Early Clinical Signs, Lesion Localization, and Prognostic Factors in Unilateral Symptomatic Internal Carotid Artery Occlusion

Güler, Sibel; Utku, Ufuk; Aynaci, Ozer

doi:10.1016/j.jstrokecerebrovasdis.2014.02.009

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Especially, the decrease of BFV in PcoA group was more apparent than that in AcoA group, suggesting collateral circulation through the AcoA may provide a better compensation for the impaired cerebral perfusion. However, Gfusi et al proposed that collateral circulation through PcoA to be important for cerebral perfusion because the absence of PcoA collaterals was found to be associated with poor prognosis [21]. Thus, we also speculate collateral circulation through the PcoA may be necessary in the absence of AcoA collaterals.…”

Section: Discussionmentioning

confidence: 57%

“…In SCWT C, subjects needed to suppress the habitual response to the meaning of the words and shift their attention to its incongruent color. The incongruent task in Stroop requires response inhibition, which may be linked with anterior cingulate gyrus [21]. Better performance in SCWT requires more blood flow in frontal lobe [31], and worse performance in patients with ICA stenosis may be explained due to the altered blood flow.…”

Section: Discussionmentioning

confidence: 99%

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Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

Wei

Ruan

et al. 2019

BMC Neurol

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Background: This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. Methods: One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. Results: On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. Conclusions: Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

Wei

Ruan

et al. 2019

BMC Neurol

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“…14,18 Outcome Among patients who undergo endovascular treatment, discrepancies exist between successful recanalization of the occluded artery and functional recovery. 43,44 Other investigators have also reported that a significant proportion of patients with successful recanalization continue to have severe neurologic deficits.…”

Section: Re-angioplastymentioning

confidence: 99%

Acute Carotid Stent Thrombosis

Moulakakis

Mylonas

Lazaris

et al. 2016

Vasc Endovascular Surg

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Acute carotid stent thrombosis (ACST) is a rare complication that can lead to dramatic and catastrophic consequences. A rapid diagnosis and prompt recanalization of the internal carotid artery are needed to minimize the ischemic insult and the reperfusion injury. We reviewed the current literature on this devastating complication of CAS with the intention of investigating the potential causative factors and to define the appropriate management. According to our study discontinuation of antiplatelet therapy, resistance to antiplatelet agents and inherent or acquired thrombotic disorders are the main causes of thrombosis. Technical intraprocedural parameters such as dissection, atheroma prolapse, kinking of the distal part of internal carotid artery and embolic protection device occlusion can also result in early carotid stent thrombosis. Rapid reperfusion ensures an improved neurological outcome and a better prognosis in the short and long term. Thrombolysis, mechanical thrombectomy or thromboaspiration in combination with drug or thrombolytic therapy, surgical therapy and re-angioplasty are treatment options that have been used with encouraging results. In conclusion, optimal perioperative antiplatelet treatment as well as technical considerations regarding the carotid artery stenting plays a determinant role.

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“…In particular, among patients with chronic occlusion of the internal carotid artery or arteries, failure of collateralization may contribute to hemodynamic compromise and increased risk of stroke or transient ischemic attacks (TIA) 4, 5 . In addition, an absence of collateral circulation in the middle cerebral artery (MCA) is associated with a poor prognosis in symptomatic unilateral carotid occlusion 6 . Furthermore, patients with metabolic syndromes are associated with poor anatomical collateral status during acute ischemic stroke 7 .…”

Section: Introductionmentioning

confidence: 99%

Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice

Nishijima¹,

Akamatsu

Yang

et al. 2016

Stroke

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BACKGROUND AND PURPOSE The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack (TIA) in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status, it is unclear whether and to what extent type 2 diabetes (T2DM) affects cerebral collateral flow regulation during hypoperfusion. METHODS We examined the spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal MCA and ACA branches over two weeks following unilateral common carotid artery occlusion (CCAO) using optical coherent tomography in db/+ and db/db mice. We also assessed the temporal adaptation of the circle of Willis (CW) following CCAO by measuring CW vessel diameters. RESULTS Following unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared to db/+ mice, which coincided with a reduced dilation of distal ACA branches, leading to reduced flow not only in pial vessels, but also in penetrating arterioles bordering the distal MCA and ACA. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the CW, in addition to a delayed post-CCAO adaptive response by one to two weeks compared to db/+ mice. CONCLUSIONS T2DM is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or TIA.

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Early Clinical Signs, Lesion Localization, and Prognostic Factors in Unilateral Symptomatic Internal Carotid Artery Occlusion

Cited by 8 publications

References 19 publications

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

Acute Carotid Stent Thrombosis

Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice

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