Background and Aims

. The carotid stenosis is graded based on the degree of narrowing.Carotid near occlusion can be subdivided into Carotid near occlusion with full collapse & with out full collapse.

The reported short term risk of recurrent ipsilateral ischemic stroke among patients with Symptomatic carotid near occlusion varies between 5-43% with a high risk probabaly limited for near occlusion with full collapse , lower for near occlusion with out full collapse.

The aim of this study was to assess the risk of recurrent ipsilateral stroke in patients with symptomatic near occlusion with & with out full collapse

Methods

We consecutively included patients eligible for revascularization with > 70%carotid stenosis (n=300), near occlusion with out full collapse(n=80) and near occlusion with full collapse (n= 54).The primary end point was pre operative recurrent ipsilateral ischemic stroke with in 90 days after the presenting event.

Results

The 90 days risk of recurrent ipsilateral stroke was 15% ( 95 % CI 9-20%among ≥ 70% stenosis, 22%( 95% CI 6-38%) among near occlusion with out full collapse and 30% (95% CI16-44) among near occlusion with full collapse ( p=0.001, log rank test). In multi variate analysis, near occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke( adjusted HR 2.6 , 95 % CI1.3-5.3) and near occlusion with out full collapse tended to have a higher risk (adjusted HR 2.0,95% CI 0.9-4.5)than ≥70% carotid stenosis.

Conclusions

symptomatic carotid near occlusion causes a high short term risk of recurrent ipsilateral stroke, especially near occlusion with full collapse

Background and Aims

Acute neurological deficits with seizure at onset (SAO)may reflect a transient post ictal phenomenon or due to actual stroke(AIS). Due to concerns about exposing patients with a stroke mimic to un necessary bleeding risk, SAO is considered a relative contra indication for intravenous thrombolysis( IVT)in patients with AIS . Here we investigated the prognostic significance of SAO in patients treated with IVT for suspected AIS.

Methods

We collected data on admitted patients with suspected AIS treated with IVT alone or followed by endo vascular treatment ( EVT).Out come measures were symptomatic intracranial hemorrhage (ECASS-11 criteria),all cause mortality at 3 months., 3 month functional out come on mRS .

Association between SAO and outcomes was assigned with aunadjusted logistic regression ,adjusted logistic regression ,coarsened exact matching and inverse probability weighted analysis.

Results

Out of 1900 patients treated with IVT 48 patients had SAO. In adjusted regression patients with SAO had generally less favourable out come than SAO patients .( SICH 4.2% vs 2.9% , mRS ­­≥ 3 ,48% Vs 42%, mortality 3 % Vs 2% .)After adjusting for confounding factors in adjusted,matched & weighted analyses all associations between SAO and any of the out come measures disappeared.These results were consistent regardless of whether patients had an eventual diagnosis of ischemic stroke or stroke mimic.

Conclusions

Among patients treated with IVT for suspected AIS, seizure at onset was not an independent predictor of poor prognosis. With holding IVT from other wise eligible patients with seizure at the onset of an acute stroke syndrome seems unjustified.

Background and Aims

Persistent trigeminal artery (PTA), is the most common of the embryonic arteries that connect the internal carotid artery with the vertebrobasilar system. We present a case of a patient presenting with “top-of-the-basilar” syndrome secondary to an occlusion of the internal carotid artery and presence of PTA.

Methods

A 62 year old male patient with a past medical history of dyslipidemia and hypertension presented with a altered sensorium and weakness of all four limbs with unsteadiness. CT angiography of the head showed severe basilar stenosis and a PTA. The patient received recombinant tissue plasminogen activator (rtPA) and was taken for cerebral angiogram (DSA) and clot retrieval.

Cerebral angiogram revealed a complete occlusion of the petrous segment of the right internal carotid artery , with an anatomical variant of PTA and a distal basilar thrombus. He underwent mechanical thrombectomy using solitaire and achieved TICI 2b recanalization.

Results

Embolic strokes have been reported in association with a persistent trigeminal artery .They can be managed well with recombinant tissue plasminogen activator and mechanical thrombectomy as in this case.

Conclusions

Understanding variant anatomy when selecting patients for thrombolysis and thrombectomy in patients presenting with stroke syndromes helps in better management of patients.

Background and Aims

Transcranial Doppler (TCD) can detect emboli in numerous cerebrovascular settings. Although previous studies have suggested that microembolic signals (MES) may predict recurrent stroke, the practical significance of such findings remains unclear. This uncertainity has deterred the widespread use of embolic monitoring among clinicians.

Methods

All ischemic stroke patients (n=186) admitted to stroke unit in our hospital who underwent MES monitoring from January 2017 to December 2021 were reviewed. A detection threshold of >9.00 dB was used.

Results

6±10 MES were detected in 19% of patients at an average of 14 ± 4.4 dB

Recurrent stroke was seen in 10% of patients ( monitoing over 10±6 days)

Patients with MES

1.More likely to have recurrent stroke (36% vs 3%, p=<0.005)

2.Undergo a revascularization procedure ( following TCDs) (29% vs 6%, p=0.005)

3.Longer length of stay (10 vs 5 days, p=0.001)

4.Discharge mRS 3-6 (72 % vs27%, p < 0.001)

Multivariable logistic regression analysis:

MES was an independent predictor of recurrent stroke

(OR 32.4,95% CI 8.6- 186.8) and of poor discharge mRS 3-6

(OR 10.7, 95% CI 5.0- 41.7) despite controlling for other stroke subtypes, antithrombotics, stroke severity, and age.

Conclusions

In our series of patients who underwent embolic monitoring with TCD, MES predicted ischemic stroke recurrence leading to worsened disability and prolonged hospital stays. Given that MES can provide important prognostic information. TCD with embolic monitoring may be clinically useful in the workup of ischemic stroke.