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Novel Approaches for the Treatment of Cerebrovascular Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 32762

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Dr. Aaron S. Dumont

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Guest Editor

1. School of Medicine, Tulane University, New Orleans, LA, USA
2. Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA, USA
Interests: cerebrovascular and endovascular surgery

Prof. Dr. Xiaoying Wang

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Guest Editor

Department Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
Interests: stroke; cerebrovascular disease; traumatic brain injury; translational therapy

Prof. Dr. Gregory J. Bix

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Guest Editor

Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA 70112, USA
Interests: stroke; vascular dementia; traumatic brain injury

Special Issue Information

Dear Colleagues,

Ischemic and hemorrhagic strokes continue to be common in the general population. Despite significant incremental improvements in prevention and management, stroke remains a leading cause of death and disability worldwide. Other cerebrovascular disorders such as cerebral aneurysms and vascular malformations also linger as important, unresolved clinical problems. Increasingly, vascular dementia is being recognized as a major source of long-term disability following repetitive cerebrovascular insults. Clinical and translational research efforts focused on prevention, acute management, and long-term management (including rehabilitation and regeneration/repair) of cerebrovascular disorders can have a tremendous impact to reduce the burden of these diseases.

The present Special Issue is dedicated to clinical and translational research focused on the treatment of cerebrovascular disorders including ischemic and hemorrhagic strokes, brain aneurysms, cerebral vascular malformations (arteriovenous malformations and cavernomas), Moyamoya disease, atherosclerosis, and vascular dementia. Original research articles, systematic reviews/meta-analyses, and focused review articles are welcome. Articles focused on prevention, genetics, disease mechanisms, and medical/interventional/surgical treatments are especially encouraged.

Dr. Aaron S. Dumont
Prof. Dr. Xiaoying Wang
Prof. Dr. Gregory J. Bix
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Ischemic stroke
hemorrhagic stroke
intracerebral hemorrhage
cerebral aneurysm
cerebral arteriovenous malformation
cerebral cavernoma
Moyamoya disease
atherosclerosis
brain injury
brain repair

Published Papers (11 papers)

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Research

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8 pages, 490 KiB

Open AccessArticle

Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

by Grzegorz Meder, Paweł Żuchowski, Wojciech Skura, Violetta Palacz-Duda, Milena Świtońska, Magdalena Nowaczewska and Paweł Sokal

J. Clin. Med. 2021, 10(9), 1802; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10091802 - 21 Apr 2021

Cited by 4 | Viewed by 2158

Abstract

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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13 pages, 855 KiB

Open AccessArticle

Serum Levels of Soluble Triggering Receptor Expressed on Myeloid Cells-1 Associated with the Severity and Outcome of Acute Ischemic Stroke

by Jyun-Bin Huang, Nai-Ching Chen, Chien-Liang Chen, Mu-Hui Fu, Hsiu-Yung Pan, Chung-Yao Hsu, Shang-Der Chen and Yao-Chung Chuang

J. Clin. Med. 2021, 10(1), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10010061 - 26 Dec 2020

Cited by 13 | Viewed by 2510

Abstract

Stroke is a neurological emergency, where the mechanism of the blood supply to the brain is impaired, resulting in brain cell ischemia and death. Neuroinflammation is a key component in the ischemic cascade that results in cell damage and death after cerebral ischemia. The triggering receptor expressed on myeloid cells-1 (TREM-1) modulates neuroinflammation after acute ischemic stroke. In the present study, 60 patients with acute ischemic stroke, who had been subjected to neurological examinations and National Institutes of Health Stroke Scale (NIHSS) and brain magnetic resonance imaging studies, were enrolled in the emergency room of Kaohsiung Chang Gung Memorial Hospital. Twenty-four healthy volunteers were recruited as controls. The serum levels of soluble TREM-1 (sTREM-1), human S100 calcium-binding protein B (S100B), and proinflammatory cytokines and chemokines, including tumor necrosis α (TNF-α), interleukin 1β, interleukin 6 (IL-6), interleukin 8, and interferon-γ were measured immediately after acute ischemic stroke. The serum levels of sTREM-1, TNFα, IL-6, and S100B were correlated with the stroke volume and NIHSS, after acute ischemic stroke. Additionally, the serum levels of sTREM-1 were significantly positively correlated with S100B. The functional outcomes were evaluated 6 months after ischemic stroke by the Barthel index, which was correlated with the age and levels of sTREM-1 and S100B. We suggest that acute ischemic stroke induces neuroinflammation by the activation of the TREM-1 signaling pathway and the downstream inflammatory machinery that modulates the inflammatory response and ischemic neuronal cell death. From a translational perspective, our results may allow for the development of a new therapeutic strategy for acute ischemic stroke by targeting the TREM-1 signaling pathway. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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19 pages, 903 KiB

Open AccessArticle

Sequence Variation in the DDAH1 Gene Predisposes for Delayed Cerebral Ischemia in Subarachnoidal Hemorrhage

by Juliane Hannemann, Daniel Appel, Miriam Seeberger-Steinmeister, Tabea Brüning, Julia Zummack and Rainer Böger

J. Clin. Med. 2020, 9(12), 3900; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9123900 - 01 Dec 2020

Cited by 7 | Viewed by 1764

Abstract

Delayed cerebral ischemia (DCI) often causes poor long-term neurological outcome after subarachnoidal hemorrhage (SAH). Asymmetric dimethylarginine (ADMA) inhibits nitric oxide synthase (NOS) and is associated with DCI after SAH. We studied single nucleotide polymorphisms (SNPs) in the NOS3, DDAH1, DDAH2, PRMT1, and AGXT2 genes that are part of the L-arginine–ADMA–NO pathway, and their association with DCI. We measured L-arginine, ADMA and symmetric dimethylarginine (SDMA) in plasma and cerebrospinal fluid (CSF) of 51 SAH patients at admission; follow-up was until 30 days post-discharge. The primary outcome was the incidence of DCI, defined as new infarctions on cranial computed tomography, which occurred in 18 of 51 patients. Clinical scores did not significantly differ in patients with or without DCI. However, DCI patients had higher plasma ADMA and SDMA levels and higher CSF SDMA levels at admission. DDAH1 SNPs were associated with plasma ADMA, whilst AGXT2 SNPs were associated with plasma SDMA. Carriers of the minor allele of DDAH1 rs233112 had a significantly increased relative risk of DCI (Relative Risk = 2.61 (1.25–5.43), p = 0.002). We conclude that the DDAH1 gene is associated with ADMA concentration and the incidence of DCI in SAH patients, suggesting a pathophysiological link between gene, biomarker, and clinical outcome in patients with SAH. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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12 pages, 1052 KiB

Open AccessArticle

Executive Functions Are Associated with Fall Risk but not Balance in Chronic Cerebrovascular Disease

by Cosimo Tuena, Valentina Mancuso, Ilaria M. A. Benzi, Pietro Cipresso, Alice Chirico, Karine Marie Goulene, Giuseppe Riva, Marco Stramba-Badiale and Elisa Pedroli

J. Clin. Med. 2020, 9(11), 3405; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113405 - 23 Oct 2020

Cited by 5 | Viewed by 1750

Abstract

Background: Older people’s deficits in executive functions (EF) have been shown to lead to higher fall risk, postural sway, and reduced speed. Crucially, EF impairments are even more pronounced in individuals with chronic cerebrovascular disease (CVD), namely vascular cognitive impairment. Methods: In this retrospective cross-sectional study, we used a complete neuropsychological battery, including the Trail Making Test (TMT) and physical measures, such as the Morse fall and EQUI scales, to assess 66 individuals with chronic CVD. Linear regressions, Bayesian analyses, and model selection were performed to see the impact of EF, global cognition, and vascular parkinsonism/hemiplegia on physical measures (fall risk and balance). Results: The TMT part B and BA correlated (r = 0.44 and r = 0.45) with Morse fall scale. Only EF significantly explained fall risk, whereas global cognition and vascular parkinsonism/hemiplegia did not. These findings were confirmed by Bayesian evidence and parsimony model selection. Balance was not significantly correlated with any of the neuropsychological tests. Conclusions: This is the first study investigating the relationship between cognitive and physical measures in a sample of older people with chronic CVD. The results are consistent with previous findings that link EF with fall risk in CVD. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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17 pages, 568 KiB

Open AccessArticle

An Integrative Neuro-Psychotherapy Treatment to Foster the Adjustment in Acquired Brain Injury Patients—A Randomized Controlled Study

by Antoine Urech, Tobias Krieger, Eveline Frischknecht, Franziska Stalder-Lüthy, Martin grosse Holtforth, René Martin Müri, Hansjörg Znoj and Helene Hofer

J. Clin. Med. 2020, 9(6), 1684; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061684 - 02 Jun 2020

Cited by 7 | Viewed by 2710

Abstract

Adjustment disorders (AjD) with depressive symptoms following an acquired brain injury (ABI) is a common phenomenon. Although brain injuries are increasing more and more, research on psychological therapies is comparably scarce. The present study compared, by means of a randomized controlled trial (RCT), a newly developed integrative treatment (Standard PLUS) to a standard neuropsychological treatment (Standard). Primary outcomes were depressive symptoms assessed with the Beck Depression Inventory (BDI-II) at post-treatment and 6-month follow-up assessment. In total, 25 patients (80% after a stroke) were randomized to one of the two conditions. Intention-to-treat analyses showed that the two groups did not significantly differ either at post-treatment nor at follow-up assessment regarding depressive symptoms. Both treatments showed large within-group effect sizes on depressive symptoms. Regarding secondary outcomes, patients in the Standard PLUS condition reported more emotion regulation skills at post-assessment than in the control condition. However, this difference was not present anymore at follow-up assessment. Both treatments showed medium to large within-group effects sizes on most measures for patients suffering from an AjD after ABI. More research with larger samples is needed to investigate who profits from which intervention. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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14 pages, 2589 KiB

Open AccessArticle

Gamma Knife Radiosurgery Followed by Flow-Reductive Embolization for Ruptured Arteriovenous Malformation

by Myung Ji Kim, So Hee Park, Keun Young Park, Hyun Ho Jung, Jong Hee Chang, Jin Woo Chang, Jae Whan Lee and Won Seok Chang

J. Clin. Med. 2020, 9(5), 1318; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9051318 - 02 May 2020

Cited by 12 | Viewed by 2986

Abstract

Background: Aggressive treatment to achieve complete obliteration of brain arteriovenous malformation (AVM) is necessary in patients with a recent history of hemorrhage. The major drawback of Gamma knife radiosurgery (GKRS) alone for AVM is risk of bleeding during the latent period until the AVM occludes. At our center, patients who present with ruptured AVMs are frequently offered GKRS followed by embolization. The goal of this study was to compare outcomes of embolization for patients who have previously undergone GKRS for ruptured AVMs. Methods: A database including 150 GKRS for ruptured AVMs between November 2008 and October 2017 was reviewed. The embolized group was selected by including AVMs with post-GKRS embolization. The non-embolized group was defined as AVMs treated by GKRS alone. Outcomes including obliteration rate, incidence of repeat hemorrhage, and delayed cyst formation were compared between two groups. The predictive factors related to AVM obliteration and complications were analyzed. Results: The study consisted of 81 patients in the non-embolized group and 17 patients in the embolized group. Statistically significant differences were detected between the two groups with respect to age, Pollock-Flickinger score, Spetzler-Martin (SM) grade, eloquence of adjacent brain, and presence of aneurysms. The embolized group included more AVMs with larger median nidus volume. The predictive factors for the obliteration of ruptured AVMs were nidus volume, SM grade, Virginia Radiosurgery AVM Scale (VRAS), and Pollock-Flickinger score and for the subsequent hemorrhage were marginal dose, nidus volume, SM grade, VRAS, and Pollock-Flickinger score. The obliteration rates and complication rates after GKRS between groups were not significantly different. However, this study demonstrated statistically significant difference in the cumulative incidence of obliteration in AVMs with SM grade III and IV (p = 0.037). Conclusion: Although the current study demonstrated similar results in patients who underwent GKRS with and without embolization, the embolized group included more AVMs with larger nidus volume, higher SM grade, Pollock-Flickinger score, and aneurysm, which have a lower chance of obliteration and a higher probability of repeat hemorrhage. GKRS followed by embolization appears to be a beneficial approach for the treatment of ruptured AVMs that are at risk for obliteration failure and repeat hemorrhage during the latency period after single-session GKRS alone. Further studies involving a larger number of cases and continuous follow-up are necessary to confirm our conclusions. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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11 pages, 1223 KiB

Open AccessArticle

Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

by Daizo Ishii, Daichi Nakagawa, Mario Zanaty, Jorge A. Roa, Sami Al Kasab, Amir Shaban, Joseph S. Hudson, Carlos Osorno-Cruz, Stefano Byer, Lauren Allan, James C. Torner, Issam A. Awad, Timothy J. Carroll, Edgar A. Samaniego and David M. Hasan

J. Clin. Med. 2020, 9(4), 979; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9040979 - 01 Apr 2020

Cited by 10 | Viewed by 5165

Abstract

Background: MR-quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) wall associated with sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited, due to associated skull base bonny and air artifact. MR-vessel wall imaging (VWI) is not limited by such artifact and therefore could be an alternative to QSM. The purpose of this study was to investigate the correlation between QSM and VWI in detecting MBs and to help develop a diagnostic strategy for SH. Methods: We performed a prospective study of subjects with one or more unruptured IAs in our hospital. All subjects underwent evaluation using 3T-MRI for MR angiography (MRA), QSM, and pre- and post-contrast VWI of the IAs. Presence/absence of MBs detected by QSM was correlated with aneurysm wall enhancement (AWE) on VWI. Results: A total of 40 subjects harboring 51 unruptured IAs were enrolled in the study. MBs evident on the QSM sequence was detected in 12 (23.5%) IAs of 11 subjects. All these subjects had a history of severe headache suggestive of SH. AWE was detected in 22 (43.1%) IAs. Using positive QSM as a surrogate for MBs, the sensitivity, specificity, positive predictive value, and negative predictive value of AWE on VWI for detecting MBs were 91.7%, 71.8%, 50%, and 96.6%, respectively. Conclusions: Positive QSM findings strongly suggested the presence of MBs with SH, whereas, the lack of AWE on VWI can rule it out with a probability of 96.6%. If proven in a larger cohort, combining QSM and VWI could be an adjunctive tool to help diagnose SH, especially in cases with negative or non-diagnostic CT and lumbar puncture. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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Review

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11 pages, 614 KiB

Open AccessReview

Caveolae-Mediated Endothelial Transcytosis across the Blood-Brain Barrier in Acute Ischemic Stroke

by Min Zhou, Samuel X. Shi, Ning Liu, Yinghua Jiang, Mardeen S. Karim, Samuel J. Vodovoz, Xiaoying Wang, Boli Zhang and Aaron S. Dumont

J. Clin. Med. 2021, 10(17), 3795; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173795 - 25 Aug 2021

Cited by 15 | Viewed by 3712

Abstract

Blood-brain barrier (BBB) disruption following ischemic stroke (IS) contributes to hemorrhagic transformation, brain edema, increased neural dysfunction, secondary injury, and mortality. Brain endothelial cells form a para and transcellular barrier to most blood-borne solutes via tight junctions (TJs) and rare transcytotic vesicles. The prevailing view attributes the destruction of TJs to the resulting BBB damage following IS. Recent studies define a stepwise impairment of the transcellular barrier followed by the paracellular barrier which accounts for the BBB leakage in IS. The increased endothelial transcytosis that has been proven to be caveolae-mediated, precedes and is independent of TJs disintegration. Thus, our understanding of post stroke BBB deficits needs to be revised. These recent findings could provide a conceptual basis for the development of alternative treatment strategies. Presently, our concept of how BBB endothelial transcytosis develops is incomplete, and treatment options remain limited. This review summarizes the cellular structure and biological classification of endothelial transcytosis at the BBB and reviews related molecular mechanisms. Meanwhile, relevant transcytosis-targeted therapeutic strategies for IS and research entry points are prospected. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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21 pages, 444 KiB

Open AccessReview

Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression

by Tissa Wijeratne and Carmela Sales

J. Clin. Med. 2021, 10(8), 1674; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081674 - 14 Apr 2021

Cited by 38 | Viewed by 4897

Abstract

Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

15 pages, 247 KiB

Open AccessFeature PaperReview

Update: Microdialysis for Monitoring Cerebral Metabolic Dysfunction after Subarachnoid Hemorrhage

by Pierce Spencer, Yinghua Jiang, Ning Liu, Jinrui Han, Yadan Li, Samuel Vodovoz, Aaron S. Dumont and Xiaoying Wang

J. Clin. Med. 2021, 10(1), 100; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10010100 - 30 Dec 2020

Cited by 5 | Viewed by 2340

Abstract

Cerebral metabolic dysfunction has been shown to extensively mediate the pathophysiology of brain injury after subarachnoid hemorrhage (SAH). The characterization of the alterations of metabolites in the brain can help elucidate pathophysiological changes occurring throughout SAH and the relationship between secondary brain injury and cerebral energy dysfunction after SAH. Cerebral microdialysis (CMD) is a tool that can measure concentrations of multiple bioenergetics metabolites in brain interstitial fluid. This review aims to provide an update on the implication of CMD on the measurement of metabolic dysfunction in the brain after SAH. A literature review was conducted through a general PubMed search with the terms “Subarachnoid Hemorrhage AND Microdialysis” as well as a more targeted search using MeSh with the search terms “Subarachnoid hemorrhage AND Microdialysis AND Metabolism.” Both experimental and clinical papers were reviewed. CMD is a suitable tool that has been used for monitoring cerebral metabolic changes in various types of brain injury. Clinically, CMD data have shown the dramatic changes in cerebral metabolism after SAH, including glucose depletion, enhanced glycolysis, and suppressed oxidative phosphorylation. Experimental studies using CMD have demonstrated a similar pattern of cerebral metabolic dysfunction after SAH. The combination of CMD and other monitoring tools has also shown value in further dissecting and distinguishing alterations in different metabolic pathways after brain injury. Despite the lack of a standard procedure as well as the presence of limitations regarding CMD application and data interpretation for both clinical and experimental studies, emerging investigations have suggested that CMD is an effective way to monitor the changes of cerebral metabolic dysfunction after SAH in real-time, and alternatively, the combination of CMD and other monitoring tools might be able to further understand the relationship between cerebral metabolic dysfunction and brain injury after SAH, determine the severity of brain injury and predict the pathological progression and outcomes after SAH. More translational preclinical investigations and clinical validation may help to optimize CMD as a powerful tool in critical care and personalized medicine for patients with SAH. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

19 pages, 337 KiB

Open AccessReview

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines

by Tyler Scullen, Mansour Mathkour, Christopher Carr, Arthur Wang, Peter S. Amenta, John D. Nerva and Aaron S. Dumont

J. Clin. Med. 2020, 9(11), 3460; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113460 - 27 Oct 2020

Cited by 5 | Viewed by 1872

Abstract

Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment. Full article

(This article belongs to the Special Issue Novel Approaches for the Treatment of Cerebrovascular Disorders)

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