Stroke Caused by Extracranial Disease

Barrett, Kevin M.; Brott, Thomas G.

doi:10.1161/circresaha.117.310138

Cited by 42 publications

(39 citation statements)

References 30 publications

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“…1 Extracranial internal carotid artery (ICA) atherosclerotic occlusive disease is a common reason for ischemic stroke and responsible for approximately 7% to 18% of all firsttime ischemic stroke incidents. 2 Although digital subtraction angiography (DSA) is considered the diagnostic reference standard, it is invasive and associated with periprocedural risks. 3 Computed tomography angiography (CTA) of the cervical vessels is established as an integral part in the imaging workup of acute ischemic stroke.…”

mentioning

confidence: 99%

Modified Dual-Energy Algorithm for Calcified Plaque Removal

Mannil¹,

Ramachandran²,

Martini³

et al. 2017

Invest Radiol

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mentioning

confidence: 99%

Modified Dual-Energy Algorithm for Calcified Plaque Removal

Mannil¹,

Ramachandran²,

Martini³

et al. 2017

Invest Radiol

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“…I 2 statistic ranges between 0 and 100%, with values of 0-25% and 75-100%, respectively, taken to indicate low and considerable heterogeneity. We will also report Tau 2 and Cochran Q test with a P value of < 0.05 considered statistically heterogeneity. When heterogeneity was found, we will conduct a subgroup analysis of the following variables if the data were sufficient, such as study design, geographical location, or risk of bias.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Stroke is a significant global health burden cause [1][2][3]. Nearly 20% of patients with anterior circulation ischemia may have carotid artery occlusion [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The best medical therapy (BMT) could reduce the risk of vascular events through the use of synthetic drugs involving blood pressure control, anti-antiplatelet aggregation, and hyperlipidemia management, as well as through lifestyle modification [2,19,20]. BMT focuses on the continuous and long-term use of synthetic drugs to prevent future stroke [2,21]. However, some of these patients, especially those who are hemodynamically compromised, showed unsatisfactory outcomes after receiving BMT [22].…”

Section: Introductionmentioning

confidence: 99%

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Extracranial-intracranial bypass surgery for occlusive atherosclerotic disease of the anterior cerebral circulation: protocol for a systematic review and meta-analysis

et al. 2020

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Background: Occlusive atherosclerotic disease of the anterior cerebral circulation is one of the most common causes of anterior circulation ischemia and stroke. Treatment options include medical therapies (including antiplatelet use, blood pressure control, lipid reduction, and lifestyle modification) and extracranial-intracranial bypass surgery (such as superficial temporal artery-middle cerebral artery bypass). However, the optimal treatment remains unclear. The objective of this study will be to compare the efficacy of and extracranial-intracranial bypass surgery with that of other medical therapy in adult patients with occlusive atherosclerotic disease of the anterior cerebral circulation. Methods: This is the study protocol for a systematic review. We will search MEDLINE, EMBASE, Web of Science, and the Cochrane Library (from January 1980 onwards). We will include randomized controlled trials, quasi-experimental studies (non-randomized, interrupted time series), and observational studies (e.g., cohort studies and case-control studies), examining the efficacy of extracranial-intracranial bypass surgery compared to other treatments for adult patients with occlusive atherosclerotic disease of anterior cerebral circulation. Two team members will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The primary outcome will include stroke or death. The secondary outcomes will include intracranial hemorrhage, transient ischemic attack, and myocardial infarction. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., study design, geographical location, or risk of bias). Discussion: This review will evaluate the evidence on the efficacy of extracranial-intracranial bypass surgery for adult patients with occlusive atherosclerotic disease of the anterior cerebral circulation. We anticipate that our findings will be of interest to patients, their families, caregivers, healthcare professionals, and in making optimal treatment selection. Implications for future clinical and epidemiological research will be discussed.

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“…Medical therapy refers to the contemporary approach of antiplatelet therapy, blood pressure control, low-density lipoprotein reduction, and lifestyle modification to reduce stroke risk. Carotid revascularization with endarterectomy or angioplasty and stenting are established treatments for patients with symptomatic carotid stenosis ≥ 70% [2]. In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation.…”

Section: Introductionmentioning

confidence: 99%

Comparison between intracranial collaterals and cerebral hemodynamics in patients with extracranial carotid stenosis versus combined extra- and intracranial stenosis using transcranial duplex

Hamdy¹,

Aref²,

Reda³

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. Objectives: To compare between collaterals in patients with extracranial carotid stenosis alone and in patients having both extracranial and intracranial carotid stenosis and therefore the difference in prognosis between them. Materials and methods: A total of 30 patients of acute ischemic stroke were enrolled. The extracranial part of the carotid artery was assessed with color-coded duplex. Transcranial color-coded duplex was done to assess cerebral hemodynamics and collaterals to differentiate between extracranial significant carotid stenosis alone versus combined extra-and intracranial significant carotid stenosis. Results: Out of 15 patients with significant extracranial stenosis, 3 of them obtained reversed flow in the ophthalmic artery and 3 patients of them showed change of flow in the anterior cerebral artery(ACA), whereas the other 15 patients of combined stenosis did not show any reversed blood flow in the same arteries which considered nonsignificant. The residual deficit of patients with extracranial stenosis alone was better when compared to that of the other group. Conclusion: Our study concluded that transcranial duplex provides useful information about cerebral reserve and status of collaterals which show nonsignificant difference between two studied groups regarding intracranial collaterals. Furthermore, patients with combined extra-and intracranial stenosis were found to have more deficit and worse prognosis than patients with internal carotid stenosis only.

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Stroke Caused by Extracranial Disease

Cited by 42 publications

References 30 publications

Modified Dual-Energy Algorithm for Calcified Plaque Removal

Modified Dual-Energy Algorithm for Calcified Plaque Removal

Extracranial-intracranial bypass surgery for occlusive atherosclerotic disease of the anterior cerebral circulation: protocol for a systematic review and meta-analysis

Comparison between intracranial collaterals and cerebral hemodynamics in patients with extracranial carotid stenosis versus combined extra- and intracranial stenosis using transcranial duplex

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