Cerebral infarct following carotid endarterectomy Frequency, clinical and hemodynamic significance evaluated by MRI and TCD

Enevoldsen, E.; Torfing, Trine; Kjeldsen, Marianne Juel; Nepper-Rasmussen, Jørgen

doi:10.1111/j.1600-0404.1999.tb01047.x

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…Full publications were retrieved of 164 studies published up to 31 December 2016. Seventy-nine studies were excluded for the following reasons: MRI to detect cerebral ischaemia did not include DWI sequences, or DWI was not done in all patients (n = 15); 22–36 no DWI was performed before treatment (n = 11); 37–47 post-procedural DWI was performed more than seven days after treatment (n = 3); 48–50 the number of DWI+ patients or procedures could not be extracted (n = 6); 51–56 or information on procedural stroke was lacking or patients with procedural stroke were excluded from the analysis (n = 6). 49,57–68 One study was excluded because the analysis was restricted to patients with available six months’ follow-up who constituted less than half of the study population (n = 1).…”

Section: Resultsmentioning

confidence: 99%

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Traenka

Engelter

Brown³

et al. 2019

European Stroke Journal

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Aim: To investigate whether lesions on diffusion-weighted imaging (DWIþ) after carotid artery stenting (CAS) or endarterectomy (CEA) might provide a surrogate outcome measure for procedural stroke. Materials and Methods: Systematic MedLine V R database search with selection of all studies published up to the end of 2016 in which DWI scans were obtained before and within seven days after CAS or CEA. The correlation between the underlying log odds of stroke and of DWIþ across all treatment groups (i.e. CAS or CEA groups) from included studies was estimated using a bivariate random effects logistic regression model. Relative risks of DWIþ and stroke in studies comparing CAS vs. CEA were estimated using fixed-effect Mantel-Haenszel models. Results: We included data of 4871 CAS and 2099 CEA procedures (85 studies). Across all treatment groups (CAS and CEA), the log odds for DWIþ was significantly associated with the log odds for clinically manifest stroke (correlation coefficient 0.61 (95% CI 0.27 to 0.87), p ¼ 0.0012). Across all carotid artery stenting groups, the correlation coefficient was 0.19 (p ¼ 0.074). There were too few CEA groups to reliably estimate a correlation coefficient in this subset alone. In 19 studies comparing CAS vs. CEA, the relative risks (95% confidence intervals) of DWIþ and stroke were 3.83 (3.17-4.63, p < 0.00001) and 2.38 (1.44-3.94, p ¼ 0.0007), respectively. Discussion: This systematic meta-analysis demonstrates a correlation between the occurrence of silent brain infarcts on diffusion-weighted imaging and the risk of clinically manifest stroke in carotid revascularisation procedures. Conclusion: Our findings strengthen the evidence base for the use of DWI as a surrogate outcome measure for procedural stroke in carotid revascularisation procedures. Further randomised studies comparing treatment effects on DWI lesions and clinical stroke are needed to fully establish surrogacy.

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Section: Resultsmentioning

confidence: 99%

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Traenka

Engelter

Brown³

et al. 2019

European Stroke Journal

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“…Transcranial Doppler (TCD) has been widely used as a tool to assess the hemodynamic changes in OI patients because of the characteristics of real‐time scan, low cost, non‐invasiveness, continuous monitoring, frequent and repeated measurement, and good accessibility although various neuroimaging techniques such as cerebral angiography, functional CT or MR scans, perfusion CT or MR scans, SPECT, and PET scan can also be used in evaluating the cerebral hemodynamic state . Several parameters including cerebral blood flow, cerebral vascular resistance (CVR), pulsatile index, and CCP and several maneuvers including breath holding, add of vasodilator agents, Valsalva maneuver, and lower body negative pressure have been be used in various investigations with TCD .…”

Section: Introductionmentioning

confidence: 99%

Cerebral hemodynamics in orthostatic intolerance with normal head-up tilt test

Shin

Park

et al. 2015

Acta Neurol Scand

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“…However, only 3 patients have clinical evidence of stroke or transient ischemic attack. 59 In a study of 57 patients undergoing coronary artery bypass grafting, there were 22 to 2072 (meanϮSDϭ326Ϯ47) highintensity transient signals per patient detected by TCD. The embolization rate was the highest at the initiation of cardiopulmonary bypass, and total embolic events were highest during aortic clamping.…”

Section: Central Nervous Systemmentioning

confidence: 99%