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1.
Ann Intern Med ; 174(6): JC62, 2021 06.
Article in English | MEDLINE | ID: covidwho-1841673

ABSTRACT

SOURCE CITATION: U.S. Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for asymptomatic carotid artery stenosis: US Preventive Services Task Force recommendation statement. JAMA. 2021;325:476-81. 33528542.


Subject(s)
Carotid Stenosis , Adult , Advisory Committees , Carotid Stenosis/diagnostic imaging , Humans , Mass Screening , Preventive Health Services
3.
J Vasc Surg ; 75(5): 1670-1678.e2, 2022 05.
Article in English | MEDLINE | ID: covidwho-1568903

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the impact of the COVID-19 pandemic on the trends of carotid revascularization (endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS]) for symptomatic and asymptomatic carotid stenosis before, during, and after the end of the first lockdown in 2020 in France. METHODS: Nationwide data were provided by the French National Hospital Discharge database (Programme de Médicalisation des Systèmes d'Information). We retrospectively analyzed patients admitted for CEA or TFCAS in all French public and private hospitals during a 9-month period (January-September) in 2017, 2018, 2019, and 2020. Procedures were identified using the French Common Classification of Medical Procedures. Stenoses were considered symptomatic in the presence of stroke and/or transient ischemic attack codes (according to the International Classification of Diseases-Tenth Revision) during the stay, and asymptomatic in the absence of these codes. Hospitalization rates in 2020 were compared with the rates in the same period in the 3 previous years. RESULTS: Between January and September 2020, 12,546 patients were hospitalized for carotid artery surgery (CEA and TFCAS) in France. Compared with the 3 previous years, there was a decrease in hospitalization rates for asymptomatic (-68.9%) and symptomatic (-12.6%) CEA procedures in April, starting at the pandemic peak concomitant with the first national lockdown. This decrease was significant for asymptomatic CEA (P < .001). After the lockdown, while CEA for asymptomatic stenosis returned to usual activity, CEA for symptomatic stenosis presented a significant rebound, up 18.52% in August compared with previous years. Lockdown also had consequences on TFCAS procedures, with fewer interventions for both asymptomatic (-60.53%) and symptomatic stenosis (-16.67%) in April. CONCLUSIONS: This study demonstrates a severe decrease for all interventions during the first peak of the COVID-19 pandemic in France. However, the trends in the postlockdown period were different for the various procedures. These data can be used to anticipate future decisions and organization for cardiovascular care.


Subject(s)
COVID-19 , Carotid Stenosis , Endarterectomy, Carotid , Endovascular Procedures , Stroke , COVID-19/epidemiology , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Carotid Stenosis/therapy , Communicable Disease Control , Constriction, Pathologic/complications , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Endovascular Procedures/methods , Humans , Pandemics , Retrospective Studies , Risk Assessment , Risk Factors , Stents , Time Factors , Treatment Outcome
5.
J Stroke Cerebrovasc Dis ; 30(3): 105609, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1012468

ABSTRACT

The case of a 70-year-old male presenting an ischemic stroke related to COVID-19 infection is described. He was initially admitted to the hospital with respiratory insufficiency syndrome secondary to pneumonia caused by SARS Co2. In the next days, he developed rapid neurological deterioration characterized by drowsiness which progressed to deep coma. D-dimer was elevated. Brain CT scan showed bilateral massive ischemic stroke located in the anterior circulation, CT angiogram showed occlusion in the left internal carotid artery and the right middle cerebral artery. The deterioration of the patient continued and he subsequently died. Large vessel occlusion has been reported in COVID-19 patients, but this clinical presentation is usually unilateral. Cases of bilateral occlusion of large vessels have not been previously reported in COVID-19 patients. This report shows that bilateral massive stroke may occur in COVID-19 cases and it should be suspected in patients who show rapid neurological deterioration without focal deficits.


Subject(s)
Arterial Occlusive Diseases/etiology , COVID-19/complications , Ischemic Stroke/etiology , Aged , Brain/diagnostic imaging , COVID-19/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/etiology , Coma/etiology , Computed Tomography Angiography , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/etiology , Ischemic Stroke/diagnostic imaging , Male , Nervous System Diseases/etiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Thrombectomy
6.
World Neurosurg ; 145: 356-359, 2021 01.
Article in English | MEDLINE | ID: covidwho-850856

ABSTRACT

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, a rapid screening method for COVID-19 detection is needed to decide the appropriate strategy to treat stroke patients. In acute ischemic stroke treatment, the efficacy and safety of emergent carotid artery stenting (eCAS) for hyperacute ischemic stroke (hAIS) due to internal carotid artery stenosis (ICS) have not been sufficiently established. CASE DESCRIPTION: A 71-year-old man with hAIS caused by severe ICS was treated via intravenous alteplase infusion. The patient underwent screening for COVID-19 by the loop-mediated isothermal amplification (LAMP) assay shortly after arrival at our institution. The LAMP result was obtained within 90 minutes, during intravenous alteplase infusion, and turned out to be negative. The symptom of hemiplegia worsened during alteplase infusion, and he, therefore, underwent eCAS after administration of aspirin (200 mg). Recanalization was achieved successfully by eCAS, and dual antiplatelet therapy and argatroban were administrated following eCAS. Hemorrhagic complications or restenosis/occlusion of the carotid artery were not observed. He was discharged without neurologic deficits 15 days following eCAS. Because of the rapid negative diagnosis for COVID-19 using the LAMP method, eCAS could be performed following standard procedures, along with infectious defense, without delay. CONCLUSIONS: This case report suggests that eCAS for hAIS due to ICS following intravenous alteplase can be an effective treatment, along with appropriate antiplatelet medication and management in select patients. During the COVID-19 pandemic, the LAMP assay for COVID-19 detection might be a suitable diagnostic strategy preceding stroke treatment because of the rapid turnaround time.


Subject(s)
COVID-19/diagnosis , Carotid Stenosis/surgery , Fibrinolytic Agents/therapeutic use , Ischemic Stroke/drug therapy , Ischemic Stroke/surgery , Molecular Diagnostic Techniques , Nucleic Acid Amplification Techniques , Stents , Tissue Plasminogen Activator/therapeutic use , Aged , Arginine/analogs & derivatives , Arginine/therapeutic use , Carotid Stenosis/complications , Carotid Stenosis/diagnostic imaging , Combined Modality Therapy , Hemiplegia/etiology , Humans , Ischemic Stroke/etiology , Magnetic Resonance Imaging , Male , Pipecolic Acids/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Sulfonamides/therapeutic use , Tomography, X-Ray Computed , Treatment Outcome
7.
J Stroke Cerebrovasc Dis ; 29(12): 105353, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-796759

ABSTRACT

Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Neurological manifestations related to COVID-19, including acute ischemic Stroke (AIS), have been reported in recent studies. In most of these, the patients are older, have multiple co-morbidities as risk factors for AIS and have developed a severe respiratory illness. Herein, we report a 36-year-old man with no significant past medical history who recently recovered from a mild COVID-19 infection and presented with unusual pattern of arterial macrothrombosis causing AIS. When the AIS happened, he had no COVID-19 related symptoms, had two negative screening tests for the infection and his chest CT was unremarkable.


Subject(s)
Brain Ischemia/etiology , COVID-19/complications , Carotid Stenosis/etiology , Intracranial Thrombosis/etiology , Stroke/etiology , Adult , Age Factors , Anticoagulants/administration & dosage , Brain Ischemia/diagnostic imaging , Brain Ischemia/therapy , COVID-19/diagnosis , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/therapy , Heparin/administration & dosage , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/therapy , Male , Stroke/diagnostic imaging , Stroke/therapy , Thrombectomy , Time Factors , Treatment Outcome
8.
J Stroke Cerebrovasc Dis ; 29(12): 105307, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-753198

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially most appreciated for its pulmonary symptoms, is now increasingly recognized for causing multi-organ disease and stroke in the setting of a hypercoagulable state. We report a case of 33-year-old African American woman with COVID-19 who developed acute malignant middle cerebral artery infarction due to thromboembolic occlusion of the left terminal internal carotid artery and middle cerebral artery stem. Mechanical thrombectomy was challenging and ultimately unsuccessful resulting in limited reperfusion of <67% of the affected vascular territory, and thrombectomized clot was over 50 mm in length, at least three times the average clot length. The final stroke size was estimated at 224 cubic centimeters. On admission her D-dimer level was 94,589 ng/mL (normal 0-500 ng/ml). Throughout the hospitalization D-dimer decreased but never reached normal values while fibrinogen trended upward. Hypercoagulability panel was remarkable for mildly elevated anticardiolipin IgM of 16.3 MPL/mL (normal: 0-11.0 MPL/mL). With respect to remaining stroke workup, there was no evidence of clinically significant stenosis or dissection in the proximal internal carotid artery or significant cardioembolic source including cardiomyopathy, atrial fibrillation, cardiac thrombus, cardiac tumor, valvular abnormality, aortic arch atheroma, or patent foramen ovale. She developed malignant cytotoxic cerebral edema and succumbed to complications. This case underscores the importance of recognizing hypercoagulability as a cause of severe stroke and poor outcome in young patients with COVID-19 and highlights the need for further studies to define correlation between markers of coagulopathy in patients with COVID-19 infection and outcome post stroke.


Subject(s)
Blood Coagulation , COVID-19/complications , Carotid Stenosis/etiology , Infarction, Middle Cerebral Artery/etiology , Thrombophilia/etiology , Adult , Biomarkers/blood , Brain Edema/etiology , COVID-19/blood , COVID-19/diagnosis , COVID-19/therapy , Carotid Stenosis/blood , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/therapy , Disease Progression , Fatal Outcome , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Infarction, Middle Cerebral Artery/blood , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/therapy , Thrombectomy , Thrombophilia/complications , Thrombophilia/diagnosis , Treatment Outcome
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