Safety of Early Carotid Artery Stenting after Systemic Thrombolysis: A Single Center Experience

Sallustio, Fabrizio; Koch, Giacomo; Rocco, Alessandro Di; Rossi, Costanza; Pampana, Enrico; Gandini, Roberto; Meschini, Alessandro; Diomedi, Marina; Stanzione, Paolo; Legge, Silvia Di

doi:10.1155/2012/904575

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…As the outcome is exacerbated by hemorrhage, even if recanalization can be achieved, we used antiplatelet agents after confirming the narrowness of the infarct area by pretreatment MRI and maintained the blood pressure low after treatment, 16) to avoid hemorrhagic complications. There has also been a report of cases in which an uneventful course without hemorrhagic complications could be obtained by performing CAS with dual-antiplatelet therapy using 100 mg aspirin and 75 mg clopidogrel following intravenous thrombolysis with rt-PA. 17) Many patients with VA or BA occlusion treated at our hospital showed satisfactory outcomes. Particularly, all the five patients with atherothrombotic brain infarction showed favorable outcomes, with the mRS score after 3 months being ≤2 in three and remaining unchanged at three from before treatment in two patients.…”

Section: Discussionmentioning

confidence: 77%

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

Kakumoto

Sankoda

Kin

et al. 2018

JNET

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Objective: While intracranial mechanical thrombectomy has been established as a treatment, atherothrombotic brain infarction due to stenosis of major cerebral arteries is occasionally difficult to treat as severe stenosis persists after recanalization, eventually requiring percutaneous transluminal angioplasty (PTA) or stent placement. The contents and results of mechanical thrombectomy for atherothrombotic brain infarction that we have encountered are presented. Methods:The subjects were 17 patients diagnosed with atherothrombotic brain infarction among the 99 patients with cerebral infarction accompanied by major intracranial artery occlusion treated at our hospital during the 30 months from January 2014 and June 2016. Recanalization graded as Thrombolysis in Cerebral Infarction (TICI) 2b or higher was regarded as effective, and the outcome was evaluated using the modified Rankin Scale (mRS). Results:The responsible lesion was located at the origin of the internal carotid artery (ICA) in three patients, in the ICA siphon in four patients, middle cerebral artery (MCA) in five patients, vertebral artery (VA) in two patients, and basilar artery (BA) in three patients. Effective recanalization was achieved in 82.4%, the mRS score was 0-2 in 52.9%, and the postoperative mRS score was the same as before treatment in 11.8%. Conclusion:The outcome of intracranial mechanical thrombectomy for atherothrombotic brain infarction accompanied by major intracranial artery stenosis was favorable in many patients, and aggressive treatment is considered recommendable. In addition, safe and appropriate execution of additional treatments for residual stenotic lesions leads to favorable outcomes.

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Section: Discussionmentioning

confidence: 77%

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

Kakumoto

Sankoda

Kin

et al. 2018

JNET

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“…Early results from five cases were encouraging with no hemorrhagic transformation [171] and were reproduced in another series of 10 patients [172]. Safety of revascularization has been also reported with CAS in six patients [173]. However, in a case series of 12 AIS patients that were submitted to CEA urgently 1 --16 days post-AIS, one patient (8%) presented symptomatic hemorrhagic transformation after CEA that had been performed 33 h after the index event [174].…”

Section: Patients With Symptomatic Carotid Artery Stenosis Scheduled mentioning

confidence: 68%

Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions

Tsivgoulis

Safouris

Alexandrov

2015

Expert Opinion on Drug Safety

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The present narrative review summarizing 20 years of clinical experience with IVT for AIS highlights that many of the current guidelines and protocols should be adjusted to accommodate recent data from registries and real-world experience underscoring the safety of IVT in numerous conditions of AIS that were originally considered as relative or absolute contraindications for administration of IV-tPA.

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“…The SAPPHIRE 98, 99 and CREST 79 studies included both symptomatic and asymptomatic patients at high or conventional risk for surgery. The results of these studies do not clearly demonstrate the superiority of endarterectomy or of stenting, the decision belonging to the treating physician, adapted to the particularity of the case [2].…”

Section: Discussionmentioning

confidence: 80%

“…thrombolysis, 6 of whom had after thrombolysis carotid stenosis >/<70% and ulcerated/unstable atherosclerotic plaques. Stenting was performed very early but after the first 24 hours, and follow up at 3, 6, and 12 months revealed stent patency and favorable course, except for one patient who suffered another stroke after four months, associated with an episode of paroxysmal fibrillation, and not due to the instability of atherosclerotic plaques [2].…”

Section: Discussionmentioning

confidence: 99%

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Recurrence of embolism post intravenous thrombolysis on an asymptomatic bilateral carotid stenosis

Secară¹,

Vulpoi²,

Cuciureanu³

et al. 2017

Arch Clin Cases

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Atherosclerosis is the most common cause of stroke and patients with stroke due to large-vessel atherosclerosis are at the highest risk of recurrent stroke. Carotid endarterectomy (CEA) is a secondary prevention method for reducing the risk of stroke, but endovascular therapy has developed rapidly in recent years. The long-term therapeutic efficacy of endovascular stenting for carotid artery stenosis has been shown not to be inferior to CEA. We present the case of a 61-year-old female, smoker, dyslipidemic, hypertensive, therapeutically neglected, who suddenly developed right hemiplegia accompanied by central facial palsy and motor aphasia. The inclusion criteria allowed the initiation of intravenous thrombolytic therapy. At 2 and 24 hours after thrombolysis the evolution was favorable with the almost complete recovery of motor and speech production deficits. At 48 hours after thrombolysis, the patient experienced rapid decompensation and worsening, with recurrence of hemiplegia on the same side and motor aphasia. Cervical echoDoppler and cerebro-cervical CT angiography (CTA) revealed a complete right internal carotid artery (ICA) and quantified the degree of left ICA stenosis asymptomatic up to that time. The case was a challenge in terms of subsequent secondary prevention. Although most studies dealt with endarterectomy as a treatment for tight carotid stenosis, in the here reported case this was not possible, so we had to resort to angioplasty with placement of a self-expandable stent in the left ICA.

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Safety of Early Carotid Artery Stenting after Systemic Thrombolysis: A Single Center Experience

Cited by 12 publications

References 11 publications

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions

Recurrence of embolism post intravenous thrombolysis on an asymptomatic bilateral carotid stenosis

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