Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Pini, Rodolfo; Faggioli, Gianluca; Longhi, Matteo; Ferrante, L; Gallitto, Enrico; Gargiulo, Mauro; Stella, Andréa

doi:10.1016/j.jvs.2016.08.077

Cited by 15 publications

(10 citation statements)

References 27 publications

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“…In case of small (typically up to 1/3 of MCA territory [15]) or no ischemic core, revascularization is advisable. Alternatively, a novel approach measuring volume of cerebral ischemic lesion can be applied; volume 4000 mm 3 was found to be independent predictor for postoperative stroke [47]. This evaluation is precise in comparison to subjective estimate of one third of MCA territory.…”

Section: Discussionmentioning

confidence: 98%

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Beneš

Bradáč

Horvath

et al. 2020

Vasa

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Summary. Acute occlusion of the extracranial internal carotid artery (eICA) is associated with poor prognosis. Surgical desobliteration has not received adequate attention in recent years. We therefore conducted a literature review and meta-analysis of surgical studies published after 2000 that treated eICA occlusion surgically in an emergency setting. The search identified 10 relevant articles that included a total of 175 patients. The outcomes analysed included rates of recanalization (93 %), early neurological improvement (66 %), modified Rankin Scale 0–2 (62 %), mortality (5 %), early reocclusion (4 %), in-hospital stroke (4 %) and symptomatic intracerebral haemorrhage (4 %). In conclusion, acute surgical desobliteration of eICA occlusion leads to high rates of recanalization and a majority of patients experience early neurological improvement and achieve favourable outcome. Rates of mortality, early reocclusion, in-hospital stroke and sICH are acceptable in the view of unfavourable natural history.

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Section: Discussionmentioning

confidence: 98%

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Beneš

Bradáč

Horvath

et al. 2020

Vasa

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“…A possible explanation of the different outcome associated with CIL in the literature data can be due to the effect of the CIL volume, that has been scarcely evaluated in many reports (30). In a paper from Pini et al (5), the presence of a CIL was not identified as a possible risk factor for carotid revascularization in 489 symptomatic patients: 4.8% vs. 3.5%, P=0.46. However, the CIL volume of patients who suffered a post-operative stroke was significantly higher compared with that of patients with favourable outcome: 5,100 mm 3 (IQR, 31,000 mm 3 ) vs. 1,000 mm 3 (IQR, 7,000 mm 3 ) P=0.01.…”

Section: Influence Of Cil Volume On the Carotid Revascularization Outcomementioning

confidence: 91%

“…As a matter of fact, the stratification of symptomatic patients according to the type of symptoms is important to identify those at higher risk of stroke and also to evaluate the risk of a revascularization procedure (1), since it is well known that patients with stroke in evolution or transient ischemic attack (TIA) in crescendo are more prone to perioperative complications compared with patients with a single stable TIA (2)(3)(4). Other than the clinical status, the presence and extension of cerebral ischemic lesions (CIL) is increasingly used as a stratification tool of these patients (5). Specifically, CIL are constantly considered in the evaluation of patients with CAS, since their presence can identify patients with "silent symptoms" who are at higher risk for further cerebral ischemic events, even if they are apparently asymptomatic (6).…”

Section: Introductionmentioning

confidence: 99%

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

et al. 2020

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Patients with carotid artery stenosis (CAS) are commonly defined as asymptomatic or symptomatic according with their neurological conditions, however, emerging evidences suggest stratifying patients according also with the presence of cerebral ischemic lesions (CIL). In asymptomatic patients, the presence of CIL increases the risk of future neurologic event from 1% to 4% per year, leading to a stronger indication to carotid revascularization. In symptomatic patients, the presence of CIL does not seem to influence the outcome of the carotid revascularization if the volume of the lesion is small (<4,000 mm 3 ); the benefit of the revascularization is also more significant if performed within 2 weeks from the index event.However, high volume (>4,000 mm 3 ) CIL are associated in some experiences with a higher risk of carotid revascularization suggesting to delay the carotid revascularization for at least 4 weeks. As a matter of fact, the evaluation of CIL dimensions and characteristics in patients with CAS gives to the physician involved in the treatment a valuable adjunctive tool in the choice of the ideal treatment.

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“…Neurological evaluation was performed before and after carotid revascularization by an in-hospital neurologist. 15 TIA was defined as a temporary focal neurological deficit with complete resolution within 24 h. cTIA was defined as two or more ipsilateral TIAs, occurring at 24-48 h intervals, with increasingly more severe symptoms and complete recovery after each TIA episode, the absence of a cerebral ischemic lesion was not necessary for the definition of TIA. 1 The time elapsed from symptoms to carotid revascularization was recorded considering the last neurologic event (considering the last event we could evaluate an association in the time elapsed from the neurologic damage and the revascularization).…”

Section: Neurological Assessmentmentioning

confidence: 99%

The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack

et al. 2018

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Objective Carotid stenosis with crescendo-transient-ischemic-attack (cTIA) requires a prompt intervention to reduce the stroke risk. Few data are reported in literature about cTIA suggesting a different perioperative risk compared with patients with single TIA (sTIA). This study aimed to compare the outcome of carotid endarterectomy (CEA) in patients with TIA (single/crescendo) and evaluate the outcome risk-factors. Methods Data from two tertiary hospitals for vascular treatment were analyzed from 2007 to 2016. All patients with TIA subjected to CEA were considered, comparing the 30-day postoperative stroke and stroke/death in patients with cTIA and sTIA, particularly in the urgent (≤48 h) setting. Results On a total of 3866 CEA, 888 (23%) were performed in symptomatic patients and 515 for TIA: 365 (71%) patients with sTIA and 150 (29%) with cTIA. When compared with sTIA, cTIA patients were younger and less frequently affected by coronary disease, dyslipidemia, and chronic pulmonary disease; however, contralateral carotid occlusion was more common (20% vs. 10%, P = .004; 56% vs. 46, P = .03; 16% vs. 7%, P = .01; >80 years 26% vs. 16%, P = .01 and 2% vs. 10%, P = .001; respectively). Postoperative stroke and stroke/death were significantly higher in cTIA compared with sTIA (5.3% vs. 1.6%, P = .02 and 6.0% vs. 2.2%, P = .03; respectively). Urgent CEA was performed in 58% ( n: 87) cTIA and in 11% ( n: 56) sTIA( P<.01). The urgent setting did not influence the stroke and stroke/death rate of CEA for sTIA (3.6% vs. 1.3%, P = .21 and 3.6% vs. 1.9%, P = .44, respectively), but was associated with lower rate of events in cTIA (1.1%vs. 11.1%, P = .01 and 2.3% vs. 11.1%, P = .03, respectively). This beneficial effect in patients with cTIA treated within 48-h was confirmed also by multivariate analysis (OR: 0.09, 95% CI: 0.76-0.01, P=.02). Conclusions cTIA subjected to CEA have a higher stroke and stroke/death risk compared with patients with sTIA. The urgent setting seems to reduce the stroke/death rate cTIA; for sTIA with a stable neurological condition, the timing of CEA did not influence the outcome.

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Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Abstract: CIL volume in symptomatic carotid stenosis seems to influence the 30-day outcome independently from the timing of carotid revascularization. A CIL volume of ≥4000 mm could be considered a significant predictor for postoperative stroke after carotid revascularization.

Cited by 15 publications

References 27 publications

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack

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