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Raoul Pop

Latest posts by Raoul Pop (see all)

  • CEREBRAL HEMODYNAMIC CHANGES IN PATIENTS WITH SEVERE CAROTID STENOSIS PRE AND POST CEA OR CAS MONITORED THROUGH TCD - 07/01/2016
  • REGIONAL ANGIOGRAPHIC EVALUATION OF COLLATERAL CIRCULATION PREDICTS INFARCTION DURING ENDOVASCULAR PROCEDURES FOR MIDDLE CEREBRAL ARTERY STROKE - 15/09/2015
  • THE ROLE OF LEPTOMENINGEAL COLLATERAL FLOW IN ACUTE ISCHEMIC STROKE - 15/09/2015

Articles signed on Romanian Journal of NEUROLOGY:

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

SELECT ISSUE

Romanian Journal of Neurology, Volume XII, No. 4, 2013
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

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.

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

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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REGIONAL ANGIOGRAPHIC EVALUATION OF COLLATERAL CIRCULATION PREDICTS INFARCTION DURING ENDOVASCULAR PROCEDURES FOR MIDDLE CEREBRAL ARTERY STROKE

SELECT ISSUE

Romanian Journal of Neurology, Volume XIII, No. 3, 2014
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

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.

REGIONAL ANGIOGRAPHIC EVALUATION OF COLLATERAL CIRCULATION PREDICTS INFARCTION DURING ENDOVASCULAR PROCEDURES FOR MIDDLE CEREBRAL ARTERY STROKE

Raoul Pop, Monica Manisor, Remy Beaujeaux, Christian Marescaux, Valérie Wolff and Mihaela Simu

ABSTRACT

Backgroud and purpose. We aimed to improve patient selection by developing a regional angiographic evaluation of leptomeningeal collateral flow that can be used to predict infarction during stroke endovascular procedures.

Matherials and methods. We evaluated all consecutive patients treated for a middle cerebral artery occlusion between 2009 and 2013. Two readers performed a zonal collateral circulation evaluation in 5 cortical regions based on the vascular anatomy. Zonal scores were correlated with the presence of infarction in the same cortical sector on pretreatment and follow-up imaging.

Results. In 49 patients with 217 cortical zones we found good correlation between the degree of zonal collateral flow and the absence of infarction in the same zone on pretreatment imaging (receiver operator characteristic (ROC) curve of 0.74, p < 0.0001).

In a subgroup of 23 recanalized patients (TICI 3) with 105 cortical zones, retrograde collateral flow to the proximal M4 segment predicted the absence of infarction within the same zone on follow-up imaging (positive predictive value 89,4% , negative predictive value 80%). We found good inter-rater agreement for the presence of collateral flow to the M4 proximal segment or further – kappa 0.77 (p = 0.05, 95%CI 0.66-0.88).

The number of cortical regions with collateral flow to the M2 segment predicts the absence of insular infarction on follow-up imaging (ROC curve of 0,76, p = 0,001).

Conclusion. Anatomic collateral flow evaluation can provide a real-time estimation of the size and location of irreversible ischemia during stroke endovascular procedures.

Keywords: regional angiographic evaluation, leptomeningeal collateral flow, endovascular procedures, middle cerebral artery stroke

Full text | PDF

THE ROLE OF LEPTOMENINGEAL COLLATERAL FLOW IN ACUTE ISCHEMIC STROKE

SELECT ISSUE

Romanian Journal of Neurology, Volume XIII, No. 3, 2014
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

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.

THE ROLE OF LEPTOMENINGEAL COLLATERAL FLOW IN ACUTE ISCHEMIC STROKE

Raoul Pop, Monica Manisor, Remy Beaujeaux, Christian Marescaux and Mihaela Simu

ABSTRACT

The importance of collateral flow through leptomeningeal anastomoses (LMA) is increasingly recognized in the physiopathology of acute ischemic stroke. We performed a review of the Medline database for studies in which collateral flow was correlated with clinical or imaging parameters in acute ischemic stroke. We also detail the anatomy of LMA, the various imaging modalities of collateral flow through LMA and current clinical trials investigating collateral flow augmentation treatments.

Keywords: collateral flow, leptomeningeal anastomoses (LMA), ischemic stroke

Full text | PDF



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