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Successful Emergency Carotid Endarterectomy after Thrombolysis with Intravenous Recombinant Tissue-Type Plasminogen Activator.
Authors: Yamamoto Y, Okazaki T, Yoda K, Tada Y, Nagahiro S Abstract Acute internal carotid artery (ICA) occlusion may result in severe disability or death. Revascularization by carotid artery stenting after treatment with intravenous (iv) recombinant tissue-type plasminogen activator (rt-PA) has been documented. However, there are few reports on emergency carotid endarterectomy (CEA) within 24 hours after the iv administration of rt-PA. We treated a 58-year-old man with right ICA occlusion with iv rt-PA. Although partial recanalization of the ICA was obtained, severe stenosis at the origin of the ICA persisted and ...
Source: Journal of Medical Investigation - September 21, 2016 Category: Journals (General) Tags: J Med Invest Source Type: research

Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting
AbstractCerebral hyperperfusion is a relatively rare syndrome with significant and potentially preventable clinical consequences. The pathophysiology of cerebral hyperperfusion syndrome (CHS) may involve dysregulation of the cerebral vascular system and hypertension, in the setting of increase in cerebral blood flow. The early recognition of CHS is important to prevent complications such as intracerebral hemorrhage. This review will focus on CHS following carotid endarterectomy and carotid artery stenting. We will discuss the typical clinical features of CHS, risk factors, pathophysiology, diagnostic modalities for detecti...
Source: Experimental and Translational Stroke Medicine - September 6, 2016 Category: Neurology Source Type: research

Carotid artery stenosis with a high-intensity signal plaque on time-of-flight magnetic resonance angiography and association with evidence of intraplaque hypoxia.
CONCLUSIONS Plaques with high-intensity signals on TOF MRA were associated with IPH and evidence of intraplaque hypoxia. This fact may represent an opportunity to establish novel therapeutic agents targeting intraplaque hypoxia. PMID: 27367236 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - June 30, 2016 Category: Neurosurgery Authors: Ogata A, Kawashima M, Wakamiya T, Nishihara M, Masuoka J, Nakahara Y, Ebashi R, Inoue K, Takase Y, Irie H, Abe T Tags: J Neurosurg Source Type: research

Leptomeningeal collateral vessels are a major risk factor for intracranial hemorrhage after carotid stenting in patients with carotid atherosclerotic plaque
Conclusions Leptomeningeal collateral vessels are a major risk factor for ICH after CAS in patients with carotid atherosclerotic plaque.
Source: Journal of NeuroInterventional Surgery - April 13, 2016 Category: Neurosurgery Authors: Lee, K. J., Kwak, H. S., Chung, G. H., Song, J. S., Hwang, S. B. Tags: Hemorrhagic stroke Source Type: research

Unusual Intersection: Elucidating the Role of Erdheim Chester Disease in Stroke (P4.366)
Conclusion:A unifying diagnosis of ECD was identified for this gentleman presenting with a stroke in the setting of critical ICA stenosis. Pathology from his CEA suggests that while ECD involves multisystem inflammation, it did not appear to play a direct role in his stroke.Disclosure: Dr. Sheikhi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Sheikhi, L. Tags: Cerebrovascular Case Reports Source Type: research

Carotid stenting and endarterectomy
Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS.
Source: International Journal of Cardiology - March 28, 2016 Category: Cardiology Authors: Hon-Kan Yip, Pei-Hsun Sung, Chiung-Jen Wu, Cheuk-Man Yu Tags: Review Source Type: research

Very Early Carotid Endarterectomy After Intravenous Thrombolysis.
CONCLUSION: This experience suggests that very early CEA after thrombolysis, aimed at removing the source of potential embolisation and restoring blood flow, may be safe and can lead to a favourable outcome. PMID: 26712132 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - December 19, 2015 Category: Surgery Authors: Azzini C, Gentile M, De Vito A, Traina L, Sette E, Fainardi E, Mascoli F, Casetta I Tags: Eur J Vasc Endovasc Surg Source Type: research

Safety and efficiency of ultrasound-guided intermediate cervical plexus block for carotid surgery
Conclusions The present work reports our first 50 cases of intermediate CPB using ultrasound guidance. The results underline that this technique is easy to perform, safe and reliable, provided good surgical conditions with continuous intraoperative neurologic monitoring and stable haemodynamics are respected.
Source: Anaesthesia, Critical Care and Pain Medicine - December 6, 2015 Category: Anesthesiology Source Type: research

High-Intensity Signal in Carotid Plaque on Routine 3D-TOF-MRA Is a Risk Factor of Ischemic Stroke
Background: Carotid atherosclerotic disease is recognized as an important risk factor for brain ischemic events. However, high-grade stenosis does not always cause ischemic strokes, whereas moderate-grade stenosis may often cause ischemic strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new cerebral ischemic events. The purpose of this study was to elucidate the relationship between high-intensity signals (HIS) on maximum intensity projection (MIP) images from routine 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and prior ischemic stroke...
Source: Cerebrovascular Diseases - November 18, 2015 Category: Neurology Source Type: research

A case of atraumatic convexal subarachnoid haemorrhage due to unusual cause
Conclusions This case shows that ICA stenosis can cause convexal SAH and it should therefore be added to the differential diagnosis of atraumatic SAH. The association is under recognised and can be missed due to the unusual location of the blood and failure to image the extra cranial carotid arteries.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 14, 2015 Category: Neurosurgery Authors: Zaidi, S., Agrawal, A., Davey, R. Tags: Neuroimaging, Stroke, Radiology, Radiology (diagnostics) Thur 21, Parallel session 5: Therapeutics Source Type: research

Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke
Carotid intervention shortly after an acute neurologic ischemic event is being performed more frequently in stroke centers to reduce the risk of recurrent stroke. Thrombolysis with recombinant tissue plasminogen activator (tPA) is offered to select patients with ischemic stroke symptoms who present within 4.5 hours. However, there is a paucity of data as to whether tPA followed by urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS) has an increased risk of complications, particularly intracerebral hemorrhage (ICH).
Source: Journal of Vascular Surgery - September 24, 2015 Category: Surgery Authors: Hernan A. Bazan, Nicolas Zea, Bethany Jennings, Taylor A. Smith, Gabriel Vidal, W. Charles Sternbergh Tags: Clinical Paper Source Type: research

Definite Plaque Echolucency is Associated with a Higher Risk of Ipsilateral Ischaemic Stroke during Early Follow up in the Asymptomatic Carotid Surgery Trial-1 (ACST-1)
Introduction: Several carotid plaque characteristics, including a thin fibrous cap, lipid necrotic core and intraplaque haemorrhage, have been suggested as potential markers to select patients at high risk for future stroke. On ultrasound, these “high risk” characteristics appear echolucent. The Asymptomatic Carotid Surgery Trial-1 (ACST-1) is the largest randomised controlled trial comparing carotid endarterectomy (CEA) with deferral of CEA in patients with severe asymptomatic carotid artery stenosis.
Source: European Journal of Vascular and Endovascular Surgery - August 25, 2015 Category: Surgery Authors: A. Huibers, G.J. de Borst, R. Bulbulia, A. Halliday, ACST-1 Collaborative Group Source Type: research

Dual Antiplatelet Therapy Prior to Expedited Carotid Surgery Reduces Recurrent Events Prior to Surgery without Significantly Increasing Peri-operative Bleeding Complications.
CONCLUSION: Early introduction of dual antiplatelet therapy was associated with a significant reduction in recurrent neurological events and spontaneous embolization prior to CEA, without incurring a significant increase in major peri-operative bleeding complications. PMID: 26283034 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - August 14, 2015 Category: Surgery Authors: Batchelder A, Hunter J, Cairns V, Sandford R, Munshi A, Naylor AR Tags: Eur J Vasc Endovasc Surg Source Type: research

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.
Abstract Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniq...
Source: Journal of Neurosurgery - July 31, 2015 Category: Neurosurgery Authors: Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G Tags: J Neurosurg Source Type: research

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