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1.
J Neurointerv Surg ; 11(2): 127-132, 2019 Feb.
Article in English | MEDLINE | ID: mdl-29930159

ABSTRACT

BACKGROUND: Stent retriever thrombectomy (SRT) in acute thromboembolic stroke can result in post-thrombectomy subarachnoid hemorrhage (PTSAH). Intraprocedural findings associated with PTSAH are not well defined. OBJECTIVE: To identify angiographic findings and procedural factors during SRT that are associated with PTSAH. MATERIALS AND METHODS: This was a retrospective, observational cohort study of consecutive patients with middle cerebral artery (MCA) acute ischemic stroke treated with SRT. Inclusion criteria were: (1) age ≥18 years; (2) thromboembolic occlusion of the MCA; (3) at least one stent retriever pass beginning in an M2 branch; (4) postprocedural CT or MRI scan within 24 hours; (5) non-enhanced CT Alberta Stroke Program Early CT Score >5. Exclusion criteria included multi-territory stroke before SRT. RESULTS: Eighty-five patients were enrolled; eight patients had PTSAH (group 1) and 77 did not (group 2). Baseline demographic and clinical characteristics were comparable between the two groups. In group 1, a significantly greater proportion of patients had more than two stent retriever passes (62.5% vs 18.2%, P=0.01), a stent retriever positioned ≥2 cm along an M2 branch (100% vs 30.2%, P=0.002), and the presence of severe iatrogenic vasospasm before SRT pass (37.5% vs 5.2%, P=0.02). One patient with PTSAH and associated mass effect deteriorated clinically. CONCLUSIONS: An increased number of stent retriever passes, distal device positioning, and presence of severe vasospasm were associated with PTSAH. Neurological deterioration with PTSAH can occur.


Subject(s)
Infarction, Middle Cerebral Artery/diagnostic imaging , Intraoperative Neurophysiological Monitoring/methods , Stents , Stroke/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Thrombectomy/adverse effects , Adolescent , Adult , Aged , Cohort Studies , Female , Humans , Infarction, Middle Cerebral Artery/surgery , Intraoperative Neurophysiological Monitoring/trends , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Retrospective Studies , Stroke/surgery , Subarachnoid Hemorrhage/etiology , Thrombectomy/trends , Young Adult
2.
Neurosurgery ; 67(2): 314-21, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20644416

ABSTRACT

BACKGROUND: The external carotid artery (ECA) anastomoses in many distal territories supplied by the internal carotid artery (ICA) and is an important source of collateral circulation to the brain. Stenosis of the ECA in ipsilateral ICA occlusion can produce ischemic sequelae. OBJECTIVE: To examine the effectiveness of ECA stenting in treating symptomatic ipsilateral ICA occlusion. METHODS: We retrospectively reviewed patient databases from 5 academic medical centers to identify all individuals who underwent ECA stenting after 1998. For all discovered cases, coinvestigators used a common submission form to harvest relevant demographic information, clinical data, procedural details, and follow-up results for further analysis. RESULTS: Twelve patients (median age, 66 years; range, 45-79 years) were identified for our cohort. Vessel disease involvement included severe ECA stenosis >or= 70% in 11 patients and ipsilateral ICA occlusion in all patients. Presenting symptoms included signs of transient ischemic attack, stroke, and amaurosis fugax. ECA stenting was associated with preservation of neurological status in 11 patients and resolution of symptoms in 5 patients at a median follow-up time of 26 months (range, 1-87 months; mean, 29 months). Symptomatic in-stent restenosis did not occur within any patient during the follow-up course. CONCLUSION: We found ECA stenting in symptomatic ipsilateral ICA disease to be a potentially effective strategy to preserve neurological function and to relieve ischemic symptoms. Further investigation with larger studies and longer follow-up periods is warranted to elucidate the true indications of this management strategy.


Subject(s)
Carotid Artery, External/surgery , Carotid Artery, Internal , Carotid Stenosis/surgery , Stents , Aged , Carotid Artery, External/pathology , Carotid Artery, Internal/pathology , Cerebrovascular Disorders/complications , Cohort Studies , Female , Follow-Up Studies , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Middle Cerebral Artery/abnormalities , Prospective Studies , Retrospective Studies , Stents/adverse effects , Temporal Arteries/abnormalities , Tomography, X-Ray Computed , Treatment Outcome
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