Diagnostic Impact of Transcranial Color-Coded Real-Time Sonography With Echo Contrast Agents for Hyperperfusion Syndrome After Carotid Endarterectomy

Fujimoto, Shigeru; Toyoda, Kazunori; Inoue, Tatsuo; Hirai, Yuko; Uwatoko, Takeshi; Kishikawa, Keiji; Yasumori, Kotaro; Ibayashi, Setsuro; Iida, Mitsuo; Okada, Yasushi

doi:10.1161/01.str.0000133131.93900.ff

Cited by 76 publications

(36 citation statements)

References 24 publications

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“…The inclusion criteria for CEA and CAS in our institute have previously been published [8,][9]. In all patients, carotid lesions were evaluated using MDCT, duplex ultrasound, and digital subtraction angiography (DSA), and cerebral hemodynamics were assessed using single photon emission computed tomography (SPECT).…”

Section: Methodsmentioning

confidence: 99%

“…SPECT was done at least 3 weeks after a stroke/transient ischemic attack (TIA) using the PRISM 2000X (two-head SPECT system, Picker, USA) and 99m Tc-ethyl cysteinate dimer as the tracer according to a previously reported method [8]. Briefly, the regional cerebral blood flow (rCBF) values in the cortical area of the middle cerebral artery territory ipsilateral to the affected carotid artery were measured quantitatively using the Patlack plot method at rest and after the acetazolamide challenge test.…”

Section: Methodsmentioning

confidence: 99%

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Carotid Artery Calcification on Multislice Detector-Row Computed Tomography

Uwatoko

Toyoda²,

Inoue³

et al. 2007

Cerebrovasc Dis

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Background: To determine the underlying conditions that affect the degree of calcification of carotid arterial plaques, measured quantitatively using multidetector row computed tomography (MDCT), and to study the association of carotid calcification with clinical symptomatology. Methods: We measured the calcification volume of stenotic lesions at the carotid bifurcation using MDCT in 84 consecutive patients who were scheduled to undergo carotid revascularization. These results were compared with the clinical and radiological characteristics of the patients. Results: On MDCT, calcification in the carotid plaques was present in 78 patients (93%). Compared to the other patients, patients in the highest quartile of calcification volume (quartile 4) had higher serum creatinine levels (p < 0.001) and tended to have fewer symptomatic ischemic events in the territory of the affected carotid artery in the preceding 6 months (29 vs. 49%, p = 0.099); in particular, there were fewer transient symptoms (5 vs. 27%, p = 0.032) and symptoms possibly occurring due to local embolism (14 vs. 37%, p = 0.045). On ultrasound, plaque ulceration was less prevalent in patients in quartile 4 than in the remaining patients (5 vs. 29%, p = 0.026), although the severity of carotid stenosis was similar among all the quartiles. Conclusions: Renal dysfunction was associated with enhanced carotid plaque calcification. Patients with severe carotid calcification were found to have a low risk of recent ischemic stroke, presumably due, in part, to a lower prevalence of emboligenic carotid ulceration. MDCT was valuable for the quantitative evaluation of carotid calcification.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Carotid Artery Calcification on Multislice Detector-Row Computed Tomography

Uwatoko

Toyoda²,

Inoue³

et al. 2007

Cerebrovasc Dis

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“…Therefore, periprocedural blood pressure control, timing of the procedure (within two weeks after stroke or TIA, only after a period of three months after contralateral revascularization), and the type of anaesthetic are considered to be preventive [52]. Periprocedural TCD may predict hyperperfusion [53].…”

Section: Benefi T and Harm From Treatmentmentioning

confidence: 99%

Carotid stenosis – basing treatment on individual patients’ needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy

Langhoff

2018

Vasa

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Summary:Though carotid artery stenosis is a known origin of stroke, risk assessment and treatment modality are not yet satisfactorily established. Guideline updates according to latest evidence are expected shortly. Current clinical weakness concerns in particular the identifi cation of "at-risk" patients. Beside the symptomatic status and the degree of stenosis, further signs of unstable plaque on carotid and cerebral imaging should be considered. Moreover, medical and endovascular therapy are continuously improving. Randomized trials and meta-analyses have shown similar long-term results for protected carotid artery stenting and endarterectomy. However, endovascular revascularization was associated with an increased 30-day rate of minor strokes. Newly developed embolic protection devices could possibly compensate for this disadvantage. Furthermore, high-level optimal medical therapy alone is currently being evaluated comparatively. We assume that a comprehensive evaluation of plaque vulnerability, serious consideration of advanced embolic protection, and more space for optimal medical therapy alone according to latest evidence, will benefi t patients with carotid stenosis.Keywords: Carotid artery stenosis, carotid artery stenting, carotid endarterectomy, optimal medical therapy Risk of strokeIn neurologically symptomatic patients with carotid artery stenosis, in particular in those with a recent stroke or transient ischaemic attack (TIA), severe atherosclerosis is known to be associated with a high risk of recurrent stroke. In a recently published study [2], the recurrence rate of ipsilateral ischaemic stroke in patients with a degree of 50-99 % stenosis increased from 2.7 % within the fi rst day, to 5.3 % within three days, to 11.5 % within 14 days and fi nally to 18.8 % within 90 days after occurrence of neurologic symptoms. Advanced age and cerebral vs. ocular symptoms were associated with a higher recurrence rate. The survey did not reveal associations between the recurrence of neurological events and the degree of stenosis, additional vascular risk factors or medication. However, a large pooled data analysis [3] on symptomatic patients showed an increased benefi t from endarterectomy compared to medical treatment alone,

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“…For example, in one interesting study published recently, Kablak et al (2010) monitored both MCAs before and after CAS, finding a relation between ICH in 3 patients and an increase in peak systolic velocities in both MCAs after CAS. Fujimoto et al (2004) examined the changes in the MCA mean flow velocity measured by TCD before and 4 days after CEA. They reported a significant correlation between changes in mean flow velocity and changes in regional CBF; mean flow velocity increased more than 50% in all cases of CHS.…”

Section: Diagnosing Cerebral Hyperperfusionmentioning

confidence: 99%

“…In patients undergoing CEA, TCD can detect increases in MCA flow velocity greater than 100% during the intervention, thus alerting to a situation of risk. Likewise, TCD monitoring during CAS and probably in the hours after the procedure can help select high risk patients (Dalman et al, 1999;Fujimoto et al, 2004;Kablak et al, 2010;Iwata et al, 2011;Sfyroeras et al, 2009). Strict control of hypertension is one of the preventive measures that has received the most attention.…”

Section: Prevention and Treatmentmentioning

confidence: 99%