Treatment Strategies for Acute Ischemic Stroke Caused by Carotid Artery Occlusion

Li, Wei; Yin, Qin; Xu, Gelin; Liu, Xinfeng

doi:10.1159/000445304

Cited by 1,736 publications

(22 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to the literature, there are several studies with different treatment combinations for acute strokes using ICA occlusion, and the results show that intravenous thrombolytic therapy alone achieves favorable outcomes in 0% -32.1% of patients. Meanwhile, when combined with intra-arterial therapies including thrombolysis, angioplasty, stents, stent-retrievers, and aspiration, 24% -100% have a favorable outcome, and 38% -100% have a successful reperfusion rate (9)(10)(11). Though the results of previous studies are diverse, our results are not significantly different, but we did see slightly fewer favorable outcomes.…”

Section: Discussioncontrasting

confidence: 56%

“…As a result, the IAT procedure will not be prolonged by the stenting procedure and the routine antiplatelet therapy after stenting can be avoided. This is important because an acute infarction with a large vessel occlusion is at risk for subsequent intracranial hemorrhages (9,20). Our procedure followed this concept, but we still used a balloon angioplasty to achieve a better lumen width, because proximal occlusion patency is also helpful for brain perfusion (21).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Imaging Findings of Multiphase CT Angiography of Acute Internal Carotid Artery Occlusion Within 6-Hour Time-Window After Thrombectomy and Its Clinical Implication

et al. 2020

View full text Add to dashboard Cite

Background: Intra-arterial thrombectomy (IAT) is one of the mainstream treatments for acute ischemic stroke. As relatively little evidence on extracranial internal carotid artery (ICA) occlusions exists in the literature, we share our experiences after using IAT for intracranial and extracranial ICA occlusions. We further clarify the imaging characteristics of multiphase computed tomography angiography (CTA) and share the experience of balloon angioplasty in acute ICA occlusion. Objectives: To investigate the imaging findings of multiphase CTA and the clinical conditions and outcomes of acute ICA occlusions at different segments after IAT. Patients and Methods: All participants receiving IAT for acute stroke with isolated ICA occlusions were included, obtained from three hospitals between June 2016 and November 2018. An imaging review for non-enhanced computed tomography (CT), multiphase CTA, and angiography was conducted. Epidemiological and clinical data were reviewed. Further comparisons were evaluated between the occlusion side from the C6 to C7 segments and C1 to C5 segments of the ICA. Results: The average age of the patients was 73.0 years, and the initial National Institutes of Health Stroke scale (NIHSS) score was 18.6. Nineteen percent of cases had good outcomes. Good reperfusion results were achieved in 50% of cases. Compared to the group with occlusion from C6-C7, the group with occlusion from C1-C5 had a relatively good Alberta Stroke Program Early CT score (ASPECTS) in the A1 phase of the multiphase CTA, and more patients had a good collateral. Three cases received a balloon angioplasty for a concurrent proximal cervical ICA tight stenosis, and all cases had good reperfusion results. Conclusion: Distal occlusion of the ICA demonstrates lower ASPECTS and a worse collateral on multiphase CTA. A multiphase CTA with an extended scan range in the A2 and A3 phases is able to exclude pseudo-occlusion of the ICA. Balloon angioplasty is helpful for concurrent proximal cervical ICA tight stenosis.

show abstract

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Imaging Findings of Multiphase CT Angiography of Acute Internal Carotid Artery Occlusion Within 6-Hour Time-Window After Thrombectomy and Its Clinical Implication

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Treatment of ischemic stroke produced by ICA occlusion is not different from treatment of any ischemic stroke, but the prognosis after intravenous thrombolysis treatment seems to be unfavorable at 3 months (21). The natural history of strokes induced by ICA occlusion showed good recovery in only 2-12% of patients and important disability in 40-69% of patients (17,22), as measured by modified Rankin Scale (mRS) (8). Unfavorable outcome with 75% rate of death and disability after 1,2 years of follow up have also been reported in ICA occlusion strokes (23).…”

Section: Resultsmentioning

confidence: 99%

Functional outcome after symtomatic internal carotid artery occlusion

Stănescu

Bulboacă

Fodor

et al. 2019

BALNEO

View full text Add to dashboard Cite

Internal carotid artery occlusion accounts for 15-20% of ischemic strokes, caused by atherosclerosis or dissection. Clinical symptoms are variable, from asymptomatic cases to minor or severe strokes. Diagnosis in internal carotid artery (ICA) occlusion is based on imaging techniques. Prognosis after ICA occlusion depends on many factors: severity of neurologic deficit, spontaneous recanalization of the artery, and the occurrence of recurrent strokes. Patients with spontaneous recanalization of the occluded ICA tend to have a retained functional ability and favorable clinical outcomes. Medical treatment, recanalization techniques and intensive rehabilitation program are essential in improving functional outcome of patients with stroke produced by ICA occlusion. We present the case of a young patient diagnosed with ischemic stroke produced by internal carotid artery occlusion, with consecutive severe neurologic deficit, and an unfavorable functional outcome, as evaluated with the Modified Rankin Scale. Spontaneous recanalization of the occluded ICA was observed after 6 weeks, suggesting a carotid dissection. The patient was included in an intensive rehabilitation program, associated with best medical therapy, showing improvement of its functional status at 3 months follow up. Key words: ischemic stroke, carotid artery occlusion, carotid dissection, spontaneous recanalization, functional outcome,

show abstract

“…(2,3) Those pathological associations with synergic effect on the development of atherosclerosis on large vessels results in current strategies of curative treatment and secondary prevention of ischemic stroke. (4,5) For the secondary prevention of ischemic stroke, the last guide of Romanian Society of Neurology (after ESO GUIDE 2008) specifies (recommendations Class I Level A):  It is recommended for patients to receive antithrombotic/antiplatelet therapy; …”

Section: Discussionmentioning

confidence: 99%

Carotid Atherosclerotic Disease and Risk Factors in Patients with Ischemic Stroke – Study Report –

Mutu

Cerei

2019

Acta Medica Transilvanica

View full text Add to dashboard Cite

Ischemic stroke (IS) is the second frequent vascular disease after myocardial infarction, with different clinical and etiological aspects and various risk factors. Large vessel atherosclerotic disease is the most frequent IS causing pathology, followed by cerebral microangiopathy and cardioembolic events. Cervical arteries Doppler ultrasonography helps identifying the subtype of IS, and by revealing the vascular status of the patient, guides the therapeutic decision and secondary IS prevention. The aim of this paper is to present the results of an observational, retrospective, analytical study on a number of 174 patients with acute IS evaluated by Doppler carotid ultrasound in CVASIC Research Centre of Academic Emergency Hospital of Sibiu from January to December 2018. Materials and methods: All patients with IS admitted in our centre received a Doppler carotid ultrasound evaluation. We observed the degree of carotid stenosis, presence of atherosclerotic risk factors and their influence. Results: The mean age of patients was 71.3 years (36 to 92 years range). 16 (9.19%) patients presented occlusion of internal carotid artery (ICA) on the same side as stroke, 37 (21.26%) had severe carotid stenosis (>70%), 31 (17.81%) presented moderate stenosis (50-70%), the remaining patients had mild or no stenosis. 129 (74,13%) patients presented arterial hypertension, 51 (29.31%) patients had diabetes mellitus, 14 (8.04%) were smokers, 81 (46.56%) had dyslipidemia. Conclusions: A large number of patients had severe carotid stenosis and occlusion. The most common risk factor was arterial hypertension, followed by dyslipidemia and diabetes mellitus. Continuous medical education of population at risk regarding good nutrition principles and healthy lifestyle are needed to reduce the social costs of ischemic stroke.

show abstract

Treatment Strategies for Acute Ischemic Stroke Caused by Carotid Artery Occlusion

Cited by 1,736 publications

References 40 publications

Imaging Findings of Multiphase CT Angiography of Acute Internal Carotid Artery Occlusion Within 6-Hour Time-Window After Thrombectomy and Its Clinical Implication

Imaging Findings of Multiphase CT Angiography of Acute Internal Carotid Artery Occlusion Within 6-Hour Time-Window After Thrombectomy and Its Clinical Implication

Functional outcome after symtomatic internal carotid artery occlusion

Carotid Atherosclerotic Disease and Risk Factors in Patients with Ischemic Stroke – Study Report –

Contact Info

Product

Resources

About