External carotid artery stenting to treat patients with symptomatic ipsilateral internal carotid artery occlusion: a multicenter case series.
ABSTRACT The external carotid artery (ECA) anastomoses in many distal territories supplied by the internal carotid artery (ICA) and is an important source of collateral circulation to the brain. Stenosis of the ECA in ipsilateral ICA occlusion can produce ischemic sequelae.
To examine the effectiveness of ECA stenting in treating symptomatic ipsilateral ICA occlusion.
We retrospectively reviewed patient databases from 5 academic medical centers to identify all individuals who underwent ECA stenting after 1998. For all discovered cases, coinvestigators used a common submission form to harvest relevant demographic information, clinical data, procedural details, and follow-up results for further analysis.
Twelve patients (median age, 66 years; range, 45-79 years) were identified for our cohort. Vessel disease involvement included severe ECA stenosis >or= 70% in 11 patients and ipsilateral ICA occlusion in all patients. Presenting symptoms included signs of transient ischemic attack, stroke, and amaurosis fugax. ECA stenting was associated with preservation of neurological status in 11 patients and resolution of symptoms in 5 patients at a median follow-up time of 26 months (range, 1-87 months; mean, 29 months). Symptomatic in-stent restenosis did not occur within any patient during the follow-up course.
We found ECA stenting in symptomatic ipsilateral ICA disease to be a potentially effective strategy to preserve neurological function and to relieve ischemic symptoms. Further investigation with larger studies and longer follow-up periods is warranted to elucidate the true indications of this management strategy.
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ABSTRACT: The importance of hemodynamic parameters for predicting outcome in patients with occlusive carotid disease remains controversial. The present study was aimed at testing the hypothesis that regional cerebrovascular reactivity (rCVR) to acetazolamide can be a reliable predictor of subsequent ischemic stroke in medically treated patients with internal carotid artery or middle cerebral artery occlusion. Seventy-seven symptomatic patients were enrolled in this prospective, longitudinal cohort study. All patients met inclusion criteria of cerebral angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow (rCBF) and rCVR to acetazolamide were quantitatively determined by (133)Xe SEPCT. All patients were categorized into 4 types on the basis of SPECT studies. During an average follow-up period of 42.7 months, 16 total and 7 ipsilateral ischemic strokes occurred. The annual risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were 35.6% and 23.7%, respectively, risks that are higher than those in other types of patients. When strokes were categorized into patients with and without decreased rCBF and rCVR, Kaplan-Meier analysis revealed that the risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were significantly higher than in those without (P<0.0001 and P=0.0001, respectively, log-rank test). Relative risk conferred by decreased rCBF and rCVR was 8.0 (95% CI, 1.9 to 34.4) for ipsilateral stroke and 3.6 (95% CI, 1.4 to 9.3) for total stroke. Decreased rCBF and rCVR to acetazolamide may identify a subgroup of patients who have a higher risk of subsequent ischemic stroke when treated medically.Stroke 09/2001; 32(9):2110-6. · 6.16 Impact Factor
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ABSTRACT: A symptomatic internal carotid artery (ICA) occlusion with hemodynamic compromise was treated at its chronic stage by using an endovascular technique. An embolic protection system was used during the recanalization procedure to prevent stroke by reversing the flow from the distal ICA to the common carotid artery. The totally occluded ICA was completely recanalized through percutaneous transluminal angioplasty and stent placement. The patient's symptom (transient ischemic attack) disappeared completely after treatment with no new neurological deficit. Single-photon emission computerized tomography findings confirmed improvement of the hemodynamic compromise, and no new high-intensity spots appeared on diffusion-weighted magnetic resonance imaging after treatment. This case shows that endovascular recanalization by using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise and refractoriness to antiplatelet therapy, even in the chronic stage of the illness.Journal of Neurosurgery 04/2005; 102(3):558-64. · 3.15 Impact Factor
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ABSTRACT: The authors performed external carotid artery (ECA) angioplasty and stenting in a 45-year-old man who had presented with right hemispheric crescendo ischemic symptoms stemming from acute right internal carotid artery occlusion (ICAO). This unique application of ECA angioplasty and stenting augmented cerebral perfusion and improved clinical symptoms. In certain situations, ECA stenting can increase cerebral perfusion in the setting of ICAO and ECA stenosis. The authors are the first to describe this approach in this context.Journal of Neurosurgery 01/2008; 107(6):1217-22. · 3.15 Impact Factor