Daniel LIGHEZAN

Latest posts by Daniel LIGHEZAN (see all)

HEMODYNAMIC CHANGES OF SEVERE CAROTID ATHEROMATOSIS PRE AND POST ENDARTERECTOMY IN THE CASE OF A CORONARY PATIENT WITH ISCHEMIC STROKE - 08/01/2016
CEREBRAL HEMODYNAMIC CHANGES IN PATIENTS WITH SEVERE CAROTID STENOSIS PRE AND POST CEA OR CAS MONITORED THROUGH TCD - 07/01/2016
PROGNOSTIC CRITERIA AND TREATMENT FOR PATIENTS CANDIDATES FOR SURGERY OR PERCUTANEOUS CAROTID REPERFUSION - 15/09/2015

Articles signed on Romanian Journal of NEUROLOGY:

HEMODYNAMIC CHANGES OF SEVERE CAROTID ATHEROMATOSIS PRE AND POST ENDARTERECTOMY IN THE CASE OF A CORONARY PATIENT WITH ISCHEMIC STROKE

Romanian Journal of Neurology, Volume XII, No. 4, 2013

ISSN 1843-8148 | e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

Marius Militaru, Anda Militaru, Stanca Ples, Gratian Miclaus, Mihaela Simu and Daniel LIGHEZAN

ABSTRACT

Nearly 25%-30% of ischemic strokes are due to atherosclerosis of the carotid bifurcation. Cerebrovascular reactivity (CVR) is an indicator for testing hemodynamic status of cerebral circulation. The purpose of the presentation was to determine the effects of CEA (endarterectomy) on cerebral hemodynamics with cerebral hemodynamic change tracking, by measuring the average flow velocities (MFV) in the ipsilateral and contralateral middle cerebral artery (MCA) severe carotid stenosis and pulsatility index (PI) by the help of the Transcranian Doppler (TCD) and the study of CVR (cerebrovascular reactivity) by performing BHT (Breath-holding test) both before and at 7 days and at 2 and 4 months post intervention, as well as cerebral hemodynamic parameters determining through Cerebral Perfusion CT and correlation with risk factors and prior stroke event. Using ultrasound methods ECD (Extracranial Doppler) and TCD (Transcranial Doppler) and imaging (Perfusion Cerebral CT, angioCT cervical region, angiocoronarography) allowed: increased detection of patients at risk of stroke and myocardial infarction, stroke diagnosis of ischemic sites, the calculation of hemodynamic parameters of cerebral circulation at patients with coronary stenosis and carotid stenosis, occlusion with stroke up, TIAs or stroke risk and heart attack.

Keywords: carotid stenosis > 70%; transcranian Doppler – breath-holding test, cerebrovascular reactivity, CT perfusion, carotid endarterectomy

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CEREBRAL HEMODYNAMIC CHANGES IN PATIENTS WITH SEVERE CAROTID STENOSIS PRE AND POST CEA OR CAS MONITORED THROUGH TCD

ISSN 1843-8148 | e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Marius Militaru, Anda Militaru, Stanca Ples, Raoul Pop, Mihaela Simu and Daniel LIGHEZAN

ABSTRACT

Purpose. We have tried to emphasize the hemodynamic changes that occur in patients who experience uni/bilateral symptomatic/asymptomatic severe carotid stenosis with acute or chronic ischemic stroke pre and post interventional (endarterectomy/stent) using TCD (Transcranian Doppler ultrasound) to determine BHT(breath holding test) and CVR (cerebrovascular reactivity) calculation.

Material and methods. 30 patients with severe carotid stenosis over 70% have been evaluated for the following endarterectomy (CEA) or stent placement (CAS). The Transcranial Doppler (TCD) was performed prior to surgery, at 72 hours and at 2 months after the intervention. Average flow velocities at middle cerebral artery (MCA) and pulsatility index (PI) ipsi/contralateral stenosis were recorded. CVR through the apnea test (BHT) was measured, recording an increase in the mean fl ow velocity and calculating MCA-BHI (breath-holding index) of ipsi and contralateral stenosis.

Results. Mean flow velocities (MFV) in the middle cerebral artery (MCA) have significantly increased both ipsilateral to stenosis from 31.01 +/-5.81cm /s prior to surgery, from 40.75 +/-7.53 cm / s (p <0.01) at 72 hours postCEA/CAS, as well as contralateral to stenosis, from 36.09 +/-6.49 before surgery to 42.31 +/-7.50 postintervention, and pulsatility index (PI) significantly increased ipsilateral from 0.72 +/-0.15 to 0.88 +/-0.12. (p <0.01) after both endarterectomy and after angioplasty and contralateral stent placement from 0.79 +/-0.16 to 0.97 +/-0.13 (p <0.01) in both postintervention studies (CEA/CAS) compared with presurgery carotid stenosis values. Mean flow velocities at MCA increased significantly 2 months after surgery both by CEA/CAS, with slightly better contralateral to carotid stenosis and after CAS. CVR (%/s) significantly increased statistically from 0.60 +/-0.58 to 0.85 +/-0.54 (p <0.05) postintervention, both at 72 hours postsurgery, and 2 months after surgery, both ipsi and contralateral to stenosis, both after endarterectomy and after stent.

Conclusions. Both endarterectomy and angioplasty with stent placement are interventional methods that produce significant increases in mean flow velocities in the MCA immediately after surgery, with improved cerebral parameters and cerebrovascular reactivity both ipsi and contralateral to stenosis right after surgery, but especially at 2 months after surgery. CVR had a significant statistical increase after endarterectomy or stent, with no difference between 72 hours and 2 months post intervention at ipsilateral and contralateral increases were significant, but with higher values at 72 hours (p <0.01) compared to 2 months (p <0.05), with slightly better ipsilateral to carotid stenosis at 2 month, regardless of the carotid atheromatosis degree contralateral to severe carotid stenosis.

Keywords: carotid stenosis > 70%; transcranian Doppler – breath-holding test, cerebrovascular reactivity, endarterectomy/stent

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PROGNOSTIC CRITERIA AND TREATMENT FOR PATIENTS CANDIDATES FOR SURGERY OR PERCUTANEOUS CAROTID REPERFUSION

Romanian Journal of Neurology, Volume XIII, No. 2, 2014

ISSN 1843-8148 | e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Marius Militaru, Anda Militaru, Daniel LIGHEZAN, Lucian Petrescu and Mihaela Simu

ABSTRACT

Background. Atherosclerosis is a systemic disease involved in cerebrovascular disease (CVD), coronary arterial disease (CAD), and peripheral arterial disease (PAD). Atherosclerotic carotid artery stenosis is an important cause of ischemic stroke, accounting for approximately 20-30% of all ischemic strokes. Carotid endarterectomy (CEA) and Carotid angioplasty stent (CAS) are interventional treatment for symptomatic and asymptomatic patients with severe carotid artery stenosis.

Purpose. The purpose of this study was to evaluate the prognostic and treatment criteria in patients with severe carotid uni/bi-lateral stenosis in different circumstances: symptomatic/asymptomatic, with recent or old ischemic stroke, candidates for (CEA) or stent (CAS), with/without involvement of coronary arteries and peripheral endothelial function.

Material and methods. The study included 85 patients with severe carotid stenosis (over 70%) that have been evaluated for CEA or CAS. Patients were evaluated with Carotid Doppler and/or Angio CT of the cervical region, cardiac ultrasound and cerebral/coronary/peripheral angiography, thus assessing the degree of coronary and peripheral involvement. The following have been calculated: ejection fraction (EF) (%), telediastolic volume (TDV) (ml), overall cardiovascular risk - blood pressure score (Score BP), (ranging 1-4 according to severity) and 2 composite scores: global cardiovascular and hemodynamic risk score (GCVHRS), (ranging 1-10 according to risk factors summation) and organic vascular risk score (OVRS), (ranging 1-10 according to the number and topographic status of stenosis). Patients were divided into four groups: a) with carotid stenosis only (CaAS), b) with CaAS damage and coronary stenosis (CoAS), c) with CaAS damage and peripheral stenosis (PAS) and d) global vascular involvement (CaAS,CoAS,PAS). All study patients were compared with 85 matched patients with cardiovascular risk factors without signs of clinical organ damage.

Results. Among the 85 patients with severe carotid stenosis, 52 (61.2%) patients had ICA stenosis between 90%- 99%, 37 (43.5%) patients had CaAS involvement and 14 (16.5%) patients had multiple organ vascular damage. GCVHRS was significantly higher in the patient group with both CaAS and CoAS (scoring 5.80+/-2.33*) and also OVRS in patients with severe multiple organ vascular involvement (scoring of 6.78+/-1.42*), compared to the other groups of patients (p < 0.05). The hemodynamic risk evaluation in CaAS had a EF mean of 52.27+/-7.56 (%) and a TDV mean of 92.13+/-30.27* (ml) while in the global vascular involvement group EF dropped to a mean of 45.71+/-13.56 (%) and TDV increased to a mean of 124.28+/-51.38 (ml).

Conclusions. Higher composite scores (GCVHRS and OVRS) and decrease of EF best correlated with: the degree of carotid stenosis, with the presence of left internal carotid involvement, with the presence of a contralateral involvement (stenosis/occlusion). Secondary vascular disease prevention is mandatory in patients with carotid, coronary and peripheral arterial disease. A composite vascular risk evaluation is useful for individually tailoring our interventional treatment strategy thus improving the global functional outcome of any given patient.

*P < 0.05

Keywords: carotid artery stenosis > 70%; endarterectomy/stent, ejection fraction, global cardiovascular and hemodynamic risk score, vascular organic risk score

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Daniel LIGHEZAN

Latest posts by Daniel LIGHEZAN (see all)

Articles signed on Romanian Journal of NEUROLOGY:

HEMODYNAMIC CHANGES OF SEVERE CAROTID ATHEROMATOSIS PRE AND POST ENDARTERECTOMY IN THE CASE OF A CORONARY PATIENT WITH ISCHEMIC STROKE

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