XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Vascular - and Neurosurgery/Interventinal
Neuroradiology
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Local Anaesthetic Carotid Endarterectomy in patients over eighty is as safe as for younger patients
R.J.Drummond
G.H.Welch
W.P.Stuart
Southern General Hospital, Glasgow
UNITED KINGDOM
Objective: Several large clinical trials have established the indications for carotid endarterectomy (CEA). However, patients over the age of 80 years have been excluded and there have been suggestions that older patients have poorer outcomes. We have attempted to operate on patients without age discrimination selecting by individual fitness and indications. The present data compares the outcomes of patients operated under local anaesthesia (LA) before or after their eightieth birthday. Methods: Data on indication and outcome were retrieved from patient records, and survival data were obtained from the Information Services Division (ISD) Scotland (giving dates and cause of death as per death certificate). Early outcome and longer-term survival were analysed and comparison made by age group. Results: Over a six-year period 226 LA CEA were performed on 220 patients. Nineteen patients were over 80 years. There were no significant differences in operative indications or post-operative complications between the groups, except that no patient over eighty was operated for asymptomatic disease. There was no significant difference in the median post-operative hospital stay was (1 day, for both groups, p=ns, Mann Whitney U). Longer-term survival was plotted and there was no significant survival difference between the two groups at a median of 32 months follow-up, with a trend towards better survival in the older patients. Conclusions: LA CEA appears to be at least as safe and effective for patients over-eighty years as younger patients, based upon on those patients presented to us by our referring physicians, and then selected for surgery.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Neurocognitive Assesment in Cardiovascular Surgery
C.N.Gandolfo
G.P.Povedano
R. Amor
J.A.Saggese
Churruca Hospital
ARGENTINA
In order to evaluate the effect of coronary artery by pass grafting (CABG ) and cardiac valve replacement (CVR) in cognitive status ,we performed a clinical exam , CT scan and cognitive tests (MMSE, Mesulam, Clock drawing Test, Digit Span, FAS test, Trail Making AB test and Choice reaction Time) in patients under extracorporeal circulation pump surgery. Preoperative evaluation was administered in the previous month and postoperative control was assessed within two months after surgery discharge. Results We evaluated preoperatively 32 patients, but only 25 completed the study, detecting significant changes between pre and postoperative performance in cognitive test, without variations on clinical status or CT scan . Surprisingly, we found a better perfomance in postoperative evaluation. Most significant items were : MMSE (p=0.005), Numeric Clock subtest ( p=0.001) Inverse Digit Span Test (p=0.0012). Mesulam Nonverbal subtotal score, Numeric Clock subtest score and Inverse Digital Span Test score allowed to differentiate male and female perfomance in postoperative testing. We did not perform formal evaluation on emotional status, but we detected that preoperative patients met criteria for mood disorder or anxiety disorder (293.83 or 293.89 DSM IV) that decreased or disappeared after surgery. Discussion: Tasks learning is not an feasible explanation due to the large intertest interval. Better perfomance after surgery was related to anxiety minimization or stress disspearence. Only one patient that showed a preoperative cognitive decline had a worst performance in postoperative test .
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Timing and Related Factors of In-Stent Restenosis Following Carotid Artery Stenting
S.I.Sohn
H.A.Yi
Y.W.Cho
J.G.Lim
S.D.Yi
C.H.Sohn
Dongsan Medical Center, Keimyung University
SOUTH KOREA
Background: In-stent restenosis is a serious complication following carotid artery stenting (CAS). However, Timing of in stent restenosis (ISR) and factors determining ISR are not well established. We examined timing of ISR by serial follow-up ultrasound and discussed the effect of clinical, ultrasound, procedural factors on IRS rates. Methods: Between September 2004 and February 2007, 68 carotid arteries of 64 patients underwent CAS with use of an emboli-protection device (54 men, 10 women, mean age :66.5 ± 10.3). Carotid duplex ultrasonography were scheduled to be evaluated at baseline, 5 days, 3 months, 6 months, 9 month, 12 months 18 month, and 24 months after CAS. IRS defined as peak systolic velocity > 125 cm/sec and 20% or higher compared with the prior study. Severe IRS defined as peak systolic velocity > 300 cm/sec and end diastolic velocity 90 cm/sec. We reviewed vascular risk factors, vascular imaging findings, and the procedure and findings of CAS. Results: Recanalization of ICA stenosis was technically successful in 68 of 68 procedures (100%). Sixty patients (92.3%) were followed up for 12-30 months. During follow-up period, three patients (4.7%) died. Death of three patients were related with malignancy. One stroke event was occurred but not related to CAS. IRS was found in four lesions (6.7%) at 3 month, 6 lesions (10%) at 6 month, and 7 lesions (11.7%) at 12 month after CAS. In univariable analysis, IRS is only associated with inappropriate control for vascular risk factors (P=0.02). Conclusion: These data suggest that patients underwent CAS needs serial follow up ultrasound study within 6 months after CAS. Also intensive vascular risks controll after CAS is important to prevent of IRS.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
PATTERNS OF BRAIN ARTERIOVENOUS MALFORMATION TREATMENT: PROSPECTIVE, POPULATION-BASED STUDY
J. van Beijnum
J.J.Bhattacharya
C.E.Counsell
V. Papanastassiou
V. Ritchie
R.C.Roberts
R.J.Sellar
C. Warlow
R. Al-Shahi Salman
Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh
THE NETHERLANDS
Background – Only North American guidelines concerning the interventional treatment of brain arteriovenous malformations (AVMs) have been published. For comparison, we explored patterns of treatment at four neuroscience centres in one European country. Methods – We included every participant with an AVM in a prospective, population-based cohort study of Scottish residents, aged ≥16 years, at the time of their AVM diagnosis in 1999-2003 inclusive. Results – Patients who were managed at one of the four neuroscience centres in the population were significantly younger (median 47 versus 70 years, p = 0.002) and more likely to have symptomatic AVMs (odds ratio [OR] 3.8, 95%CI 1.1 to 13.2) than those who were not referred. The only difference between all the patients seen at the four centres was in AVM Spetzler-Martin grade (p=0.04). Patients who received interventional treatment were younger (median 43 versus 54 years, p = 0.0000005), more likely to have presented with haemorrhage (OR 2.8, 95%CI 1.6 to 4.9), and had smaller AVMs (median 2cm versus 3cm, p = 0.003) than those who were not treated. The four centres differed significantly in the Spetzler-Martin grade of the AVMs they treated (p = 0.002), and the interventional treatments used (p = 0.004). Discussion – Patient characteristics and patterns of interventional treatment for AVMs differ between neuroscience centres in the same population, necessitating careful consideration of these factors when comparing one hospital’s outcome with another.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Systematic review of the 30-day risks of carotid angioplasty stenting in symptomatic and asymptomatic patients
E. Touzé
L. Trinquart
G. Chatellier
J.P.Becquemin
J.-L.Mas
Hôpital Sainte-Anne
FRANCE
Background - Reliable data on the risks of carotid angioplasty and stenting (CAS) are needed for comparison with endarterectomy. Methods - We performed a systematic review of all studies published since 1990 and unpublished data (identified from electronic databases and by hand-searching reference lists) that reported the 30-day risk of stroke, death, and myocardial infarction (MI) resulting from CAS. We assessed risks according to clinical indication (symptomatic vs. symptomatic) and study characteristics. Results - In preliminary analyses of 54 published and 5 unpublished studies which enrolled >=100 patients from independent populations, the absolute pooled 30-day risk of stroke was 3.7% (95% CI, 3.2-4.4; I2=82%; phet<0.0001 - 53 studies), that of stroke or death 4.6% (3.9-5.3; I2=77%; phet<0.0001 - 47 studies), and that of stroke, death, or MI 5.2% (4.4-6.0; I2=72%; phet<0.0001 - 27 studies). The 30-day risk of stroke or death was higher in studies in which patients were systematically assessed by a neurologist after CAS than in studies were there was no such assessment or no clear information on assessment (table). Symptomatic patients had a significantly higher risk of stroke (RR=2.1, 1.5-2.8; I2=35%; phet=0.15) or stroke or death (RR=2.0, 1.4-2.7; I2=61%; phet=0.01) (table). There was no temporal trend in the risk of stroke or death. Final results, updated with smaller studies, will include more subgroup analyses. Conclusion - The reported risks of CAS vary considerably. Heterogeneity can be partly accounted for by differences in study methodology and clinical indication.
http://www.eurostroke.org/ni_graphics/t_aid3052.htm
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Improved cerebrovascular reactivity following Carotid Endarterectomy: a BOLD hypercapnia study
S.D.Goode
N. Altaf
S.T.MacSweeney
D.P.Auer
Queens Medical Centre, Nottingham
UNITED KINGDOM
Introduction In patients with symptomatic carotid artery disease the predominant mechanism causing ischaemic injury is considered to be thromboembolic, however carotid stenosis and occlusion can also compromise cerebral haemodynamics. In particular stenotic disease can decrease CBF and Cerebrovascular Reserve (CVR) in the ipsilateral hemisphere. Removal of the embolic source is accepted as the major benefit from Carotid Endarterectomy (CEA), however improvement in cerebral haemodynamics may be another beneficial outcome as suggested by TCD. BOLD hypercapnia fMRI can be used to map the cerebrovascular reactivity in more detail. The aim of this study was to assess the effects of carotid surgery on CVR in patients with carotid artery disease using hypercapnia BOLD fMRI. Methods 16 patients with symptomatic internal carotid artery stenosis were scanned using a clinical 1.5T Intera (Philips, Best, Netherlands) MR scanner. Scanning was done immediately prior and between 4-8 weeks after CEA. 8 % carbon dioxide was administered to achieve transient episodes of hypercapnia, with all patients undergoing a 9 minute long paradigm consisting of 2 periods of hypercapnia (lasting 2 minutes 20 seconds) and 3 periods of normocapnia (air). The data was analyzed using FSL software to derive percentage signal change (%SC) for the grey matter of the middle cerebral artery (MCA) territory for both hemispheres. Results We found a significant improvement in ipsilateral MCA territory CVR following CEA; Preop – Mean %SC 2.57 [SD 0.35] versus postop – Mean %SC 2.74 [SD 0.32], p=0.02 (Paired T-Test). There was no improvement in CVR in the contralateral MCA territory; Preop – mean %SC 2.64 [SD 0.46) versus postop – Mean %SC 2.69 [SD 0.33], p=0.62 (Paired T-Test). Conclusion CEA resulted in improved ipsilateral cerebrovascular reserve capacity in patients with symptomatic high-grade carotid artery disease. These findings suggest haemodynamic benefits by CEA in addition to removing the embolic source.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Factors associated with 30-day perioperative risk of stroke or death after carotid angioplasty stenting (CAS): results from the EVA-3S randomized
E. Touzé
O. Naggara
L. Trinquart
B. Beyssen
H. Rousseau
J.-P.Favre
D. Krause
J. Drouineau
S. Bracard
J.-L.Mas
Hôpital Sainte-Anne
FRANCE
Background - Risk factors for perioperative complications associated with carotid angioplasty and stenting (CAS) are not well known. Methods - We assessed clinical, anatomical, and technical factors potentially associated with 30-day perioperative stroke or death in 260 patients randomized in the CAS arm of the EVA-3S trial. Angiograms of CAS procedures were reviewed independently by 2 radiologists, blinded to clinical outcome. Results - Within 30 days following CAS, 25 (9.6%) patients had a nonfatal stroke or died (n=2). 19 (76%) events occurred during (n=17) or within the 48 hours (n=2) of the procedure. Patients who had complications were more likely to have a history of any stroke (RR=3.2; 95%CI, 1.5-6.9), a history of coronary revascularization (RR=2.5; 1.1-5.6), a cerebral vs. an ocular event (RR=2.0; 0.5-8.0), an ischaemic stroke vs. a TIA (RR=2.0; 0.9-4.5). Age and gender had no effect. Looking at anatomical factors, calcified stenosis (RR=2.4; 0.7-8.0), greater internal carotid artery angulation (30-59° vs <30°: RR=1.6, 0.3-3.1 and >=60° vs <30°: RR=4.7; 1.6-13.5), aortic atheroma (1.6; 0.5-5.1), and type C aortic arch (RR=1.5; 0.5-5.1) were more frequent in patients with ischaemic events occurring within 2 days of CAS. Operator experience had no effect. Regarding technical factors, patients with complications were more likely to have had unprotected CAS (RR=3.2; 1.3-7.7), balloon vs. filter type protection (RR=2.3; 0.5-10.1), and open- vs. closed-cells stents (RR=2.0; 0.8-5.3). Conclusion - Taking into account clinical and anatomical factors may help to improve the safety of CAS.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Long Term Survival Following Carotid Endarterectomy Under Local Anaesthesia
R.J.Drummond
G.H.Welch
W.P.Stuart
Southern General Hospital, Glasgow
UNITED KINGDOM
Objective: The indications for carotid endarterectomy (CEA) are well established by clinical trials. However the development of local anaesthetic (LA) techniques may have allowed a perceived risk reduction for CEA, perhaps resulting in operation to patients whose life expectancy (due to co-morbidity) is too short to accrue meaningful benefit. Accordingly, we examined the medium to long-term survival of our patients. Method: Survival data on two hundred and twenty-six consecutive cases of CEA under LA were obtained from the Information Services Division (ISD) Scotland, giving dates of death and the cause of death as per death certificate. Survival curves were plotted. Results: There were 226 procedures on 80 female (36%) and 140 male patients (64%). The median age of the patients was 69 years (range 40-86). The indications for surgery were transient ischaemic attack in 96 (42.5%) cases, cerebrovascular accident (CVA) in 79 (35%), and amaurosis fugax in 35 (15.5%). Sixteen (7%) patients were technically asymptomatic. There was one early death (25 days). Four patients (1.8%) suffered a disabling CVA with a further eight (3.5%) suffering a minor CVA. Median follow-up was 958 days (range 25-2409). There were 27 deaths reported (11.9%). Of these, eight were due to cardiac disease and eight secondary to malignancy. Only four deaths were from CVA of any type. The overall death rate was 0.34% per month. Conclusion: The immediate outcomes compare favourably with trial data. The longer-term survival is also in accordance with that presented by the major trials conducted over the last 20 years.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Balloon assisted-coiling technique does not increase procedural or embolic complications in the coiling of intracranial aneurysms
J. Perl II
J. Fease
D. Tubman
Abbott Northwestern Hospital, Minneapolis, MN
USA
Background: Balloon remodeling is an important adjunctive technique used in the endovascular coil treatment of cerebral aneurysms. Recent publications have questioned the safety of this technique. The objective of this study was to asses the safety of modern balloon devices adjunctive to cerebral aneurysm coiling by evaluating procedural complications. Methods: 471 consecutive aneurysm coiling procedures after the introduction of the modern EV3® Hyperglide and Hyperform balloon device were evaluated for complications including procedural thromboembolic cerebrovascular accident (CVA) and aneurysmal rupture. Thromboembolic CVAs were characterized as emboli that resulted in a clinical or imaging stroke. 320 aneurysms were coiled using balloon assistance with EV3 Hyperglide or Hyperform balloons (96 ruptured), 151 were coiled without balloon assistance (101 ruptured). Results: In ruptured aneurysms coiled with balloon assistance thromoembolic CVAs complications and procedural ruptures occurred 4.17% (4/96) and 3.12% (3/96), and in unruptured aneurysms 0.45% (1/224) and 2.68% (6/224), respectively. In ruptured aneurysms coiled without balloon assistance these complications occurred in 7.92% (8/101) and 1.98% (2/101) of aneurysms, and 0.00% and 2.00% (1/50) of unruptured aneurysms, respectively. There was no statistically significant difference between the complications of the groups when comparing ruptured and unruptured aneurysms. Discussion: The use of modern balloon devices in the balloon-assisted technique in coiling of cerebral aneurysms does not lead to an increase in embolic or procedural complications compared to aneurysms coiled without the use of this technique.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Carotid Angioplasty and Stenting in Developing Countries: Experience from Mainland China
G. Xu
X. Liu
R. Zhang
Q. Yin
Jinling Hosptital, Nanjing University School of Medicine
CHINA
BACKGROUND: Carotid endarterectomy (CEA) is a surgical intervention for treating exracranial carotid stenosis. Although feasibility of CEA has been proved, its practice in developing countries, with China as an example, is very limited due to the shortage of skilled vascular surgeons. Carotid angioplasty and stenting (CAS) is a new endovascular technique developed for treating carotid stenosis. Its efficacy in patients at high risk for CEA has been proved by multicenter randomized trials. CAS is clinically more feasible in developing countries, because it is relatively simple technically than CEA. These unique situations in developing countries require a study to directly compare CAS with best medical treatment in patients with carotid stenosis. METHODS: A tandem comparison was designed to evaluate the safety and efficacy of CAS and best medical treatment. Patients with symptomatic stenosis more than 50% or asymptomatic stenosis more than 70% in extracranial carotid were selected as subjects. All enrolled patients were treated according to the established guidelines. Additionally, patients enrolled between July 1, 2002 and December 31, 2003 were treated with only medications; while patients enrolled between January 1, 2004 and December 31, 2006 were treated with CAS. Patients in both groups were followed for one year. Any cerebrovascular events and suspected adverse events were recorded. RESULTS: A total of 170 patients with extracranial carotid stenois were enrolled, of which 79 were treated with CAS and 91 without CAS. During the one year follow-up, 6 (7.6%) patients treated with CAS and 13 (14.3%) without CAS developed one or more cerebral ischemic events. Stroke/TIA incidence in patients without CAS was higher than that in patients with CAS (p<0.05). There were 4 (5.6%) deaths in CAS treated patients, and 7 (7.7%) deaths in medicine treated patients in the first year after the enrollment (p = 0.35). CONCLUSION: Compared with medical treatment, CAS may decrease stroke/TIA incidence in patients with extracranial carotid stenosis.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Complex shaped coil system (Guglielmi detachable coils(GDC)® 360º) results in greater angiographic occlusion durability compared to traditional GDC coils
J. Perl II
J. Fease
D. Tubman
Abbott Northwestern Hospital
USA
Background: The technology for endovascular treatment of cerebral aneurysms is evolving. Complex shaped coils were developed to increase the durability of aneurysm occlusion. This study’s objective is to assess if the aneurysms treated with complex coil shape have greater durable angiographic occlusion compared to those treated with traditional helical coils. Methods: 144 aneurysms were treated with GDC 360º coils and 147 aneurysms were treated with helical GDC coil system. Control post-coiling angiograms were compared to 1st follow-up (<12 months) and second follow-up angiograms (>12 months) after the initial treatment. Occlusion was classified as complete occlusion, neck remnant (filling at aneurysm neck but no room for additional coil), and residual filling (room for additional coil). Balloon remodeling was used in 59% of the cases. Packing density was calculated for each aneurysm using consistent methodology. Results: First and 2nd follow-up angiograms showed 73% and 71% complete occlusion for aneurysms coiled with GDC 360º and helical GDC showed 59% and 53%, respectively. Initially post-procedure, GDC 360º had 72.8% and helical GDC had 59.8% complete occlusion. Helical GDC showed 26% residual filling at 1st follow-up and GDC 360º showed 6%. Rupture status and the use of balloon assistance showed the same angiographic trends when these results were compared. The packing density was 32% in both groups with no statistically significant difference in ruptured and unruptured aneurysms or between aneurysm volumes. Discussion: The GDC 360º coiled aneurysm has better angiographic occlusion and durability compared to standard GDC coil design (similar packing densities). This implies that complex coil design results in better aneurysm neck coverage than standard helical coils.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Angioplasty with stent for post-irradiation extra-cranial stenosis
T.W.Leung
S. Yu
A. Lau
Y. Chan
W. Lam
K.S.Wong
Prince of Wales Hospital, The Chinese University of Hong Kong
HONG-KONG
Background and Purpose: Many long-term survivors of primary pharyngeal and laryngeal malignancy suffer from refractory transient ischemic attacks (TIA) and strokes from extensive post-irradiation extracranial stenoses which are not amenable for endarectomy. Methods: Fifty patients who had refractory TIA and/or strokes attributed to high grade (≥70%) post-irradiation extra-cranial stenosis consecutively underwent angioplasty with stent from Jan 2006 to Dec 2007. Results: Angioplasty was performed for 60 culprit lesions, distributing at common carotid artery (n= 13); proximal internal carotid artery (n=46), and vertebral artery ostium (n=1). In patients with bilateral carotid stenoses, angioplasty was performed on both sides in one session. Technical success (residual stenosis <30%) was attained in all lesions. 30-day stroke and death was 2% (TIA=1). In a mean follow-up of 14 months, no further TIA or stroke was recorded. Conclusion: Angioplasty with stent appears to be an effective treatment for post-irradiation symptomatic extra-cranial stenosis, and bilateral lesions can be treated in one session.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Posterior circulation revascularization by microvascular anastomosis via supracerebellar transtentorial approach: cases and results
Y. Yonekawa
M. Curcic
C. Muroi
E. Keller
University Hospital Zürich
SWITZERLAND
Background: Microvascular revascularization of the posterior circulation is an infrequent procedure. We present our cases submitted to the occipital artery OA -superior cerebellar artery SCA or -posterior cerebral artery PCA bypass during the last 13.5 years, the results along with discussion on its indication, technique and importance. Cases and methods: Among 250 times microvascular revascularization procedures on 173 cases (atherosclerosis 76, Moyamoya angiopathy 47, aneurysm 45, skull base tumor 5), 13 times on 13 cases were those for the posterior circulation revascularization. The OA-SCA and OA-PCA bypasses were performed on 4 and 1 cases respectively. Indication was based on symptoms, angiography and 15H2O-PET. Surgery was done via supracerebellar transtentorial approach in sitting position: linear skin incision over the OA, paramedian suboccipital craniotomy and microvascular anastomosis between the OA and the SCA or the PCA. Representative cases: Case 1: 20-year-old female suffered from headache, nausea, dizziness, deterioration of cognitive function and blacking out almost everyday. Symptoms improved as she lay down. Angiography revealed a dysplastic left internal carotid artery (fibromuscular dysplasia), stenosis of the middle cerebral artery MCA along with aplasia of the left vertebral artery. The OA-SCA bypass and the superficial temporal artery-MCA bypass were constructed on the left side. The patient recovered almost free from complaints. Examination 3 months later, revealed patent bypasses and improved CBF. Case 2: 48-year-old female presented with subarachnoid hemorrhage due to ruptured basilar artery-SCA aneurysm. The aneurysm could not be clipped directly as the SCA originated from the aneurysm dome. The OA-SCA bypass and aneurysm coiling procedures were successfully performed in 2 sessions. The patient recovered without deficits. Conclusion: Application of posterior circulation revascularization through this approach should be kept in mind in some special situation in order to prevent disastrous ischemia of the posterior circulation.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
ENDOVASCULAR TREATMENT IN EXTRACRANIAL CAROTID SUBACUTE OCCLUSION
L. Benavente
S. Calleja
A. Gil
P. Vega
E. Murias
C.H.Lahoz
Hospital Universitario Central de Asturias
SPAIN
BACKGROUND. The high morbidity and mortality related to the stroke secondary to the internal carotid artery occlusion is well-known. In this context, carotid endovascular recanalization is an alternative in patients selected very carefully. Preliminary promising data are being reported. OBJECTIVE. Report our experience with endovascular carotid recanalizations in stroke patients related to cervical carotid occlusion. Analyse safety and efficacy of this technique. PATIENTS AND METHODS. Patients with carotid occlusion led to subtraction digital angiography with intention to revascularization, recorded in a period of eighteen months. There were seven patients who suffered clinical fluctuations, lead to endovascular treatment in a subacute phase of the stroke. RESULTS. Carotid recanalization with angioplasty an stenting was possible in six patients (efficacy 85,7%). Every patient treated reached the clinical stabilization. M-Rankin at 30 days was <= 1 in four patients and 3 in the other three patients. There were a total of two complications: a yatrogenic carotid dissection clinically asymptomatic, an asympthomatic intracranial haemorrhage. CONCLUSIONS. Endovascular carotid recanalization in well selected patients is technically possible with acceptable complication rates and excellent clinical results, having into account the devastating natural history of this pathology. It has promising results in efficacy and safety. Larger studies are needed to determine which patients would benefice more to undergo to this treatment.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Intensity of the inflammatory response to carotid artery endarterectomy or stent implantation
G. Gromadzka
A. Kobayashi
W. Czepiel
P. Bialek
A. Czlonkowska
Institute of Psychiatry and Neurology; Medical University
POLAND
Background and purpose: The interventional profilactics of acute ischemic incidents in patients with symptomatic cartodid artery atherosclerosis contains two different methods: endartherectomy (E) and angioplasty (A). Experimental and clinical studies have indicated that vascular intervetions are accompanied by the inflammatory process. The extent of inflammatory response might contribute to in-stent restenosis. We aimed to compare serum levels of C-reactive protein (CRP): a well-known marker of systemic inflammation, between patients who underwent A and stenting (AS) of the carotid artery and these after E. Material and methods: 21 E patients, and 33 AS patients were analyzed. Duplex ultrasonography was used to assess the baseline location, grade, extent, and morphology of stenosis in the carotid arteries. All interventions were performed according to a standardized protocol. Blood samples were collected one day before the procedure, and 24 hours, 72 hours, 1 month and 6 months afterwards. CRP was measured with a high-sensitivity assay. Results: Preprocedural CRP was not correlated with the grade of stenosis nor with intima-media thickness of the treated carotid artery. Significant increase of CRP was noticed at the first day after the procedure (median: 11.5mg/dL, compared to baseline: 2.5mg/dL). More extensive increase was detected at the 3rd day (median: 20.6mg/dL). CRP measurements after 1 month and 6 months did not differ from baseline values. E was associated with a similar time course of postinterventional CRP compared with the course of these values after AS. However, at the 3rd day a more pronounced increase in CRP level was noted after AS (22.5mg/dL vs. 15.2mg/dL); relatively to baseline values: 10-fold increase in the AS group, and 5-fold in the E group were detected. Higher acute CRP increases were noticed in patients with a positive history of stroke, as well as in smokers. Low number of patients with restenosis did not allow us to perform reliable statistical analysis aimed to evaluate association between serum CRP and risk of restenosis. Conclusion: Vascular injury after carotid AS or E induces a systemic inflammation. The intensity of the inflammatory response to stent implantation in terms of CRP increase seems be higher than the response to E. Thus, possibly, patients after AS may demand more aggressive anti-inflammatory treatment than these after E.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Angioplasty-stenting of symptomatic basilar stenosis in patients resistant to optimal medical prevention
The Lyon Stroke Unit Experience
I.C.Ralea
N. Nighoghossian
F. Tahon
L. Derex
S. Cakmak
P. Trouillas
F. Turjman
Cerebrovascular Unit, Lyon
FRANCE
Abstract Intracranial angioplasty stenting may be an efficient therapy. We present our experience in angioplasty stenting of patients with symptomatic vertebrobasilar artery stenosis unresponsive to optimal medical therapy.We report a retrospective analysis of 12 consecutive patients with vertebrobasilar stenosis All patients underwent a percutaneous endovascular balloon angioplasty and stent placement. Results:The study included 12 cases (8 men, 4 women), age range 43-78 years (mean 62,6± years). Intracranial stenosis involved the vertebral artery (n=4), lower basilar artery (n=1) and mid-basilar artery (n=5). Tandem stenosis included intracranial vertebral artery and basilar artery (n=1) and both intracranial vertebral arteries (n=1). The degree of stenosis ranged between 70 and 90% in basilar and vertebral artery. Angioplasty-stenting was performed in all lesions. A successful reduction of the stenosis to <50% occurred in 12 vessels. Periprocedural adverse event occurred in one case and was related to a brain haemorrhage. Mean patients follow-up was 12±3 months; 11 patients remained symptom-free . Conclusions: This study supports the safety and the potential efficiency of stent-assisted angioplasty in patients resistant to optimal prevention. Randomized larger prospective trials are needed to confirm the benefit of this approach.
