mortality in older subjects at risk of cardiovascular disease. Methods:We included 411 subjects with a mean age of 74.5 years from the MRI substudy of the Prospective Study of Pravastatin in the Elderly at Risk. Total CBF was measured at baseline, and occurrence of death was recorded in an average follow-up period of 11.8 years. For each participant, total CBF was standardized for brain parenchymal volume. Cox regression models were used to estimate risk of all-cause, noncardiovascular, and cardiovascular mortality in relation to CBF.Results: Mortality rates among participants in low, middle, and high thirds of total CBF were 52.1, 41.5, and 28.7 per 1,000 person-years, respectively. Compared with participants in the high third of CBF, participants in the low third had 1.88-fold (95% confidence interval [CI]: 1.30-2.72) higher risk of all-cause mortality, 1.66-fold (95% CI: 1.06-2.59) higher risk of noncardiovascular mortality, and 2.50-fold (95% CI: 1.28-4.91) higher risk of cardiovascular mortality. Likewise, compared with participants in the high third of CBF, participants in the middle third had 1.44-fold (95% CI: 0.98-2.11) higher risk of all-cause mortality, 1.29-fold (95% CI: 0.82-2.04) higher risk of noncardiovascular mortality, and 1.86-fold (95% CI: 0.93-3.74) higher risk of cardiovascular mortality. These associations were independent of prevalent vascular status and risk factors. Structural and functional integrity of the brain depends on adequate supply of nutrients and oxygen through blood flow. 1 The brain is a demanding organ and consumes approximately 20% of the oxygen inspired at rest while accounting for only 2% of the body weight. 2 This high metabolic demand renders the brain tissue vulnerable to low cerebral blood flow (CBF), as several animal studies have shown that long-standing cerebral hypoperfusion leads to neuronal loss, microvascular abnormalities, and cognitive deficit. 3,4 Decreased cerebral perfusion in patients with acute traumatic brain injury and cerebrovascular accidents has been linked to adverse clinical outcomes and shorter survival. 5,6 Likewise, clinical conditions with a state of chronic reduction in CBF, such as heart failure and carotid stenosis, have been associated with an increased risk of mortality. 7,8 Despite this evidence, the independent role of CBF in the maintenance of health and survival in old age has not been thoroughly investigated.

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“…Fuchs et al (2002) showed that stroke after PCI affects mainly elderly patient with risk factors for atherosclerosis. Cerebral hemodynamic impairment in these patients would increase the risk of ischemic disease secondary to reduced flow (Weiller et al, 1991;Miyazava et al, 2001), which may be additionally compromised by systemic hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

Posterior Cerebrovascular Accidents After Percutaneous Coronary Intervention

Quattrocchi¹,

Alexandre²,

Scarciolla³

et al. 2014

American Medical Journal

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Percutaneous Coronary Interventional procedures (PCIs) are recognised as gold standard treatment for high risks patients with diffuse coronary atherosclerosis. Neurologic complications are one of the most dreaded procedural outcomes, stroke after PCI affects mainly elderly and high-risk patients (age more than 80 years and use of intra-aortic balloon pump), with longer times of the procedure and angiographic complications, such as dissection, abrupt closure and no reflow. We report two consecutive cases of posterior CVAs after percutaneous coronary procedures involving the ponto-mesencephalon and the cerebellum. Especially when risk factors are present, careful attention should be devoted to the preparation of the patient and to minimize catheter manipulation and exchanges.

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Clinical and hemodynamic aspects of low-flow infarcts.

Cited by 115 publications

References 27 publications

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Total cerebral blood flow and mortality in old age

Posterior Cerebrovascular Accidents After Percutaneous Coronary Intervention

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