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Toudou-Daouda M, Yatwa-Zaniwe RV, Aminou-Tassiou NR, Baby M, Soumah D, Altarcha T, Aghasaryan M, Laine O, Chausson N, Smadja D. Intravenous thrombolysis plus tirofiban versus tirofiban alone in Caucasian patients with acute anterior choroidal or paramedian pontine infarction. Brain Circ 2024; 10:250-256. [PMID: 39526109 PMCID: PMC11542752 DOI: 10.4103/bc.bc_15_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Tirofiban has been shown to be superior to aspirin in achieving functional independence at 3 months for acute ischemic stroke of atheromatous or microatheromatous origin. As intravenous thrombolysis (IVT) has previously been shown to be nonsuperior to aspirin in achieving functional independence at 3 months for anterior choroidal or paramedian pontine infarction (ACI/PPI), we aimed to compare the outcomes of Caucasian patients receiving IVT plus tirofiban (IVT + T) with those receiving tirofiban alone for acute ACI/PPI. METHODS A retrospective study was conducted in patients aged ≥ 18 years with ACI/PPI treated in our stroke unit between December 1, 2020, and April 30, 2023, who received therapeutic intervention within 9 hours of symptom onset or after awakening with stroke symptoms. Modified Rankin Scale (mRS) ≤ 1 at 3 months was the primary endpoint. Secondary endpoints were National Institutes of Health Stroke Scale (NIHSS) ≤ 2 at day 7 or discharge and post-procedural neurological deterioration (PPND) within 72 hours. Symptomatic intracranial hemorrhage (SICH) and major systemic bleeding (MSB) were the safety measures of the study. RESULTS A total of 24 patients were enrolled in the tirofiban group and 43 patients in the IVT + T group. Compared to tirofiban alone, IVT + T was associated with a higher probability of achieving mRS ≤1 at 3 months (adjusted odds ratio [aOR], 8.79; 95% confidence interval [CI], 2.06-37.52; P = 0.003) and National Institutes of Health Stroke Scale ≤2 at day 7 or discharge (aOR, 3.70; 95% CI, 1.05-12.99; P = 0.041). No significant difference was seen between the two groups in preventing postprocedural neurological deterioration. One case of SICH and two cases of MSB occurred in the IVT + T group and no cases in the tirofiban group. One case of inhospital mortality was recorded in the IVT + T group. CONCLUSIONS Our results showed that IVT + T may be safe and effective in Caucasian patients with acute ACI/PPI.
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Affiliation(s)
- Moussa Toudou-Daouda
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
- Department of Neurology, Amirou Boubacar Diallo National Hospital, Niamey, Niger
| | | | | | - Mohamed Baby
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Djibril Soumah
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Tony Altarcha
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Manvel Aghasaryan
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Olga Laine
- Department of Gerontology, Les Magnolias Private Hospital, Ballainvilliers, France
| | - Nicolas Chausson
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
- University of Paris, INSERM, FHU NeuroVasc, Paris, France
| | - Didier Smadja
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
- University of Paris, INSERM, FHU NeuroVasc, Paris, France
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Wardlaw JM, Chabriat H, de Leeuw FE, Debette S, Dichgans M, Doubal F, Jokinen H, Katsanos AH, Ornello R, Pantoni L, Pasi M, Pavlovic AM, Rudilosso S, Schmidt R, Staals J, Taylor-Rowan M, Hussain S, Lindgren AG. European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke. Eur Stroke J 2024; 9:5-68. [PMID: 38380638 PMCID: PMC10916806 DOI: 10.1177/23969873231219416] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/22/2024] Open
Abstract
A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hugues Chabriat
- CNVT and Department of Neurology, Hopital Lariboisière, Paris, France
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Stéphanie Debette
- Bordeaux Population Health Research Center; University of Bordeaux – Inserm U1219; Bordeaux; Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Medical Center, Munich; Munich Cluster for Systems Neurology (SyNergy), Munich; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich; German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, Edinburgh, UK
| | - Hanna Jokinen
- Neurocenter, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Aristeidis H Katsanos
- Neurology, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - Raffaele Ornello
- Neurology/Department of Biotechnological ad Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Marco Pasi
- Department of Neurology, University of Tours, Tours, France
| | - Aleksandra M Pavlovic
- University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Julie Staals
- Department of Neurology and CARIM School for cardiovascular diseases, MUMC+, Maastricht, The Netherlands
| | - Martin Taylor-Rowan
- School of Health and Wellbeing; General Practice and Primary Care, Clarice Pears Building, University of Glasgow, Glasgow, UK
| | | | - Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University; Department of Neurology, Skåne University Hospital, Lund, Skånes Universitetssjukhus, Lund, Sweden
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3
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Mantri A, Harjpal P, Chavan N. Physiotherapy Approach to an Internal Capsule Infarct With Upper Motor Neuron Facial Nerve Palsy: A Case Report. Cureus 2024; 16:e55337. [PMID: 38562357 PMCID: PMC10982154 DOI: 10.7759/cureus.55337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
The internal capsule (IC) is a vital brain structure housing descending and ascending fiber tracts, with traditional assumptions about the corticobulbar and corticospinal tracts descending through the genu and anterior third of the posterior limb of internal capsule (PLIC), respectively. However, observations of IC infarctions reveal that symptoms often deviate from the expected fiber pattern, prompting a deeper exploration of these complexities. The posterior limb of the IC receives its blood supply from the lenticulostriate branches of the middle cerebral artery and the anterior choroidal artery (AChA). AChA infarctions present a diverse array of symptoms beyond the classic triad, reflecting the intricate vascular supply and lesion patterns within this region. We present a case of a 74-year-old male farmer with right-hand dominance, who experienced a fall resulting in head and right lower limb injuries. Subsequently, he developed weakness in his left upper and lower limbs, facial deviation, slurred speech, and swelling in the right lower limb. Following these symptoms, his family promptly brought him to the hospital on November 30, 2023. Extensive investigations, including magnetic resonance imaging (MRI), revealed a hyper-acute infarct in the posterior limb of the left IC. The patient was admitted to the intensive care unit (ICU) for three days and later shifted to the neurology ward where medical management was commenced, including physiotherapy protocol that was started on December 2, 2023. Physiotherapy interventions were designed to address the patient's weakness, altered sensation, and diminished reflexes. Therapeutic goals focused on preventing complications, improving posture, enhancing range of motion (ROM), and mitigating breathing difficulties and mobility issues. The physiotherapy aimed to enhance the patient's overall physical and mental well-being, emphasizing independence and improved quality of life. Regular assessments and adjustments to the therapeutic interventions were made based on the patient's progress. This case underscores the importance of tailored physiotherapy interventions in addressing the diverse manifestations of IC infarctions, contributing to a comprehensive understanding of rehabilitation strategies in neurologically compromised individuals.
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Affiliation(s)
- Achal Mantri
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitika Chavan
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Tsika A, Stamati P, Tsouris Z, Provatas A, Papa A, Tsimoulis D, Ralli S, Siokas V, Dardiotis E. Acute Anterior Choroidal Artery Territory Infarction: A Case Series Report. Neurol Int 2024; 16:289-298. [PMID: 38525700 PMCID: PMC10961810 DOI: 10.3390/neurolint16020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Due to the occlusion of the anterior choroidal artery (AChA), ischemic strokes are described with the classic clinical triad, namely hemiplegia, hemianesthesia, and homonymous hemianopsia. The aim of this study is to document the characteristic clinical presentation and course of AChA infract cases. We describe five cases with acute infarction in the distribution of the AChA, admitted to the Neurological Department of the University General Hospital of Larissa. Results: All cases presented with hemiparesis and lower facial nerve palsy, while four of them had dysarthria, and two patients exhibited ataxia. Two cases underwent intravenous thrombolysis. A notable feature was the worsening of the clinical course, specifically the exacerbation of upper limb weakness within 48 h. Stabilization occurred after the third day, with the final development of a more severe clinical presentation than the initial one. Additionally, muscle weakness was more severe in the upper limb than in the lower limb. The recovery of upper limb function was poor in the three-month follow-up for the four cases. While vascular brain episodes are characterized by sudden onset, in AChA infraction, the clinical onset can be gradually developed over a few days, with a greater burden on the upper limb and poorer recovery.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, 41100 Larissa, Greece; (A.T.); (P.S.); (Z.T.); (A.P.); (A.P.); (D.T.); (S.R.); (V.S.)
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Zhao N, Li J, Zhang QX, Yang L, Zhang LJ. Elevated neutrophil-related immune-inflammatory biomarkers in acute anterior choroidal artery territory infarction with early progression. Clin Neurol Neurosurg 2023; 229:107720. [PMID: 37084652 DOI: 10.1016/j.clineuro.2023.107720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The anterior choroidal artery territory (AChA) infarction has a high rate of progression and poor functional prognosis. The aim of the study is to search for fast and convenient biomarkers to forecast the early progression of acute AChA infarction. METHODS We respectively collected 51 acute AChA infarction patients, and compared the laboratorial index between early progressive and non-progressive acute AChA infarction patients. The receiver-operating characteristics curve (ROC) analysis was used to determine the discriminant efficacy of indicators that had statistical significance. RESULTS The white blood cell, neutrophil, monocyte, white blood cell to high-density lipoprotein cholesterol ratio, neutrophil to high-density lipoprotein cholesterol ratio (NHR), monocyte to high-density lipoprotein cholesterol ratio, monocyte to lymphocyte ratio, neutrophil to lymphocyte ratio (NLR), and hypersensitive C-reaction protein in acute AChA infarction are significantly higher than healthy controls (P < 0.05). The NHR (P = 0.020) and NLR (P = 0.006) are remarkably higher in acute AChA infarction patients with early progression than non-progression. The area under the ROC curve of NHR, NLR, the combine of NHR and NLR are 0.689 (P = 0.011), 0.723 (P = 0.003), 0.751 (P < 0.001), respectively. But there are no significant differences in efficiency between NHR and NLR and their combined marker in predicting progression (P > 0.05). CONCLUSION NHR and NLR may be significant predictors of early progressive patients with acute AChA infarction, and the combination of NHR and NLR could be a preferable prognostic marker for AChA infarction with early progressive course in acute stage.
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Affiliation(s)
- Ning Zhao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jia Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiu-Xia Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Cheng Z, Duan H, Meng F, Du H, Zhang W, Li H, Geng X, Tong Y. Acute Anterior Choroidal Artery Territory Infarction: A Retrospective Study. Clin Neurol Neurosurg 2020; 195:105826. [PMID: 32344281 DOI: 10.1016/j.clineuro.2020.105826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore the clinical features, risk factors, etiopathogenesis, mechanism of progression, effect of intravenous thrombolysis therapy (IVT) and prognosis of acute ischemic stroke (AIS) in the anterior choroidal artery (AChA) territory. PATIENTS AND METHODS A total of 113 AChA infarction patients were enrolled in the current study retrospectively. The demographic and clinical characteristics were collected and analyzed in all patients. The clinical characteristics were compared between clinical progression and no clinical progression groups, good and poor outcome groups, as well as with and without intravenous rt-PA groups. RESULTS Hemiparesis was the most common clinical manifestation (92.9%), followed by dyslexia (54.9%), hemianesthesia (43.4%) and other syndromes. Forty-nine patients (43.4%) suffered from clinical progression and showed a higher rate with multiple risk factors together than patients without clinical progression (30.6% vs.14.1%, P = 0.039). Moreover, more patients with progression were found with carotid plaques (73.5% vs. 51.6%, P = 0.018) or carotid artery stenosis (18.4% vs. 6.3%, P = 0.045) than patients without progression. 69.9% of patients got good prognosis at 6-months. In good prognosis group, the proportion of patients with atrial fibrillation, clinical progression and large infarct size were significantly lower than in poor prognosis group (1.3% vs. 11.8%, P = 0.047; 23.9% vs. 67.6%, P = 0.001; 15.2% vs. 38.2%, P = 0.007). No significant difference was found on rate of clinical progression and good prognosis between patients with and without IVT. CONCLUSION Motor deficits are the most frequent and typical symptoms in AChA infarcts. Although small artery disease was considered to be the important etiopathogenesis of the AChA infarcts, large vascular disease may be associated with clinical progression in AChA infarcts. Additionally, prognosis of AChA infarcts is correlated with clinical progression, infarct size and atrial fibrillation. IVT does not seem to prevent the clinical progression and improve prognosis of AChA infarcts.
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Affiliation(s)
- Zhe Cheng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Fanhua Meng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Huishan Du
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Weidong Zhang
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Han Li
- Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.
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Li W, Wu Y, Li XS, Liu CC, Huang SH, Liang CR, Wang H, Zhang LL, Xu ZQ, Wang YJ, Zhang M. Intravenous tirofiban therapy for patients with capsular warning syndrome. Stroke Vasc Neurol 2019; 4:22-27. [PMID: 31105975 PMCID: PMC6475082 DOI: 10.1136/svn-2018-000163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background Capsular warning syndrome (CWS) is defined as recurrent episodes of transient ischaemic attacks ≥3 times during a short time frame. There is no effective therapy to stop these attacks. We, herein, report our experience of using intravenous tirofiban to treat CWS. Methods All patients with CWS in our hospital from January 2013 to September 2017 were reviewed. Patients in tirofiban group (T-group) were treated by intravenous tirofiban at 0.4 μg/kg/min for 30 min followed by 0.1–0.15 µg/kg/min infusion. Other treatments (non-T-group) included thrombolytic, oral antiplatelet agents and anticoagulant. Intracerebral haemorrhage (ICH), systematic bleeding, new attacks after treatment, National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and modified Rankin Scales (mRSs) at 3 months were recorded. Descriptive statistics were used for analysis. Results Of 23 patients qualified (15 in T-group, 8 in non-T-group), the duration of symptoms ranged from 2 to 100 min before treatments. After treatment, in T-group, four patients (26.7%) had recurrent attacks, and NIHSS scores were 0 in 11 patients (73.3%) at 24 hours. All patients reached a favourable outcome (mRS ≤2 at 3 months. In non-T-group, five patients (62.5%) had new attacks. NIHSS scores were 0 in two patients (25%) at 24 hours. At 3 months, seven patients (87.5%) reached a favourable outcome. Neither ICH nor systematic bleeding or thrombocytopaenia occurred in both groups of patients. Conclusions Intravenous tirofiban can be a potentially effective and safe therapy to stop early symptomatic fluctuations and shorten the duration of functional deficits in patients with CWS.
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Affiliation(s)
- Wei Li
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Ya Wu
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Xiao-Shu Li
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Cheng-Chun Liu
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Shu-Han Huang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Chun-Rong Liang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Huan Wang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Li-Li Zhang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Zhi-Qiang Xu
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Yan-Jiang Wang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
| | - Meng Zhang
- Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China
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Hieber M, Bardutzky J. Immediate Reversal of Dabigatran by Idarucizumab Prior to Laboratory and Imaging Results in Acute Stroke. Front Neurol 2019; 10:230. [PMID: 30930841 PMCID: PMC6428745 DOI: 10.3389/fneur.2019.00230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/22/2019] [Indexed: 01/01/2023] Open
Abstract
We report a case of intravenous thrombolysis in acute ischemic stroke of anterior choroidal artery following the antagonization of dabigatran with idarucizumab. No secondary complication, like hemorrhagic or thrombotic/thrombembolic event, of neither idarucizumab nor subsequent intravenous thrombolysis emerged. The recent approval of idarucizumab enables intravenous thrombolysis despite preexisiting oral anticoagulation with dabigatran, but raises the question of the optimal management and work flow of patients under medication with dabigatran and with acute neurological deficit, highly suspicious for an acute cerebrovascular event. In contrast to hitherto case reports and series, here, we explicitly refrained from awaiting the results of the thrombin time, as a marker for present anticoagulation by dabigatran, as well as the results of cerebral imaging before administration of idarucizumab. Based on the presented case we propose this approach to minimize door-to-needle time of intravenous thrombolysis in acute ischemic stroke and thus to enhance the chance for a good outcome.
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Affiliation(s)
- Maren Hieber
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Juergen Bardutzky
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Freiburg, Germany
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9
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Suzuki H, Yamaguchi S, Nishino K, Nakase T, Shimizu H. Hemodynamic ischemia of the anterior choroidal artery and reversal by carotid artery stenting 10 years after ipsilateral superficial temporal artery-middle cerebral artery bypass for symptomatic left middle cerebral artery stenosis. Neurol Int 2018; 10:7867. [PMID: 30687467 PMCID: PMC6322046 DOI: 10.4081/ni.2018.7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022] Open
Abstract
The pathogenesis of anterior choroidal artery (AChA) territory infarction includes various mechanisms, but hemodynamic causes are rare and difficult to diagnose. 77- year-old man, who had moderate left ICA stenosis and he had treated with STA-MCA bypass surgery for severe symptomatic left MCA stenosis 10 years earlier, was admitted with right hemiparesis and confused state. On admission, magnetic resonance imaging and angiography demonstrated patent bypass, but severe stenosis of left ICA with no opacification of the left AChA and A1 portion of the left ACA. Diffusionweighted imaging demonstrated ischemic lesion in the left corona radiata. Together with clinical findings, hemodynamic ischemia of the AChA region was suspected and left carotid artery stenting resulted in prompt improvement of symptoms. Hemodynamic ischemia of the AChA territory is rare, however, should be considered as a potential target of treatment when the ipsilateral ICA, A1 and M1 show stenoocclusive lesions.
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Affiliation(s)
- Hayato Suzuki
- Department of Neurosurgery, Kakunodate General Hospital, Akita.,Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Taizen Nakase
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
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Yu J, Xu N, Zhao Y, Yu J. Clinical importance of the anterior choroidal artery: a review of the literature. Int J Med Sci 2018; 15:368-375. [PMID: 29511372 PMCID: PMC5835707 DOI: 10.7150/ijms.22631] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/05/2018] [Indexed: 12/13/2022] Open
Abstract
The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.
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Affiliation(s)
- Jing Yu
- Department of Surgery and Operating Room, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ning Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ying Zhao
- Department of Training, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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Alqahtani SA, Luby M, Nadareishvili Z, Benson RT, Hsia AW, Leigh R, Lynch JK. Perfusion Deficits and Association with Clinical Outcome in Patients with Anterior Choroidal Artery Stroke. J Stroke Cerebrovasc Dis 2017; 26:1755-1759. [PMID: 28457620 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/02/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Anterior choroidal artery (AChA) strokes have a varied pattern of tissue injury, prognosis, and clinical outcome. It is unclear whether perfusion deficit in AChA stroke is associated with the clinical outcome. This study aims to determine the frequency of perfusion abnormalities in AChA stroke and association with clinical outcome. METHODS The study cohort was derived from ischemic stroke patients admitted to 2 stroke centers between July 2001 and July 2014. All patients received an acute magnetic resonance imaging (MRI) scan. Patients with ischemic stroke restricted to the AChA territory were included in the study. Lesion size was measured as the largest diameter on diffusion-weighted imaging (DWI) or apparent diffusion coefficient and divided into 2 groups (<20 mm or ≥20 mm). Group comparisons were performed among patients with and without perfusion abnormalities and based on diffusion diameter. Favorable clinical outcome was defined as discharge to home. RESULTS A total of 120 patients were included in the study. Perfusion deficits were identified in 67% of patients. The admission National Institutes of Health Stroke Scale (NIHSS) was higher in patients with perfusion abnormalities (P = .027). Diameter lesion size on DWI was larger among patients with a perfusion deficit median [interquartile range], 1.63 [1.3-2.0], as compared with those without, 1.18 [1.0-1.7], P < .0001. Patients with a perfusion deficit were less likely to be discharged to home than those without (36% versus 60%, P = .013). CONCLUSIONS Two thirds of patients with an AChA stroke have a perfusion deficit on MRI, higher admission NIHSS, and larger DWI lesion size at presentation.
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Affiliation(s)
- Saeed A Alqahtani
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland.
| | - Marie Luby
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
| | - Zurab Nadareishvili
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Program, Suburban Hospital, Bethesda, Maryland
| | - Richard T Benson
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Center, MedStar Washington Hospital Center, Washington, DC, Washington
| | - Amie W Hsia
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Center, MedStar Washington Hospital Center, Washington, DC, Washington
| | - Richard Leigh
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
| | - John K Lynch
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
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