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Direct carotid puncture in acute ischaemic stroke intervention

Stroke & Vascular Neurology 2020年第1期5卷 71-79页

作者： Elisa Colombo Lorenzo Rinaldo giuseppe lanzino Neurologic Surgery Mayo ClinicRochesterMinnesotaUSA

Endovascular intervention for acute ischaemic stroke care is mostly performed in older patients,often with unfavourable aortic and supra-aortic anatomy,as well as cardiovascular comorbidities.A significant subset of them may benefit from transcervical access as the initial approach for mechanical *** fact,direct carotid artery puncture in these cases has the advantage to bypass the anatomical obstacles and achieve faster *** is advised when common carotid artery access is pursued in order to avoid adverse events,including haematoma formation,iatrogenic arterial dissection and sheath *** spite of potential complications,direct carotid puncture in acute ischaemic stroke intervention overcomes challenging angioarchitecture and may reduce the rate of poor clinical outcomes associated with delayed revascularisation in certain cases.

关键词： carotid puncture anatomy

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Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis

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Stroke & Vascular Neurology 2022年第1期7卷 6-12页

作者： Anthony Larson Valentina Nardi Waleed Brinjikji John Benson giuseppe lanzino Luis Savastano Department of Radiology Mayo ClinicRochesterMinnesotaUSA Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Objective To systematically analyse prior reports of carotid endarterectomy(CEA)performed in cases of≤50%carotid stenosis in order to understand patient tolerance and potential *** A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** English-language search was performed of online databases using librarian-selected search *** were reviewed for relevance which included mention of carotid endarterectomy and *** or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal(≤50%)luminal stenosis with reported outcomes were *** Six studies(which included our institutional series)with a total of 143 patients met the inclusion *** weighted mean age at the time of CEA was 72.3 years;113(79.0%)were male.55.8%of patients with available data had recurrent ipsilateral ischaemic events despite medical *** patients out of 129 with available perioperative data(1.6%)had perioperative MRI findings of acute ischaemic stroke,both within the hemisphere contralateral to the side of *** the 138 patients with available follow-up(mean,36 months),none had recurrent ipsilateral ischaemic *** Endarterectomy for symptomatic carotid disease causing≤50%stenosis may be a potentially beneficial strategy to prevent stroke *** with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.

关键词： carotid stenosis analysis

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Carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease

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Stroke & Vascular Neurology 2022年第3期7卷 251-257页

作者： Valentina Nardi John C Benson Anthony S Larson Waleed Brinjikji Luca Saba Fredric B Meyer giuseppe lanzino Amir Lerman Luis E Savastano Department of Cardiovascular Diseases Mayo ClinicRochesterMinnesotaUSA Radiology Mayo ClinicRochesterMinnesotaUSA Radiology Azienda Ospedaliero UniversitariaCagliariItaly Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Object We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy(CEA)in patients with symptomatic non-stenotic carotid artery disease(SyNC).Methods This was a single-centre retrospective case *** patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateral<50%carotid stenosis from 2002 to 2020 were *** hallmarks including the degree of luminal stenosis and the presence of various vulnerable plaque characteristics(eg,intraplaque haemorrhage(IPH)on MR angiography,ulceration or low-density plaque on CT angiography)were *** presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral *** prevalence of perioperative/intraoperative complications,as well as recurrent ischaemic events at follow-up was *** Thirty-two patients were included in the analysis,of which 25.0%were *** arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries(80.0%vs 0.0%;p<0.001).There were no intraoperative *** patient(3.1%)developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without *** a median follow-up of 18.0 months(IQR 5.0-36.0),only one patient(3.1%)experienced a transient neurologic deficit with complete resolution(annualised rate of recurrent stroke after CEA of 1.5%for a total follow-up of 788 patient-months following CEA).All other patients(31/32,96.9%)were free of recurrent ischaemic *** CEA appears to be safe and well-tolerated in patients with *** studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.

关键词： patients carotid prevention

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未破裂脑动脉瘤的治疗选择

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国际脑血管病杂志 2006年第4期 247-251页

作者： David Z.Wang Huan Wang Kenneth Fraser giuseppe lanzino 冯东侠高恒陈罡 From the OSF Saint Francis Stroke Center/Illinois Neurological Institute University of Illinois College of MedicineOne Illini DrivePeoriaIL61605USA. 东南大学微侵袭神经外科研究所

未破裂脑动脉瘤的处理存在争议。由于其自然史尚未完全明确,因此最佳的治疗策略也不清楚。目前对未破裂脑动脉瘤处理的共识包括观察、显微手术夹闭和血管内治疗。用于随访已知未破裂脑动脉瘤的方法学也有争议,可能取决于经治医生的偏好... 详细信息

未破裂脑动脉瘤的处理存在争议。由于其自然史尚未完全明确,因此最佳的治疗策略也不清楚。目前对未破裂脑动脉瘤处理的共识包括观察、显微手术夹闭和血管内治疗。用于随访已知未破裂脑动脉瘤的方法学也有争议,可能取决于经治医生的偏好。大多数动脉瘤由神经外科医师和介入神经放射科医师处理,但未破裂动脉瘤通常是由神经科医师在对患者进行其他神经系统疾病的筛查时首先发现的。因此,关于何时对患者进行筛查和如何对未破裂动脉瘤采取最佳处理的知识将对其日常医疗实践有直接的影响。未破裂动脉瘤经常导致包括缺血事件、癫和头痛在内的其他神经系统症状,这些症状可能促进更积极的干预治疗。由于缺乏设计完善真正基于人群的研究或随机试验,因此目前的最佳处理必须以现有文献和每例患者当时的具体情况为根据。

关键词：未破裂动脉瘤治疗

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动脉瘤性蛛网膜下腔出血患者的重症监护处理：神经危重症监护学会多学科共识会议的推荐意见

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国际脑血管病杂志 2013年第5期21卷 324-347页

作者： Michael N. Diringer Thomas P. Bleck J. Claude Hemphill David Menon Lori Shutter Paul Vespa Nicolas Bruder E. Sander Connolly Jr giuseppe Citerio Daryl Gress Daniel Hanggi Brian L. Hoh giuseppe lanzino Peter Le Roux Alejandro Rabinstein, Erich Schmut zhard Nino Stocchetti Jose I. Suarez Miriam Tresgiari Ming-Yuan Tseng Mervyn D. I. Vergouwen Stefan Wolf Gregory Zip fel 田飞(译) 宿英英(译) From the Neurology/Neurosurgery Intensive Care Unit Washingion University St. Louis MO USA Rush Medical College Chicago IL USA University of California at San Francisco San Francisco CA USA University of Cambridge Cambridge UK University of Cincinnati Cincinnati OH USA University of California at Los Angeles LOs Angeles CA USA Universit6 de la M.diterranae Marsedle France Columbia University New York NY USA San Gerardo Hospital Monza Italy University of Virginia Charlottesville VA USA Heinrich-Heine University Dttsseldorf Germany University of Florida Gainesville FL USA Mayo Clinic Rochester MN USA University of Pennsylvania Philadelphia PA USA University Hospital Innsbruck lnnsbruck Austria Fondazione IRCCS Ch Granda- Ospedale Policlinico Milan University Milan Italy University of Washington St. Louis MO USA Baylor College of Medicine Houston TX USA Nottingham University Hospitals Nottingham UK University of Utrecht Utrecht The Netherlands Freie Universitit Berlin Berlin Germany Washington University St. Louis MO USA 首都医科大学宣武医院神经内科北京100053

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法... 详细信息

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法各异，可供选择的指导意见不多。现有的指南主要强调危险因素、预防、自然史以及再出血的预防，很少涉及SAH患者的重症监护问题。美国神经危重症监护学会组织了一次国际性多学科共识会议来探讨SAH的重症监护处理。根据发表的文章和研究领域，此次会议召集了来自欧洲和北美地区的神经重症监护科、神经外科、神经内科、介入神经放射科和神经麻醉科方面的专家。根据临床经验和制定实践指南方面的经验，选择4名经验丰富的神经重症监护专家组成评判委员会。应用推荐分级的评估、制定与评价（GradesofRecommendationsAssessment，DevelopmentandEvaluation，GRADE）系统进行文献回顾，结合参会者的经验、评判委员会的审评以及文献讨论产生推荐意见。应用GRADE系统制定推荐意见，其制定原则不仅强调研究资料的质量，而且还重视利弊权衡与实践转化。对SAH患者日常处理过程中面临的所有问题均提供指导和推荐意见，即使缺乏高质量的证据。

关键词：蛛网膜下腔出血重症监护动脉瘤血管痉挛抗惊厥药低钠血症血管内发热

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