24 results on '"Carotid occlusive disease"'
Search Results
2. Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice
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Nishijima, Yasuo, Akamatsu, Yosuke, Yang, Shih Yen, Lee, Chih Cheng, Baran, Utku, Song, Shaozhen, Wang, Ruikang K, Tominaga, Teiji, and Liu, Jialing
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Biomedical and Clinical Sciences ,Neurosciences ,Clinical Sciences ,Stroke ,Diabetes ,Brain Disorders ,Cardiovascular ,2.1 Biological and endogenous factors ,Aetiology ,Metabolic and endocrine ,Animals ,Arterioles ,Cerebral Angiography ,Cerebral Arterial Diseases ,Cerebrovascular Circulation ,Circle of Willis ,Collateral Circulation ,Diabetes Mellitus ,Type 2 ,Disease Models ,Animal ,Male ,Meninges ,Mice ,Optical Imaging ,Risk Factors ,anastomosis ,arteriogenesis ,carotid occlusive disease ,CCAO ,doppler OCT ,vascular remodeling ,Cardiorespiratory Medicine and Haematology ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposeThe presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status, it is unclear whether and to what extent type 2 diabetes mellitus affects cerebral collateral flow regulation during hypoperfusion.MethodsWe examined the spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal middle cerebral artery and anterior cerebral artery branches over 2 weeks after unilateral common carotid artery occlusion (CCAO) using optical coherent tomography in db/+ and db/db mice. We also assessed the temporal adaptation of the circle of Willis after CCAO by measuring circle of Willis vessel diameters.ResultsAfter unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared with db/+ mice, which coincided with a reduced dilation of distal anterior cerebral artery branches, leading to reduced flow not only in pial vessels but also in penetrating arterioles bordering the distal middle cerebral artery and anterior cerebral artery. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the circle of Willis, in addition to a delayed post-CCAO adaptive response by 1 to 2 weeks, compared with db/+ mice.ConclusionsType 2 diabetes mellitus is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or transient ischemic attack.
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- 2016
3. Perforating artery flow velocity and pulsatility in patients with carotid occlusive disease. A 7 tesla MRI study
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L.P. Onkenhout, Tine Arts, D. Ferro, E.A. Oudeman, M.J.P. van Osch, J.J.M. Zwanenburg, J. Hendrikse, L.J. Kappelle, and GJ. Biessels
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Cerebral perforating artery flow ,Vessel function ,Cerebral small vessels ,7 tesla magnetic resonance imaging ,Carotid occlusive disease ,Specialties of internal medicine ,RC581-951 ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Patients with carotid occlusive disease express altered hemodynamics in the post-occlusive vasculature and lesions commonly attributed to cerebral small vessel disease (SVD). We addressed the question if cerebral perforating artery flow measures, using a novel 7T MRI technique, are altered and related to SVD lesion burden in patients with carotid occlusive disease.21 patients were included with a uni- (18) or bilateral (3) carotid occlusion (64±7 years) and 19 controls (65±10 years). Mean flow velocity and pulsatility in the perforating arteries in the semi-oval center (CSO) and basal ganglia (BG), measured with a 2D phase contrast 7T MRI sequence, were compared between patients and controls, and between hemispheres in patients with unilateral carotid occlusive disease. In patients, relations were assessed between perforating artery flow measures and SVD burden score and white matter hyperintensity (WMH) volume.CSO perforating artery flow velocity was lower in patients than controls, albeit non-significant (mean difference [95% confidence interval] 0.08 cm/s [0.00–0.16]; p = 0.053), but pulsatility was similar (0.07 [-0.04–0.18]; p = 0.23). BG flow velocity and pulsatility did not differ between patients and controls (velocity = 0.28 cm/s [-0.32–0.88]; p = 0.34; pulsatility = 0.00 [-0.10–0.11]; p = 0.97). Patients with unilateral carotid occlusive disease showed no significant interhemispheric flow differences. Though non-significant, within patients lower CSO (p = 0.06) and BG (p = 0.11) flow velocity related to larger WMH volume.Our findings suggest that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to SVD lesion burden in these patients, although our observations need corroboration in larger study populations.
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- 2022
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4. Acute Carotid Artery Stenting Versus Balloon Angioplasty for Tandem Occlusions: A Systematic Review and Meta‐Analysis
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Cynthia B. Zevallos, Mudassir Farooqui, Darko Quispe‐Orozco, Alan Mendez‐Ruiz, Andres Dajles, Aayushi Garg, Milagros Galecio‐Castillo, Mary Patterson, Osama Zaidat, and Santiago Ortega‐Gutierrez
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carotid artery ,carotid occlusive disease ,intervention ,reperfusion ,stroke ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Despite thrombectomy having become the standard of care for large‐vessel occlusion strokes, acute endovascular management in tandem occlusions, especially of the cervical internal carotid artery lesion, remains uncertain. We aimed to compare efficacy and safety of acute carotid artery stenting to balloon angioplasty alone on treating the cervical lesion in tandem occlusions. Similarly, we aimed to explore those outcomes’ associations with technique approaches and use of thrombolysis. Methods and Results We performed a systematic review and meta‐analysis to compare functional outcomes (modified Rankin Scale), reperfusion, and symptomatic intracranial hemorrhage and 3‐month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random‐effects model was used for analysis. Thirty‐four studies were included in our systematic review and 9 in the meta‐analysis. Acute carotid artery stenting was associated with higher odds of modified Rankin Scale score ≤2 (odds ratio [OR], 1.95 [95% CI, 1.24–3.05]) and successful reperfusion (OR, 1.89 [95% CI, 1.26–2.83]), with no differences in mortality or symptomatic intracranial hemorrhage rates. Moreover, a retrograde approach was significantly associated with modified Rankin Scale score ≤2 (OR, 1.72 [95% CI, 1.05–2.83]), and no differences were found on thrombolysis status. Conclusions Carotid artery stenting and a retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach, respectively, in patients with tandem occlusions. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease.
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- 2022
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5. Cerebral blood flow and cognitive functioning in patients with disorders along the heart–brain axis
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Anna E. Leeuwis, Astrid M. Hooghiemstra, Esther E. Bron, Sanne Kuipers, Eline A. Oudeman, Tugba Kalay, Hans‐Peter Brunner‐La Rocca, L. Jaap Kappelle, Robert J. vanOostenbrugge, Jacoba P. Greving, Wiro J. Niessen, Mark A. vanBuchem, Matthias J.P. vanOsch, Albert C. vanRossum, Niels D. Prins, Geert‐Jan Biessels, Frederik Barkhof, Heart–Brain Connection consortium, and Wiesje M. vander Flier
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carotid occlusive disease ,cognitive impairment ,heart failure ,perfusion ,small vessel disease ,vascular cognitive impairment ,Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Abstract
Abstract Introduction We examined the role of hemodynamic dysfunction in cognition by relating cerebral blood flow (CBF), measured with arterial spin labeling (ASL), to cognitive functioning, in patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (MRI; ie, possible vascular cognitive impairment [VCI]). Methods We included 439 participants (124 HF; 75 COD; 127 possible VCI; 113 reference participants) from the Dutch multi‐center Heart–Brain Study. We used pseudo‐continuous ASL to estimate whole‐brain and regional partial volume‐corrected CBF. Neuropsychological tests covered global cognition and four cognitive domains. Results CBF values were lowest in COD, followed by VCI and HF, compared to reference participants. This did not explain cognitive impairment, as we did not find an association between CBF and cognitive functioning. Discussion We found that reduced CBF is not the major explanatory factor underlying cognitive impairment in patients with hemodynamic dysfunction along the heart–brain axis.
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- 2020
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6. The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study
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Astrid M. Hooghiemstra, Anne Suzanne Bertens, Anna E. Leeuwis, Esther E. Bron, Michiel L. Bots, Hans-Peter Brunner-La Rocca, Anton J.M. de Craen, Rob J. van der Geest, Jacoba P. Greving, L. Jaap Kappelle, Wiro J. Niessen, Robert J. van Oostenbrugge, Matthias J.P. van Osch, Albert de Roos, Albert C. van Rossum, Geert Jan Biessels, Mark A. van Buchem, Mat J.A.P. Daemen, and Wiesje M. van der Flier
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Cerebral hypoperfusion ,Cardiovascular dysfunction ,Cognitive decline ,Heart failure ,Carotid occlusive disease ,Cerebral blood flow ,Small vessel disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol. Methods: The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alzheimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines. Results and Conclusions: The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor.
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- 2017
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7. IMAGING ALGORITHMS FOR OCCLUSIVE CAROTID DISEASE IN TREATMENT STRATEGY
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M. V. Vishnyakova
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carotid occlusive disease ,imaging algorithm ,surgical treatment ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Objective – to optimize imaging algorithms of preoperative evaluation and postoperative changes and complications in patients with occlusive carotid disease.Material and methods. Results of pre- and postoperative imaging of patients with occlusive carotid disease during 2012–2016 years were analyzed. Four groups were defined: assessment of CT-angiography (CTA) for preoperative planning (256 patients); the role of CTA for postoperative changes (51 patients); CT-perfusion (CTP) abilities in cerebral circulation assessment before and after surgery (103 and 76 patients); CT and MRI in diagnosis of postoperative neurologic complications (595 patients).Results. CTA employment in preoperative examination increased accuracy of occlusive process evaluation and changed management strategy in 6 patients. With CTA data we were able to define three variants of postoperative carotid changes: “expected” condition; changes that require further dynamic control studies; complications. The most reasonable was CTP employment for patients with combination of stenosis of one carotid artery and occlusion of contralateral artery. For diagnosis of neurologic complication first line examination was MRI, than for further assessment – CTA and CTP.Conclusion. Complex imaging algorithm for occlusive carotid disease assessment, defining of postoperative vascular status and possible neurologic complications provide necessary information for management strategy examination.
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- 2017
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8. Cerebral amyloid-β deposition in patients with heart disease or carotid occlusive disease: A systematic review and meta-analysis.
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Starmans, Naomi Louisa Paula, Leeuwis, Anna Elisabeth, Biessels, Geert Jan, Kappelle, Laurens Jaap, van der Flier, Wiesje Maria, and Tolboom, Nelleke
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CEREBRAL amyloid angiopathy , *CARDIAC patients , *POSITRON emission tomography , *CORONARY disease , *HEART diseases , *CARDIOVASCULAR diseases - Abstract
Cardiovascular disease is an important contributor to cognitive impairment. This likely involves prototypical vascular disease mechanisms like ischemia, but cardiovascular disease might also impact the brain by accelerating cerebral amyloid-β accumulation. We aimed to determine whether there is an association between heart disease or carotid occlusive disease (COD) and cerebral amyloid-β burden. We conducted a systematic review of studies investigating cerebral amyloid-β burden, measured with positron emission tomography, in adults with and without heart disease or COD. Where possible, we obtained standardized mean differences (SMD) of amyloid-β standardized uptake volume ratios (SUVr) for meta-analysis. Eight cross-sectional studies were identified (1478 participants, aged 60–81 years, 51% female). Three studies on heart disease (two on atrial fibrillation (AF) only, one on AF, coronary artery disease and heart failure) did not find a difference in amyloid-β burden between patients and controls. The pooled difference for 746 participants with and without AF did not reach significance (SMD SUVr 0.14, 95%CI -0.06–0.34). Of the five studies on COD (one on differences between participants with and without COD, four on differences between hemispheres in unilateral COD), four did not find a difference in amyloid-β between participants or hemispheres. The pooled difference in amyloid-β load between hemispheres in 24 patients with unilateral COD was not significant (SMD SUVr −0.13, 95%CI -0.70–0.43). Based on current studies, although limited and heterogeneous, there is insufficient evidence to support the hypothesis that heart disease or COD are associated with increased cerebral amyloid-β burden. • Cardiovascular disease is an important contributor to cognitive impairment. • Cardiovascular disease may impact the brain by accelerating amyloid-β accumulation. • We found no link between heart or carotid occlusive disease and amyloid-β load. [ABSTRACT FROM AUTHOR]
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- 2023
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9. Neighbourhood walkability in relation to cognitive functioning in patients with disorders along the heart-brain axis.
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Timmermans, Erik J., Leeuwis, Anna E., Bots, Michiel L., van Alphen, Juliette L., Biessels, Geert Jan, Brunner-La Rocca, Hans-Peter, Kappelle, L. Jaap, van Rossum, Albert C., van Osch, Matthias J.P., and Vaartjes, Ilonca
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WALKABILITY , *COGNITIVE ability , *EXECUTIVE function , *COGNITION disorders , *BUILT environment - Abstract
This study examined associations of neighbourhood walkability with cognitive functioning (i.e., global cognition, memory, language, attention-psychomotor speed, and executive functioning) in participants without or with either heart failure, carotid occlusive disease, or vascular cognitive impairment. Neighbourhood walkability at baseline was positively associated with global cognition and attention-psychomotor speed. These associations were stronger in patients with vascular cognitive impairment. Individuals who live in residential areas with higher walkability levels were less likely to have impairments in language and executive functioning at two-year follow-up. These findings highlight the importance of the built environment for cognitive functioning in healthy and vulnerable groups. • We assessed associations of neighbourhood walkability with cognitive functioning. • We did this in reference participants and various heart-brain axis patient groups. • Walkability was positively cross-sectionally associated with global cognition. • Higher walkability lowered the odds of impaired executive functioning at follow-up. • Some associations were stronger in patients with vascular cognitive impairment. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: a study on brain perfusion single-photon emission computed tomography with acetazolamide.
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Ken-ichi Imasakaa, Masahiro Yasaka, Eiki Tayama, and Yukihiro Tomita
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OBSTRUCTIVE lung disease diagnosis , *SINGLE-photon emission computed tomography , *COMPLICATIONS of cardiac surgery , *STROKE patients , *BRAIN concussion , *PYRAMIDAL neurons , *HEMODYNAMICS - Abstract
OBJECTIVES: Ischaemic stroke is a major complication of cardiac surgery. The optimal strategies for operating on patients with obstructive carotid and/or intracranial artery disease (CIAD) are controversial. We aimed to clarify whether single-photon emission computed tomography (SPECT) with acetazolamide, to quantify the cerebral perfusion reserve, could predict the risk of haemodynamic ischaemic stroke during cardiac surgery. METHODS: The incidence of stroke related to obstructive CIAD and the corresponding autoregulatory reserve were prospectively assessed in 514 consecutive patients who underwent elective cardiac surgery with cardiopulmonary bypass (n = 484) and off-pump coronary artery bypass grafting (n = 30) between 2009 and 2013. Preoperative cerebral blood flow and its reactivity to acetazolamide were quantitatively determined in patients (n = 88) with obstructive CIAD, diagnosed by carotid ultrasonography and/or magnetic resonance angiography. RESULTS: An impaired cerebral perfusion reserve was identified in 1 (1.1%) of the 88 patients. This patient underwent prophylactic superficial temporal artery to middle cerebral artery anastomosis 1 month before coronary artery bypass surgery. Subsequently, the patient underwent conventional coronary artery bypass surgery, without experiencing perioperative stroke. Seven (1.4%) patients died in-hospital mortality and 5 (1.0%) experienced perioperative stroke. However, no patients experienced perioperative haemodynamic ischaemic stroke. CONCLUSIONS: It is unusual for CIAD to affect the incidence of haemodynamic ischaemic stroke during cardiac surgery. Brain perfusion SPECT with acetazolamide is effective for narrowing down patients at high risk of ischaemic stroke during cardiac surgery. Meanwhile, the application of brain perfusion single-photon emission tomography should be confined only to patients with obstructive CIAD because it is an expensive examination tool. [ABSTRACT FROM AUTHOR]
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- 2015
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11. Cerebral blood flow and cognitive functioning in patients with disorders along the heart–brain axis: Cerebral blood flow and the heart–brain axis
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Leeuwis, Anna E. (author), Hooghiemstra, Astrid M. (author), Bron, Esther E. (author), Kuipers, Sanne (author), Oudeman, Eline A. (author), Kalay, Tugba (author), Niessen, W.J. (author), Leeuwis, Anna E. (author), Hooghiemstra, Astrid M. (author), Bron, Esther E. (author), Kuipers, Sanne (author), Oudeman, Eline A. (author), Kalay, Tugba (author), and Niessen, W.J. (author)
- Abstract
Introduction: We examined the role of hemodynamic dysfunction in cognition by relating cerebral blood flow (CBF), measured with arterial spin labeling (ASL), to cognitive functioning, in patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (MRI; ie, possible vascular cognitive impairment [VCI]). Methods: We included 439 participants (124 HF; 75 COD; 127 possible VCI; 113 reference participants) from the Dutch multi-center Heart–Brain Study. We used pseudo-continuous ASL to estimate whole-brain and regional partial volume-corrected CBF. Neuropsychological tests covered global cognition and four cognitive domains. Results: CBF values were lowest in COD, followed by VCI and HF, compared to reference participants. This did not explain cognitive impairment, as we did not find an association between CBF and cognitive functioning. Discussion: We found that reduced CBF is not the major explanatory factor underlying cognitive impairment in patients with hemodynamic dysfunction along the heart–brain axis., ImPhys/Medical Imaging, ImPhys/Computational Imaging
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- 2020
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12. Cerebral blood flow and cognitive functioning in patients with disorders along the heart-brain axis
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Esther E. Bron, Wiesje M. van der Flier, Wiro J. Niessen, Frederik Barkhof, Mark A. van Buchem, Albert C. van Rossum, Niels D. Prins, Matthias J.P. van Osch, Hans-Peter Brunner-La Rocca, Jacoba P. Greving, Anna E. Leeuwis, Tugba Kalay, L. Jaap Kappelle, Sanne Kuipers, Eline A. Oudeman, Geert Jan Biessels, Robert J. van Oostenbrugge, Astrid M. Hooghiemstra, MUMC+: MA AIOS Neurologie (9), Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H02 Cardiomyopathy, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, Neurology, Amsterdam Neuroscience - Neurodegeneration, Cardiology, ACS - Heart failure & arrhythmias, Radiology and nuclear medicine, APH - Personalized Medicine, APH - Methodology, Faculteit Medische Wetenschappen/UMCG, Radiology & Nuclear Medicine, and Medical Informatics
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0301 basic medicine ,medicine.medical_specialty ,small vessel disease ,Hemodynamics ,heart failure ,perfusion ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Internal medicine ,medicine ,Cognitive skill ,vascular cognitive impairment ,Research Articles ,cognitive impairment ,medicine.diagnostic_test ,business.industry ,Neuropsychology ,Magnetic resonance imaging ,Cognition ,medicine.disease ,carotid occlusive disease ,Psychiatry and Mental health ,030104 developmental biology ,Cerebral blood flow ,Heart failure ,Cardiology ,Neurology (clinical) ,business ,Perfusion ,030217 neurology & neurosurgery ,Research Article - Abstract
Introduction: We examined the role of hemodynamic dysfunction in cognition by relating cerebral blood flow (CBF), measured with arterial spin labeling (ASL), to cognitive functioning, in patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (MRI; ie, possible vascular cognitive impairment [VCI]).Methods: We included 439 participants (124 HF; 75 COD; 127 possible VCI; 113 reference participants) from the Dutch multi-center Heart-Brain Study. We used pseudo-continuous ASL to estimate whole-brain and regional partial volume-corrected CBF. Neuropsychological tests covered global cognition and four cognitive domains.Results: CBF values were lowest in COD, followed by VCI and HF, compared to reference participants. This did not explain cognitive impairment, as we did not find an association between CBF and cognitive functioning.Discussion: We found that reduced CBF is not the major explanatory factor underlying cognitive impairment in patients with hemodynamic dysfunction along the heart-brain axis.
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- 2020
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13. Perforating artery flow velocity and pulsatility in patients with carotid occlusive disease. A 7 tesla MRI study.
- Author
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Onkenhout LP, Arts T, Ferro D, Oudeman EA, van Osch MJP, Zwanenburg JJM, Hendrikse J, Kappelle LJ, and Biessels GJ
- Abstract
Patients with carotid occlusive disease express altered hemodynamics in the post-occlusive vasculature and lesions commonly attributed to cerebral small vessel disease (SVD). We addressed the question if cerebral perforating artery flow measures, using a novel 7T MRI technique, are altered and related to SVD lesion burden in patients with carotid occlusive disease. 21 patients were included with a uni- (18) or bilateral (3) carotid occlusion (64±7 years) and 19 controls (65±10 years). Mean flow velocity and pulsatility in the perforating arteries in the semi-oval center (CSO) and basal ganglia (BG), measured with a 2D phase contrast 7T MRI sequence, were compared between patients and controls, and between hemispheres in patients with unilateral carotid occlusive disease. In patients, relations were assessed between perforating artery flow measures and SVD burden score and white matter hyperintensity (WMH) volume. CSO perforating artery flow velocity was lower in patients than controls, albeit non-significant (mean difference [95% confidence interval] 0.08 cm/s [0.00-0.16]; p = 0.053), but pulsatility was similar (0.07 [-0.04-0.18]; p = 0.23). BG flow velocity and pulsatility did not differ between patients and controls (velocity = 0.28 cm/s [-0.32-0.88]; p = 0.34; pulsatility = 0.00 [-0.10-0.11]; p = 0.97). Patients with unilateral carotid occlusive disease showed no significant interhemispheric flow differences. Though non-significant, within patients lower CSO ( p = 0.06) and BG ( p = 0.11) flow velocity related to larger WMH volume. Our findings suggest that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to SVD lesion burden in these patients, although our observations need corroboration in larger study populations., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 Published by Elsevier B.V.)
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- 2022
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14. Acute Carotid Artery Stenting Versus Balloon Angioplasty for Tandem Occlusions: A Systematic Review and Meta-Analysis.
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Zevallos CB, Farooqui M, Quispe-Orozco D, Mendez-Ruiz A, Dajles A, Garg A, Galecio-Castillo M, Patterson M, Zaidat O, and Ortega-Gutierrez S
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- Carotid Artery, Internal, Humans, Intracranial Hemorrhages, Retrospective Studies, Stents, Thrombectomy adverse effects, Thrombectomy methods, Treatment Outcome, Angioplasty, Balloon adverse effects, Endovascular Procedures adverse effects, Endovascular Procedures methods, Stroke therapy
- Abstract
Background Despite thrombectomy having become the standard of care for large-vessel occlusion strokes, acute endovascular management in tandem occlusions, especially of the cervical internal carotid artery lesion, remains uncertain. We aimed to compare efficacy and safety of acute carotid artery stenting to balloon angioplasty alone on treating the cervical lesion in tandem occlusions. Similarly, we aimed to explore those outcomes' associations with technique approaches and use of thrombolysis. Methods and Results We performed a systematic review and meta-analysis to compare functional outcomes (modified Rankin Scale), reperfusion, and symptomatic intracranial hemorrhage and 3-month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random-effects model was used for analysis. Thirty-four studies were included in our systematic review and 9 in the meta-analysis. Acute carotid artery stenting was associated with higher odds of modified Rankin Scale score ≤2 (odds ratio [OR], 1.95 [95% CI, 1.24-3.05]) and successful reperfusion (OR, 1.89 [95% CI, 1.26-2.83]), with no differences in mortality or symptomatic intracranial hemorrhage rates. Moreover, a retrograde approach was significantly associated with modified Rankin Scale score ≤2 (OR, 1.72 [95% CI, 1.05-2.83]), and no differences were found on thrombolysis status. Conclusions Carotid artery stenting and a retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach, respectively, in patients with tandem occlusions. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease.
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- 2022
- Full Text
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15. Carotid artery angioplasty versus stenting for management of acute tandem occlusions.
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Garg, Aayushi, Farooqui, Mudassir, Zevallos, Cynthia B., Quispe-Orozco, Darko, Mendez-Ruiz, Alan, Zaidat, Osama, and Ortega-Gutierrez, Santiago
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CAROTID artery , *ANGIOPLASTY , *ENDOVASCULAR surgery , *INTRACRANIAL hemorrhage , *INTRACEREBRAL hematoma , *LOGISTIC regression analysis , *PERCUTANEOUS endoscopic gastrostomy , *STROKE , *ARTIFICIAL respiration - Abstract
Background The optimal approach to treat the cervical carotid artery lesion during endovascular thrombectomy (EVT) for acute strokes with tandem occlusions is unclear. While carotid artery stenting (CAS) might be a more definitive recanalization method, the potential risk of intracranial hemorrhage (ICH) limits its routine usage. In this study, we aimed to evaluate the safety outcomes of CAS and carotid artery angioplasty (CAA) in patients with acute tandem occlusions. Methods In this retrospective cohort study, data were obtained from the Nationwide Readmissions Database 2016–2017. The primary safety outcome was a composite of ICH and all-cause in-hospital mortality. Logistic regression analysis was used to compare the in-hospital outcomes. Survival analysis was used to estimate the 30-day readmissions. Results We identified 2042 hospitalizations meeting the study inclusion criteria (median age: 66 years, female 31.3%). Of these, 1391 (68.1%) had undergone CAS and 651 (31.9%) CAA alone. Baseline characteristics between the two groups were similar, except patients with CAS were more likely to be on anti-thrombotic medications and were less likely to have received intravenous thrombolysis. There was no significant difference in the clinical outcomes including ICH, in-hospital mortality, gastrostomy tube placement, prolonged mechanical ventilation, length of stay, hospital charges, and 30-day readmissions between the two groups, however, patients with CAS were more likely to be discharged home after adjusting for the confounding variables [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05–2.12, P 0.025]. Conclusion The emergent CAS-EVT approach appears to be safe with no adverse outcomes compared to CAA alone. • Acute carotid artery intervention in tandem occlusions involves stenting in most (68%) cases. • Carotid artery angioplasty and stenting for acute tandem occlusions have similar safety profile for in-hospital outcomes. • Patients with carotid artery stenting are more likely to be discharged home as compared to those with angioplasty alone. [ABSTRACT FROM AUTHOR]
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- 2021
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16. The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study
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Hooghiemstra, A.M. (Astrid M.), Bertens, A.S. (Anne Suzanne), Leeuwis, A.E. (Anna E.), Bron, E.E. (Esther), Bots, M.L. (Michiel), Brunner La Rocca, H.P. (Hans Peter), Craen, A.J. (Anton) de, Geest, R.J. (Rob) van der, Greving, J.P. (Jacoba), Kappelle, L.J. (Jaap), Niessen, W.J. (Wiro), Oostenbrugge, R.J. (Robert) van, Osch, M.J.P. (Matthias J.) van, Roos, A. (Albert) de, Rossum, A.C. (Albert) van, Biessels, G.J. (Geert Jan), Buchem, M.A. (Mark) van, Daemen, M.J.A.P. (Mat), Flier, W.M. (Wiesje) van der, Hooghiemstra, A.M. (Astrid M.), Bertens, A.S. (Anne Suzanne), Leeuwis, A.E. (Anna E.), Bron, E.E. (Esther), Bots, M.L. (Michiel), Brunner La Rocca, H.P. (Hans Peter), Craen, A.J. (Anton) de, Geest, R.J. (Rob) van der, Greving, J.P. (Jacoba), Kappelle, L.J. (Jaap), Niessen, W.J. (Wiro), Oostenbrugge, R.J. (Robert) van, Osch, M.J.P. (Matthias J.) van, Roos, A. (Albert) de, Rossum, A.C. (Albert) van, Biessels, G.J. (Geert Jan), Buchem, M.A. (Mark) van, Daemen, M.J.A.P. (Mat), and Flier, W.M. (Wiesje) van der
- Abstract
Background: Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that th
- Published
- 2017
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17. The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study
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Matthias J.P. van Osch, Mat J.A.P. Daemen, L. Jaap Kappelle, Astrid M. Hooghiemstra, Wiro J. Niessen, Robert J. van Oostenbrugge, Anne Suzanne Bertens, Jacoba P. Greving, Rob J. van der Geest, Michiel L. Bots, Anton J. M. de Craen, Anna E. Leeuwis, Geert Jan Biessels, Albert de Roos, Hans-Peter Brunner-La Rocca, Esther E. Bron, Mark A. van Buchem, Wiesje M. van der Flier, Albert C. van Rossum, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: CARIM - R2.05 - Clinical heart failure, RS: CARIM - R2.02 - Cardiomyopathy, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: CARIM - R3.03 - Cerebral small vessel disease, Neurology, Amsterdam Neuroscience - Neurodegeneration, Cardiology, ACS - Atherosclerosis & ischemic syndromes, APH - Personalized Medicine, APH - Methodology, Epidemiology and Data Science, ACS - Heart failure & arrhythmias, Amsterdam Cardiovascular Sciences, Pathology, Radiology & Nuclear Medicine, and Medical Informatics
- Subjects
Male ,PARTICIPANTS AGED 24-81 ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Neurology ,Time Factors ,Carotid occlusive disease ,Hemodynamics ,Cognitive decline ,030204 cardiovascular system & hematology ,Neuropsychological Tests ,0302 clinical medicine ,Cognition ,CAROTID-ARTERY OCCLUSION ,Carotid Stenosis ,Prospective Studies ,Cooperative Behavior ,CARDIAC TRANSPLANTATION ,Netherlands ,AMERICAN-SOCIETY ,medicine.diagnostic_test ,Brain ,Heart ,Middle Aged ,Cerebral blood flow ,Mental Status and Dementia Tests ,Prognosis ,Small vessel disease ,ALZHEIMERS-DISEASE ,Echocardiography ,Research Design ,CARDIOVASCULAR-DISEASE ,Cerebrovascular Circulation ,Cerebral hypoperfusion ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,NORMATIVE DATA ,Clinical Neurology ,Magnetic Resonance Imaging, Cine ,Physical examination ,Heart failure ,03 medical and health sciences ,Internal medicine ,Coronary Circulation ,medicine ,Journal Article ,Humans ,Medical history ,Original Paper ,Cardiovascular dysfunction ,business.industry ,Dementia, Vascular ,medicine.disease ,Cerebrovascular Disorders ,lcsh:RC666-701 ,PULSE-WAVE VELOCITY ,Physical therapy ,CEREBRAL-BLOOD-FLOW ,Interdisciplinary Communication ,Neurology (clinical) ,TRANSIENT ISCHEMIC ATTACKS ,business ,Cognition Disorders ,030217 neurology & neurosurgery ,Blood sampling - Abstract
Background: Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol. Methods: The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alzheimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines. Results and Conclusions: The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor.
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- 2017
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18. NEOVASCULAR GLAUCOMA SECONDARY TO CAROTID ARTERY ATHEROSCLEROSIS
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Bangal Surekha, Bhandari Akshay, Patil Bhushan, and Padghan Dipti
- Subjects
Intraocular pressure ,medicine.medical_specialty ,lcsh:R5-920 ,genetic structures ,business.industry ,Carotid arteries ,Carotid occlusive disease ,lcsh:R ,lcsh:Medicine ,Neovascular glaucoma ,Blood flow ,medicine.disease ,Pupil ,eye diseases ,Surgery ,Slit-lamp Examination ,Right Common Carotid Artery ,Carotid artery disease ,Ophthalmology ,medicine ,sense organs ,business ,lcsh:Medicine (General) - Abstract
A 65 year old male patient presented with pain, redness and loss of vision in right eye. Slit lamp examination revealed mid dilated, fixed pupil with rubeosisiridis. Intraocular pressure was raised in right eye. Fluroscein examination showed dye leaking in right eye anterior chamber due to iris neovascularisation. Carotid Doppler and CT carotid angiography study showed right common carotid artery atherosclerotic plaque and reduced blood flow in right central retinal artery. Proper ophthalmological evaluation of patient having carotid artery disease is essential for prevention of intractable neovascular glaucoma and permanent blindness.
- Published
- 2015
19. Cerebral blood flow and cognitive functioning in patients with disorders along the heart-brain axis: Cerebral blood flow and the heart-brain axis.
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Leeuwis AE, Hooghiemstra AM, Bron EE, Kuipers S, Oudeman EA, Kalay T, Brunner-La Rocca HP, Kappelle LJ, van Oostenbrugge RJ, Greving JP, Niessen WJ, van Buchem MA, van Osch MJP, van Rossum AC, Prins ND, Biessels GJ, Barkhof F, and van der Flier WM
- Abstract
Introduction: We examined the role of hemodynamic dysfunction in cognition by relating cerebral blood flow (CBF), measured with arterial spin labeling (ASL), to cognitive functioning, in patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (MRI; ie, possible vascular cognitive impairment [VCI])., Methods: We included 439 participants (124 HF; 75 COD; 127 possible VCI; 113 reference participants) from the Dutch multi-center Heart-Brain Study. We used pseudo-continuous ASL to estimate whole-brain and regional partial volume-corrected CBF. Neuropsychological tests covered global cognition and four cognitive domains., Results: CBF values were lowest in COD, followed by VCI and HF, compared to reference participants. This did not explain cognitive impairment, as we did not find an association between CBF and cognitive functioning., Discussion: We found that reduced CBF is not the major explanatory factor underlying cognitive impairment in patients with hemodynamic dysfunction along the heart-brain axis., Competing Interests: A.E. Leeuwis, A.M. Hooghiemstra, S. Kuipers, E.A. Oudeman, T. Kalay, H.P. Brunner La Rocca, R.J. van Oostenbrugge, W.J. Niessen, M.A. van Buchem, A.C. van Rossum: report no conflicts.E.E. Bron and J.P. Greving have been funded by the Dutch Heart Foundation.N.D. Prins serves on the advisory board of Boehringer Ingelheim and Probiodrug, and on the DSMB of Abbvie's M15‐566 trial. He has provided consultancy services for Sanofi, Takeda, and Kyowa Kirin Pharmaceutical Development. He also receives research support from Alzheimer Nederland (project number WE.03‐2012‐02) and is CEO and co‐owner of Brain Research Center, Amsterdam, the Netherlands.M.J.P. van Osch has received research funding from Philips, the Netherlands Organisation for Scientific Research (NWO), and European Union Horizon 2020 and serves on the editorial boards of JCBFM and NMR in Biomedicine.G.J. Biessels has been funded by the Dutch Heart Foundation (grant 2010T073), ZonMW (Vici grant 918.16.616), The Netherlands Organisation for Health Research and Development and European Union Horizon 2020 (grant agreement no. 666881, SVDs@target).F. Barkhof is supported by the NIHR biomedical research centre at UCLHF. Barkhof serves as a consultant for Biogen‐Idec, Janssen Alzheimer Immunotherapy, Bayer‐Schering, Merck‐Serono, Roche, Novartis, Genzyme, and Sanofi‐aventis.F. Barkhof has received sponsoring from EU‐H2020, NWO, SMSR, TEVA, Novartis, Toshiba, and Imi and serves on the editorial boards of Radiology, Brain, Neuroradiology, MSJ, and Neurology.Research programs of W.M. van der Flier have been funded by ZonMW, NWO, EU‐FP7, Alzheimer Nederland, Cardiovasculair Onderzoek Nederland, stichting Dioraphte, Gieskes‐Strijbis fonds, Pasman Stichting, Boehringer Ingelheim, Piramal Imaging, Roche BV, Janssen Stellar, Biogen, and Combinostics. All funding is paid to her institution., (© 2020 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)
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- 2020
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20. Timing of Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Snapshot of Current Trends and Systematic Review of Literature on Changing Paradigm towards Early Surgery.
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Savardekar AR, Narayan V, Patra DP, Spetzler RF, and Sun H
- Subjects
- Endarterectomy, Carotid trends, Humans, Ischemic Attack, Transient prevention & control, Prospective Studies, Risk Assessment, Risk Factors, Stents, Stroke prevention & control, Time Factors, Carotid Stenosis surgery, Endarterectomy, Carotid methods
- Abstract
Carotid revascularization has been recommended as the maximally beneficial treatment for stroke prevention in patients with recently symptomatic carotid stenosis (SCS). The appropriate timing for performing carotid endarterectomy (CEA) within the first 14 d after the occurrence of the index event remains controversial. We aim to provide a snapshot of the pertinent current literature related to the timing of CEA for patients with SCS. A systematic review of literature was conducted to study the timing of CEA for SCS. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. A total of 63 articles were identified as relevant to this topic. A summary of 15 articles favoring urgent CEA (within 48 h) for SCS within 48 h of index event and 9 articles not favoring urgent CEA is presented. A consensus is still to be achieved on the ideal timing of CEA for SCS within the 14-d window presently prescribed. The current literature suggests that patients who undergo urgent CEA (within 48 h) after nondisabling stroke as the index event have an increased periprocedural risk as compared to those who had transient ischemic attack (TIA) as the index event. Further prospective studies and clinical trials studying this question with separate groups classified as per the index event are required to shed more light on the subject. The current literature points to a changing paradigm towards early carotid surgery, specifically targeted within 48 h if the index event is TIA, and within 7 d if the index event is stroke., (Copyright © 2019 by the Congress of Neurological Surgeons.)
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- 2019
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21. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion.
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Jadhav A, Panczykowski D, Jumaa M, Aghaebrahim A, Ranginani M, Nguyen F, Desai SM, Grandhi R, Ducruet A, Gross BA, Jankowitz BT, and Jovin TG
- Subjects
- Adult, Aged, Aged, 80 and over, Angioplasty instrumentation, Cohort Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Angioplasty methods, Carotid Artery, Internal diagnostic imaging, Carotid Stenosis diagnostic imaging, Carotid Stenosis therapy, Stents
- Abstract
Introduction: Symptomatic internal carotid artery occlusion (ICAO) can lead to neurologic decline, recurrent stroke, and mortality., Objective: We sought to evaluate the safety and feasibility of endovascular revascularization for ICAO without tandem intracranial large vessel occlusion (LVO)., Design, Setting, and Participants: This is a retrospective cohort analysis of all patients presenting to a single academic center with ischemic stroke and ipsilateral cervical ICAO from November 2003 through April 2016. Patients were excluded if pre-procedural angiography demonstrated tandem LVO or if patients were known to have chronic ICAO., Main Outcomes and Measures: Study endpoints included discharge neurologic examination, post-procedural infarct burden, 3-month functional outcomes, and treatment durability., Results: A total of 107 patients with symptomatic angiographically-confirmed cervical ICAO without tandem LVO were identified. Median admission NIH Stroke Scale (NIHSS) score was 8 (IQR 11). Baseline radiographic stroke severity was assessed by ASPECT score (median 9; IQR 2), perfusion mismatch (present in 93%), and clinical imaging mismatch (42%). Median time from symptom onset to treatment was 25 hours (IQR 61). Successful revascularization was achieved in 92% of patients. At discharge, 83% had stable/improved NIHSS score, while at 3 months 65% achieved independence (modified Rankin Scale score ≤2). The most common complication was distal embolization (22%) of which 16% required intra-arterial treatment. Rate of significant restenosis (≥70%) was 15% at 1 year., Conclusions: Stenting in selected patients at risk of neurologic deterioration due to symptomatic ICAO can be performed with high rates of technical success and good clinical outcomes. Because of significant peri-procedural risks and high rates of restenosis, randomized studies are necessary to understand the benefit of this approach., Competing Interests: Competing interests: TGJ has the following disclosures: Consultant, Neuravi (steering committee -modest), Codman Neurovascular (DSMB - modest), Stryker Neurovascular (PI DAWN - unpaid), Fundacio Ictus (PI REVASCAT unpaid); stock, Anaconda, Silk Road, Blockade Medical (modest). AFD has the following disclosure: Consultant, Medtronic (device proctor - modest)., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
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22. The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study.
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Hooghiemstra AM, Bertens AS, Leeuwis AE, Bron EE, Bots ML, Brunner-La Rocca HP, de Craen AJM, van der Geest RJ, Greving JP, Kappelle LJ, Niessen WJ, van Oostenbrugge RJ, van Osch MJP, de Roos A, van Rossum AC, Biessels GJ, van Buchem MA, Daemen MJAP, and van der Flier WM
- Subjects
- Carotid Stenosis diagnosis, Carotid Stenosis epidemiology, Carotid Stenosis psychology, Cerebrovascular Circulation, Cerebrovascular Disorders diagnosis, Cerebrovascular Disorders epidemiology, Cerebrovascular Disorders psychology, Cognition Disorders diagnosis, Cognition Disorders epidemiology, Cognition Disorders psychology, Cooperative Behavior, Coronary Circulation, Dementia, Vascular diagnosis, Dementia, Vascular epidemiology, Dementia, Vascular psychology, Echocardiography, Female, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure psychology, Hemodynamics, Humans, Interdisciplinary Communication, Magnetic Resonance Imaging, Cine, Male, Mental Status and Dementia Tests, Middle Aged, Netherlands epidemiology, Neuropsychological Tests, Prognosis, Prospective Studies, Research Design, Time Factors, Brain physiopathology, Carotid Stenosis physiopathology, Cerebrovascular Disorders physiopathology, Cognition, Cognition Disorders physiopathology, Dementia, Vascular physiopathology, Heart physiopathology, Heart Failure physiopathology
- Abstract
Background: Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol., Methods: The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alz-heimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines., Results and Conclusions: The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor., (© 2017 The Author(s). Published by S. Karger AG, Basel.)
- Published
- 2017
- Full Text
- View/download PDF
23. Internal Carotid Artery S-Shaped Curve as a Marker of Fibromuscular Dysplasia in Dissection-Related Acute Ischemic Stroke.
- Author
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Haussen DC, Jadhav A, Rebello LC, Belagaje S, Anderson A, Jovin T, Aghaebrahim A, Gulati D, Wells B, Frankel M, and Nogueira RG
- Abstract
Background and Purpose: Craniocervical fibromuscular dysplasia (FMD) is associated with dissections and with S-shaped curves in the internal carotid artery (ICA). We evaluated the occurrence of S-curves in patients presenting with acute strokes due to ICA steno-occlusive dissections., Methods: This was a retrospective review of the interventional databases of two academic tertiary-care institutions. The presence of ICA S-shaped curves, C-shaped curves, 360-degree loops, as well as classic FMD and atherosclerotic changes at the ICA bulb and curve/loop was determined. Cases of carotid dissections were compared with a control group (consecutive non-tandem anterior circulation strokes)., Results: Twenty-four patients with carotid dissections were compared to 92 controls. Baseline characteristics and procedural variables were similar, with the exception of younger age, less frequent history of hypertension, diabetes, atrial fibrillation and stent retriever use in patients with dissections. The rates of mTICI2b-3 reperfusion, parenchymal hematoma, good outcome and mortality were similar amongst groups. The frequency of S-curves (any side without superimposed atherosclerosis) was 29% in the dissection group versus 7% in controls (p < 0.01). S-curves were typically mirror images within the dissection group (85% had bilateral occurrence). The frequency of C-shaped and 360-degree curves was similar between groups. FMD changes within the craniocervical arteries were statistically more common in dissection patients. Ten patients (41%) of the dissection group had S-curves or classic FMD changes. Multivariate analysis indicated that S-curves were independently associated with the presence of dissections., Conclusion: S-shaped ICA curves are predictably bilateral, highly associated with carotid dissections in patients with moderate to severe strokes, and may suggest an underlying presence of FMD.
- Published
- 2016
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24. Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: a study on brain perfusion single-photon emission computed tomography with acetazolamide.
- Author
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Imasaka K, Yasaka M, Tayama E, and Tomita Y
- Subjects
- Acetazolamide therapeutic use, Aged, Aged, 80 and over, Brain Ischemia epidemiology, Carotid Stenosis complications, Coronary Artery Bypass adverse effects, Female, Humans, Male, Prospective Studies, Stroke complications, Carotid Stenosis epidemiology, Cerebrovascular Circulation physiology, Coronary Artery Bypass statistics & numerical data, Stroke epidemiology, Tomography, Emission-Computed, Single-Photon methods
- Abstract
Objectives: Ischaemic stroke is a major complication of cardiac surgery. The optimal strategies for operating on patients with obstructive carotid and/or intracranial artery disease (CIAD) are controversial. We aimed to clarify whether single-photon emission computed tomography (SPECT) with acetazolamide, to quantify the cerebral perfusion reserve, could predict the risk of haemodynamic ischaemic stroke during cardiac surgery., Methods: The incidence of stroke related to obstructive CIAD and the corresponding autoregulatory reserve were prospectively assessed in 514 consecutive patients who underwent elective cardiac surgery with cardiopulmonary bypass (n = 484) and off-pump coronary artery bypass grafting (n = 30) between 2009 and 2013. Preoperative cerebral blood flow and its reactivity to acetazolamide were quantitatively determined in patients (n = 88) with obstructive CIAD, diagnosed by carotid ultrasonography and/or magnetic resonance angiography., Results: An impaired cerebral perfusion reserve was identified in 1 (1.1%) of the 88 patients. This patient underwent prophylactic superficial temporal artery to middle cerebral artery anastomosis 1 month before coronary artery bypass surgery. Subsequently, the patient underwent conventional coronary artery bypass surgery, without experiencing perioperative stroke. Seven (1.4%) patients died in-hospital mortality and 5 (1.0%) experienced perioperative stroke. However, no patients experienced perioperative haemodynamic ischaemic stroke., Conclusions: It is unusual for CIAD to affect the incidence of haemodynamic ischaemic stroke during cardiac surgery. Brain perfusion SPECT with acetazolamide is effective for narrowing down patients at high risk of ischaemic stroke during cardiac surgery. Meanwhile, the application of brain perfusion single-photon emission tomography should be confined only to patients with obstructive CIAD because it is an expensive examination tool., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
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