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

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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Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: lessons from retrieved stroke emboli

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Stroke & Vascular Neurology 2021年第4期6卷 658-667页

作者： Waleed Brinjikji Oana Madalina Mereuta Daying Dai David F Kallmes luis savastano Yang Liu Shahid M Nimjee Raul G Nogueira Mehdi Abbasi Ramanathan Kadirvel Radiology Mayo ClinicRochesterMinnesotaUSA Neurosurgery Mayo ClinicRochesterMinnesotaUSA Neurosurgery Ohio State University Medical CenterColumbusOhioUSA Neurology Emory University School of MedicineAtlantaGeorgiaUSA

There has been growing interest and insight into the histological composition of retrieved stroke *** of the main focuses of the stroke clot analysis literature has been the implications of clot composition on mechanical thrombectomy ***,the holy grail of clot analysis may not be in the field of clot-device interaction,but rather,in understanding mechanisms of fibrinolysis *** mechanisms underlying the low response to fibrinolytic therapy,even with the newer,more powerful agents,remain poorly *** factors such as embolus size,location and collateral status influence alteplase delivery and recanalisation rates;compositional analyses focused on histological and ultrastructural characteristics offer unique insights into mechanisms of alteplase *** this review,we strive to provide comprehensive review of current knowledge on clot composition and ultrastructural analyses that help explain resistance to fibrinolysis.

关键词： fibrin histological resistance

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