Cerebral Microemboli and Brain Injury During Carotid Artery Endarterectomy and Stenting

Skjelland, Mona; Krohg‐Sørensen, Kirsten; Tennøe, Bjørn; Bakke, Søren Jacob; Brucher, Rainer; Russell, David

doi:10.1161/strokeaha.107.513341

Cited by 88 publications

(76 citation statements)

References 28 publications

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“…11,12 In addition, gaseous emboli were shown to be independently associated with clinical stroke or new DWI lesions after carotid stenting. 13 In this study, TCD monitoring was restricted to the stenting procedure, whereas the MRI brain was done within 24 hours of the procedure. Therefore, any embolization occurring after the procedure might have been missed.…”

Section: Discussionmentioning

confidence: 99%

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Almekhlafi

Demchuk

Mishra

et al. 2013

Stroke

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This was a prospective, single-arm, cohort study to assess the safety of each step performed during CAS procedure. Eligible subjects were identified from the Foothills Medical Center of the University of Calgary, Alberta, Canada. Subjects with carotid stenosis (any symptom-status) planned for CAS and able to provide an informed consent were included. Subjects unable to have an MRI scan or those with absent bone window for TCD monitoring were excluded. Carotid Stenting ProcedureCAS was performed under intravenous conscious sedation in all but 1 subject who required general anesthesia for severe agitation. All procedures were attended by anesthesiologists. A common femoral Background and Purpose-Carotid angioplasty and stenting (CAS) has a higher incidence of periprocedural stroke compared with endarterectomy.

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Section: Discussionmentioning

confidence: 99%

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Almekhlafi

Demchuk

Mishra

et al. 2013

Stroke

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“…To eliminate potential iatrogenic strokes, we also excluded all cases that had heart surgery or a carotid endarterectomy in the previous month or during the index hospital event. 16 For details on ICD-9-CM codes, see Supplemental Table II, available online at http://stroke.ahajournals.org.…”

Section: Selection Of Incident Casesmentioning

confidence: 99%

Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System

Cesaroni

Agabiti

Forastiére

et al. 2009

Stroke

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Background and Purpose-Low socioeconomic position (SEP) is associated with high overall stroke mortality, but its contribution to stroke prognosis is unclear. We evaluated socioeconomic disparities in stroke incidence and poststroke outcomes. Methods-We collected hospital discharge and mortality data for all 35-to 84-year-old Rome residents who had a first acute ischemic or hemorrhagic stroke in 2001 to 2004. We used a small-area SEP index. We calculated age-adjusted incidence rates and rate ratios by SEP for fatal and nonfatal stroke subtypes using Poisson regression. Logistic regression was used to study outcomes by SEP (30-day mortality, and among 1-month survivors: 1-year mortality, hospital readmissions for a successive stroke, and cardiovascular diseases). Results-A total of 10 033 incident strokes (75% ischemic) were observed. Incidence rates (per 100 000) for ischemic and hemorrhagic stroke were: 104 and 34 in men and 81 and 28 in women, respectively. There were socioeconomic disparities in stroke incidence in both genders (rate ratios between extreme SEP categories in ischemic and hemorrhagic stroke: 1.76; 95% CI,1.59 to 1.95; 1.50; 95% CI, 1.26 to 1.80 in men; 1.72; 95% CI, 1.55 to 1.91; 1.37; 95% CI, 1.15 to 1.63 in women). No association was found for SEP and mortality after stroke. Men with low SEP with an ischemic event were more likely to be hospitalized for a new stroke than men with high SEP. Women with low SEP with hemorrhagic stroke were more likely to be hospitalized for cardiovascular disease compared with women with high SEP. Conclusions-Stroke

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“…Cerebrovascular accidents in case of CAS are the most frequent complications. Asymptomatic microembolus has been reported in all cases of CAS (8). Endothelium has been damaged and the inflammatory process has been activated because of these microembolus.…”

Section: Discussionmentioning

confidence: 99%

“…Further, ischemic lesions and hyperperfusion syndrome are well-known complications of CAS, and new cerebral microembolic lesions detected via diffusionweighted imaging (DWI) are observed in almost all patients after CAS (7,8). Fluid-attenuated inversion recovery (FLAIR) is very sensitive in detecting leptomeningeal hyperintensity (9), which has been noted to disappear after the symptoms resolve.…”

Section: Introductionmentioning

confidence: 99%

Transient neurological deficits mimicking left middle cerebral artery infarct after carotid artery stenting without associated imaging findings: A case report

Kandemir¹,

Tepe²,

Yalçıner³

2017

Türk Beyin Damar Hast Derg

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Various complications have been reported after carotid artery stenting. Ischemic lesions and hyperperfusion syndrome are well-known complications, and new cerebral microembolic lesions detected via diffusion-weighted imaging are observed in almost all patients. We describe a case who developed transient neurological deficits immediately after stenting without additional imaging findings. A 64-year-old male underwent carotid artery stenting complicated by transient neurological deficits mimicking a left middle cerebral artery infarction. The complication occurred immediately after stenting, but the symptoms resolved within less than 48 h. Magnetic resonance imaging findings showed no signs of a new infarct, no hemorrhage, and no high signal intensity in the meninges. We conclude that the most likely pathogenesis of this complication was vasogenic edema because of vasoparalysis of the local vessels, resulting from hemodynamic changes occurring after stenting and/or biochemical effects of repeated contrast agent administration. Keywords: Carotid artery stenting, transient neurological deficit, blood-brain barrier, reversible vasoparalysis, contrast agent. KAROTİS ARTERE STENT YERLEŞTİRME SONRASINDA İLİŞKİLİ GÖRÜNTÜLEME BULGUSU OLMAKSIZIN SOL ORTA SEREBRAL ARTER ENFARKTINI TAKLİT EDEN GEÇİCİ NÖROLOJİK DEFİSİTLER: BİR OLGU SUNUMU ÖZETKarotis artere stent uygulama esnasında çeşitli komplikasyonlar görülebilmektedir. İskemik lezyonlar ve hiperperfüzyon sendromu iyi bilinen komplikasyonlardır ve diffüzyon görüntüleme tekniği ile yeni serebral mikroembolik lezyonlar hemen hemen tüm hastalarda saptanmaktadır. Biz bu yazıda, stent uygulanmasından hemen sonra geçici nörolojik defisit gelişen ve ek görüntüleme bulgusu olmayan bir vaka sunmak istedik. Altmış dört yaşında erkek hastada karotis artere stent yerleştirme sonrasında sol orta serebral arter enfarktını taklit eden geçici nörolojik defisit ile karakterize bir komplikasyon gözlenmiştir. Komplikasyon stent yerleştirme işleminden hemen sonra gözlenmiş ve semptomlar 48 saat içerisinde düzelmiştir. Manyetik rezonans görüntüleme tetkiklerinde yeni enfarkt, hemoraji veya meninkslerde yüksek sinyal intensitesi gözlenmemiştir. Bu komplikasyonun en olası patogenezi olarak stent yerleştirme sonrasında meydana gelen hemodinamik değişikliklerden kaynaklanan lokal damarların vazoparalizisinin sonucu olarak gelişen vazojenik ödem ve/veya tekrarlanan kontrast madde uygulanmasının biyokimyasal etkileri olduğu düşünülmüştür. Anahtar Sözcükler: Karotis arter stentleme, geçici nörolojik defisit, kan-beyin bariyeri, geri dönüşlü vazoparalizi, kontrast madde.

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Cerebral Microemboli and Brain Injury During Carotid Artery Endarterectomy and Stenting

Cited by 88 publications

References 28 publications

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System

Transient neurological deficits mimicking left middle cerebral artery infarct after carotid artery stenting without associated imaging findings: A case report

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