STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY?
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.52 |
Resumo: | Acute ischemic stroke as a result of tandem occlusion, is defined as a combination of internal cervical carotid artery (ICA) stenosis with synchronous intracranial thrombus and accounts for about 10–20% of all strokes. Nevertheless, their approach remains controversial and variable according to the center's experience. The aim of any stroke treatment must be to successfully revascularize as soon as possible. In tandem occlusion, the primary cause of symptoms and clinical outcome is thrombus in the intracranial arteries rather than the occlusion of the cervical ICA. Today, standard of care for such intracranial lesions is mechanical thrombectomy with stent retriever combined with thrombolysis. However, distal access is hampered by the ICA stenosis/occlusion. The objective of this review was to evaluate the clinical importance and risks associated with emergent revascularization of the internal carotid artery using angioplasty and stenting in tandem occlusions. With this purpose a revision of existing literature was performed using Medline database. Surpassing an extra-cranial ACI lesion with subsequent stent placement seems to have a high recanalization rate, but it is time-consuming, thus delaying the time for distal recanalization and potentially conditioning less favorable neurological outcomes. In the literature, there is no evidence of patient outcome improvement with emergent stent placement in regard to intracranial recanalization (Thrombolysis in Cerebral Infarction≥2b), clinical outcome (modified Rankin Scale ≤2) and mortality rate at 90 days. Additionally, emergent stent placement exposes the patient to the additional risk of stroke associated with the procedure and intracranial hemorrhage. We therefore conclude that currently, there is no evidence in the literature to support emergent carotid stenting in stroke due to tandem occlusions. |
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STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY?ACIDENTE VASCULAR CEREBRAL EM DOENTES COM LESÕES EM TANDEM: QUAL A IMPORTÂNCIA CLÍNICA E O RISCO DA REVASCULARIZAÇÃO EMERGENTE DA ARTÉRIA CARÓTIDA INTERNA EXTRACRANIANA?Acute ischemic strokeTandem occlusionEmergent carotid stentingAngioplasty-assisted mechanical thrombectomyAcidente Vascular CerebralLesões síncronasStent carotídeo emergenteTrombectomia mecânica assistida por angioplastiaAcute ischemic stroke as a result of tandem occlusion, is defined as a combination of internal cervical carotid artery (ICA) stenosis with synchronous intracranial thrombus and accounts for about 10–20% of all strokes. Nevertheless, their approach remains controversial and variable according to the center's experience. The aim of any stroke treatment must be to successfully revascularize as soon as possible. In tandem occlusion, the primary cause of symptoms and clinical outcome is thrombus in the intracranial arteries rather than the occlusion of the cervical ICA. Today, standard of care for such intracranial lesions is mechanical thrombectomy with stent retriever combined with thrombolysis. However, distal access is hampered by the ICA stenosis/occlusion. The objective of this review was to evaluate the clinical importance and risks associated with emergent revascularization of the internal carotid artery using angioplasty and stenting in tandem occlusions. With this purpose a revision of existing literature was performed using Medline database. Surpassing an extra-cranial ACI lesion with subsequent stent placement seems to have a high recanalization rate, but it is time-consuming, thus delaying the time for distal recanalization and potentially conditioning less favorable neurological outcomes. In the literature, there is no evidence of patient outcome improvement with emergent stent placement in regard to intracranial recanalization (Thrombolysis in Cerebral Infarction≥2b), clinical outcome (modified Rankin Scale ≤2) and mortality rate at 90 days. Additionally, emergent stent placement exposes the patient to the additional risk of stroke associated with the procedure and intracranial hemorrhage. We therefore conclude that currently, there is no evidence in the literature to support emergent carotid stenting in stroke due to tandem occlusions. O acidente vascular cerebral (AVC) isquémico agudo no contexto de lesões síncronas, define-se como a combinação de estenose da artéria carótida interna (ACI) extra-craniana com trombo intracraniano. Apesar de corresponder a cerca de 10–20% de todos os AVC, a sua abordagem permanece controversa e variável de acordo com a experiência do centro. Na literatura, é consensual que a lesão com implicação imediata mais importante na apresentação clínica aguda é o trombo intracraniano. A revascularização intracraniana deve ser o mais célere possível, estando demonstrada a superioridade da trombectomia mecânica com stent retriever na oclusão de grande vaso da circulação anterior quando comparadas com a trombólise isolada. No entanto, no contexto de lesão aterosclerótica carotídea síncrona, é controverso o benefício e perfil de segurança do stent carotídeo emergente concomitante. O objetivo da presente revisão foi avaliar a importância clínica e os riscos associados a revascularização emergente da artéria carótida interna com recurso a angioplastia e stenting no contexto de lesões síncronas. Com esse objetivo foi realizada uma revisão da literatura existente utilizando a base de dados da Medline. Ultrapassar uma lesão da ACI extra-craniana e colocação de stent emergente parece ter uma elevada taxa de recanalização, mas é um procedimento time-consuming, podendo assim atrasar o tempo para a recanalização distal e potencialmente condicionar resultados neurológicos menos favoráveis. Na literatura, não existe evidência de uma melhoria do outcome do doente com o recurso a stent emergente no que concerne a recanalização intracraniana (Thrombolysis in Cerebral Infarction≥2b), outcome clínico (modified Rankin Scale≤2) e taxa de mortalidade aos 90 dias. Adicionalmente, expõe o doente a risco de complicações como AVC associado ao procedimento e hemorragia intracraniana. Conclui-se assim não existir atualmente evidência na literatura que suporte a realização de stenting carotídeo emergente no contexto de AVC devido a lesões síncronas.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2017-12-30T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.52oai:ojs.acvjournal.com:article/52Angiologia e Cirurgia Vascular; Vol. 13 No. 4 (2017): December; 57-63Angiologia e Cirurgia Vascular; Vol. 13 N.º 4 (2017): Dezembro; 57-632183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://acvjournal.com/index.php/acv/article/view/52https://doi.org/10.48750/acv.52http://acvjournal.com/index.php/acv/article/view/52/70Copyright (c) 2017 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCoelho, AndreiaLobo, MiguelGouveia, RicardoSilveira, DiogoCampos, JacintaAugusto, RitaCoelho, NunoSemião, Ana CarolinaPinto, EveliseCanedo, Alexandra2022-05-23T15:09:59Zoai:ojs.acvjournal.com:article/52Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:27.935855Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? ACIDENTE VASCULAR CEREBRAL EM DOENTES COM LESÕES EM TANDEM: QUAL A IMPORTÂNCIA CLÍNICA E O RISCO DA REVASCULARIZAÇÃO EMERGENTE DA ARTÉRIA CARÓTIDA INTERNA EXTRACRANIANA? |
title |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
spellingShingle |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? Coelho, Andreia Acute ischemic stroke Tandem occlusion Emergent carotid stenting Angioplasty-assisted mechanical thrombectomy Acidente Vascular Cerebral Lesões síncronas Stent carotídeo emergente Trombectomia mecânica assistida por angioplastia |
title_short |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
title_full |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
title_fullStr |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
title_full_unstemmed |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
title_sort |
STROKE IN PATIENTS WITH TANDEM LESIONS: WHAT IS THE CLINICAL SIGNIFICANCE AND SAFETY OF EMERGENT REVASCULARIZATION OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY? |
author |
Coelho, Andreia |
author_facet |
Coelho, Andreia Lobo, Miguel Gouveia, Ricardo Silveira, Diogo Campos, Jacinta Augusto, Rita Coelho, Nuno Semião, Ana Carolina Pinto, Evelise Canedo, Alexandra |
author_role |
author |
author2 |
Lobo, Miguel Gouveia, Ricardo Silveira, Diogo Campos, Jacinta Augusto, Rita Coelho, Nuno Semião, Ana Carolina Pinto, Evelise Canedo, Alexandra |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Coelho, Andreia Lobo, Miguel Gouveia, Ricardo Silveira, Diogo Campos, Jacinta Augusto, Rita Coelho, Nuno Semião, Ana Carolina Pinto, Evelise Canedo, Alexandra |
dc.subject.por.fl_str_mv |
Acute ischemic stroke Tandem occlusion Emergent carotid stenting Angioplasty-assisted mechanical thrombectomy Acidente Vascular Cerebral Lesões síncronas Stent carotídeo emergente Trombectomia mecânica assistida por angioplastia |
topic |
Acute ischemic stroke Tandem occlusion Emergent carotid stenting Angioplasty-assisted mechanical thrombectomy Acidente Vascular Cerebral Lesões síncronas Stent carotídeo emergente Trombectomia mecânica assistida por angioplastia |
description |
Acute ischemic stroke as a result of tandem occlusion, is defined as a combination of internal cervical carotid artery (ICA) stenosis with synchronous intracranial thrombus and accounts for about 10–20% of all strokes. Nevertheless, their approach remains controversial and variable according to the center's experience. The aim of any stroke treatment must be to successfully revascularize as soon as possible. In tandem occlusion, the primary cause of symptoms and clinical outcome is thrombus in the intracranial arteries rather than the occlusion of the cervical ICA. Today, standard of care for such intracranial lesions is mechanical thrombectomy with stent retriever combined with thrombolysis. However, distal access is hampered by the ICA stenosis/occlusion. The objective of this review was to evaluate the clinical importance and risks associated with emergent revascularization of the internal carotid artery using angioplasty and stenting in tandem occlusions. With this purpose a revision of existing literature was performed using Medline database. Surpassing an extra-cranial ACI lesion with subsequent stent placement seems to have a high recanalization rate, but it is time-consuming, thus delaying the time for distal recanalization and potentially conditioning less favorable neurological outcomes. In the literature, there is no evidence of patient outcome improvement with emergent stent placement in regard to intracranial recanalization (Thrombolysis in Cerebral Infarction≥2b), clinical outcome (modified Rankin Scale ≤2) and mortality rate at 90 days. Additionally, emergent stent placement exposes the patient to the additional risk of stroke associated with the procedure and intracranial hemorrhage. We therefore conclude that currently, there is no evidence in the literature to support emergent carotid stenting in stroke due to tandem occlusions. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-12-30T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.52 oai:ojs.acvjournal.com:article/52 |
url |
https://doi.org/10.48750/acv.52 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/52 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/52 https://doi.org/10.48750/acv.52 http://acvjournal.com/index.php/acv/article/view/52/70 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 13 No. 4 (2017): December; 57-63 Angiologia e Cirurgia Vascular; Vol. 13 N.º 4 (2017): Dezembro; 57-63 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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