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Carotid Artery Occlusion

Carotid Occlusion


Presentation

  • We present a case of bilateral carotid artery occlusion presented with intraventricular hemorrhage.[ncbi.nlm.nih.gov]
  • Among the 104 patients who showed no deficits during the test, only one case (0.9 %) presented complications, while among the three cases that showed deficits during the test and who were submitted to carotid endarterectomy, two cases presented complications[ncbi.nlm.nih.gov]
  • Five of seven patients (71 %) with successful cervical and intracranial recanalization presented favorable outcomes. In contrast, none of the patients without cervical or intracranial recanalization presented favorable outcomes.[ncbi.nlm.nih.gov]
  • Case 1 was a 65-year-old woman who presented with a two-month history of headache accompanied by blurred vision of the left eye.[ncbi.nlm.nih.gov]
  • METHODS AND RESULTS: A 48-year-old woman presented with episodes of recurrent headache and progressively worsening muscle weakness.[ncbi.nlm.nih.gov]
Coronary Artery Disease
  • Furthermore, they were evaluated in terms of risk factors, such as cigarette and alcohol use, presence of temporary ischemic attack and stroke history, hypertension, diabetes mellitus, coronary artery disease, previous myocardial infarction, hyperlipidemia[ncbi.nlm.nih.gov]
  • Three-quarters had hypertension, 76% had hyperlipidemia, 29% had atrial fibrillation, 24% had coronary artery disease, and 38% were smokers. The stroke resulted from a large artery occlusion in 62%, cardioembolism in 33%, and dissection in 5%.[medpagetoday.com]
  • artery disease (CAD) Atherosclerotic aortic aneurysm (AAA) Two or more of the following risk factors: High blood pressure ( hypertension ) High cholesterol ( hyperlipidemia ) Tobacco smoking Family history – First degree relative diagnosed with atherosclerosis[en.wikipedia.org]
  • The latter included ipsilateral ischemic stroke, ipsilateral TIA, total stroke, total TIA, death, stroke-related death, and cardiac death (defined as death caused by coronary artery disease or heart failure).[ahajournals.org]
  • A similar buildup occurs in the heart’s blood vessels when someone has coronary artery disease .[healthline.com]
Pharyngitis
  • The inferior pharyngeal constrictor (IPC) mean dose was 5,341, 6,456, and 6,451 cGy for IMRT, 3D RT, and 2D RT, respectively. IMRT provided the best homogeneity but at a higher cost and with prolonged treatment time.[ncbi.nlm.nih.gov]
Carotid Bruit
  • Carotid bruits are not sensitive or specific enough to confirm or exclude significant carotid stenoses. [ 3 ] Absence of carotid bruit in patients with cardiovascular disease does not exclude a carotid stenosis.[patient.info]
  • bruit, or murmur, over the carotid artery by listening through a stethoscope during a physical exam.[en.wikipedia.org]
Orthostatic Hypotension
  • Abstract Medically refractory positional cerebral ischemia (PCI) and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare.[ncbi.nlm.nih.gov]
Muscle Weakness
  • METHODS AND RESULTS: A 48-year-old woman presented with episodes of recurrent headache and progressively worsening muscle weakness.[ncbi.nlm.nih.gov]
Diplopia
  • Another symptom that might raise a red flag would be when a patient reports ischemic diplopia, PCON Editorial Board member John A. McCall Jr., OD, said in an interview. “Anytime a patient has double vision, it’s due to a microclot,” he said.[healio.com]
  • The two commonest ocular lesions are homonymous hemianopia and uniocular blindness or optic atrophy, although diplopia, ptosis, papilloedema, and pupillary changes may occur. Uniocular blindness may be transient (amaurosis fugax) or permanent.[ijo.in]
Stroke
  • CONCLUSIONS: The rate of ischemic stroke following carotid sacrifice remains high and most strokes are thromboembolic in nature. Our testing protocol did not eliminate the risk of hypoperfusion-related stroke.[ncbi.nlm.nih.gov]
  • Functional outcome was assessed with the modified Rankin Score (mRS) and neurological disability with the NIH Stroke Scale Score (NIHSS) at 90 days from stroke onset.[ncbi.nlm.nih.gov]
  • BACKGROUND AND PURPOSE: The aim of this systematic review was to quantify the risk of ipsilateral stroke in patients with asymptomatic carotid artery occlusion (ACAO).[ncbi.nlm.nih.gov]
  • METHODS: At least 10 BP measurements during the first 48 h after stroke onset were obtained in 89 patients with ICA occlusion.[ncbi.nlm.nih.gov]
Dizziness
  • Clinical symptoms included dizziness, amaurosis fugax, persistent limb numbness, and transient ischemic attack.[ncbi.nlm.nih.gov]
  • […] identified, as well as hypoplastic left vertebral artery.( Figure 1 ) One week after arteriography was performed, the patient presented a picture of transitory ischemic stroke again with motor deficit in upper right limb, accompanied by episodes of dizziness[scielo.br]
  • Sudden loss of vision or blurred vision in one or both eyes Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body Slurred speech, difficulty talking or understanding what others are saying Loss of coordination Dizziness[my.clevelandclinic.org]
  • Some people with carotid artery stenosis may experience dizziness, fainting and blurred vision which may be signs of the brain not receiving enough blood.[radiologyinfo.org]
Recurrent Headache
  • One case had recurrent headache symptoms after the first procedure and was retreated. Two cases suffered from post-procedural intracranial hemorrhagic complications.[ncbi.nlm.nih.gov]
  • METHODS AND RESULTS: A 48-year-old woman presented with episodes of recurrent headache and progressively worsening muscle weakness.[ncbi.nlm.nih.gov]
Hemianesthesia
  • On the following day, the patient presented with left hemiplegia with hemianesthesia (National Institutes of Health Stroke Scale score   14).[ncbi.nlm.nih.gov]

Workup

  • Asymptomatic carotid artery occlusion (ACAO) is most frequently discovered as an incidental finding during radiological workup for cerebrovascular disease or after auscultation of a neck bruit. 3 Improvements in ultrasound technology and wide-scale diffusion[ahajournals.org]
Thrombocytosis
  • The screening tests revealed thrombocytosis, hyperfibrinogenemia, increased C-reactive protein values, and multiple left pleural mesothelioma nodularity confirmed at the immunohistochemical investigation.[ncbi.nlm.nih.gov]
Hypercapnia
  • Here we investigated whether a predefined threshold of hemispheric asymmetry in hypercapnia fMRI predicts recurrent symptoms in patients with carotid artery occlusion.[ncbi.nlm.nih.gov]

Treatment

  • Treatment consisted of surgery for eight aneurysms and endovascular embolization for 13 aneurysms. No invasive treatment was recommended for 14 aneurysms (eight patients with single aneurysm).[ncbi.nlm.nih.gov]
  • INTRODUCTION: Acute stroke from occlusion of the intracranial internal carotid artery (ICA) is associated with a poor clinical outcome despite a thrombolytic treatment.[ncbi.nlm.nih.gov]
  • Internal carotid artery occlusion (ICAO) is defined as "untouchable" by all specialists; no treatment is indicated because intervention risks (carotid endarterectomy (CEA) or endovascular treatment) are usually much more than benefits.(1,2) We report[ncbi.nlm.nih.gov]
  • Intra-arterial (IA) treatment is a promising alternative. However, its effectiveness is still unproven. METHODS: We collected all publications describing results of IA treatment in acute ICA occlusions.[ncbi.nlm.nih.gov]
  • Azathioprine, applied as an alternative treatment, was shown to result in remarkable PH improvement.[ncbi.nlm.nih.gov]

Prognosis

  • Patients were evaluated by modified Rankin Scale in terms of prognosis at discharge and after 3 months.[ncbi.nlm.nih.gov]
  • Bilateral internal carotid artery occlusion (BICAO) is a rare disease that carries a gloomy prognosis.[ncbi.nlm.nih.gov]
  • INTRODUCTION: Acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion has a poor prognosis if treated by intravenous thrombolysis. Intra-arterial (IA) treatment is a promising alternative.[ncbi.nlm.nih.gov]
  • Thus, in our patient, a favorable prognosis was achieved, but further follow-up is still required.[ncbi.nlm.nih.gov]
  • The nature and severity of the presenting ischaemic symptoms did not appear to have a significant impact on prognosis.[karger.com]

Etiology

  • Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion.[ncbi.nlm.nih.gov]
  • In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO.[ncbi.nlm.nih.gov]
  • The etiology of lymphocytic hypophysitis is still unclear, but an autoimmune pathogenesis has been advocated.[ncbi.nlm.nih.gov]
  • On the aspect of etiology, in atherosclerotic cases, 4 of 10 (40 %) showed favorable outcomes. However, all four AF cases deteriorated into poor outcomes.[ncbi.nlm.nih.gov]
  • Stroke etiology was 2 cardioembolic, 11 atherothrombotic, and a single unspecified case.[ajnr.org]

Epidemiology

  • Further studies on the epidemiology of de novo aneurysms after carotid artery occlusion are warranted.[ncbi.nlm.nih.gov]
  • […] artery occlusion, vertebrobasilar occlusion, dissections, cerebral venous and sinus thrombosis, thrombolysis, mechanical recanalization materials, and treatment concepts and results, with information on anatomy, imaging studies, etiology, symptoms, epidemiology[medical-dictionary.thefreedictionary.com]
  • Epidemiology [ 1 ] Moderate-to-severe asymptomatic carotid atherosclerotic stenosis occurs in 2-5% of European women and 2-8% of European men aged over 60 years. The prevalence is much higher in high-risk groups. Risk factors Increasing age.[patient.info]
  • Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome. Arch Neurosci. 2015. 2: e26670- 6. Bögershausen N, Altunoglu U, Beleggia F, Yigit G, Kayserili H, Nürnberg P.[surgicalneurologyint.com]
Sex distribution
Age distribution

Pathophysiology

  • In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO.[ncbi.nlm.nih.gov]
  • In order to obtain more comprehensive information, it would also be appropriate to consider the possibility of acquiring data related to the pathophysiology of stroke and to cerebral hemodynamic changes. Copyright 2014 Elsevier B.V.[ncbi.nlm.nih.gov]
  • We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and[ncbi.nlm.nih.gov]
  • Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management Bhomraj Thanvi 1 , Tom Robinson 2 1 Department of Integrated Medicine, Glenfield General Hospital, University Hospitals of Leicester[pmj.bmj.com]
  • The cerebral hemodynamic insufficiency has been considered as the primary pathophysiological factor for patients with ICA or MCA occlusion.[clinicaltrials.gov]

Prevention

  • In the frontal cortex, BCP further prevented activation of the endocannabinoid system (ECS), spared the docosahexaenoic acid (DHA), appeared to prevent the increase of cyclooxygenase-2 and increased the peroxisome-proliferator activated receptor-alpha[ncbi.nlm.nih.gov]
  • Abstract Inadvertent occlusion of an internal carotid artery (ICA) during stenting may be a catastrophic situation requiring a bailout operation to prevent permanent neurologic sequelae.[ncbi.nlm.nih.gov]
  • Immediate corticosteroid treatment was followed by improvement, with radiological documentation of reversal of the vasculitic changes, preventing arterial occlusion.[ncbi.nlm.nih.gov]
  • Before ICA occlusion for giant supraclinoid aneurysm, balloon occlusion test was used to evaluate the collateral anastomosis between the external carotid artery (ECA) and the ICA, and still plays an important role in preventing treatment failure.[ncbi.nlm.nih.gov]
  • Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.[ncbi.nlm.nih.gov]

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