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Single photon emission computed tomography (SPECT), three-dimensional computed tomographic angiography (3D-CTA) and carotid ultrasonography. (A) PAO-SPECT (1 day after endovascular surgery) reveals increased cerebral blood flow in the right cerebral hemisphere. (B, C) 3D-CTA (B) and carotid ultrasonography (C) shows sufficient patency 14 days postoperatively.
Source publication
Introduction:
We report a patient treated successfully via endovascular surgery within 24h after intravenous thrombolysis using recombinant tissue plasminogen activator for acute cervical internal carotid artery occlusion.
Presentation of case:
A 68-year-old man was admitted to our hospital. Neurological examination revealed severe left-sided mo...
Contexts in source publication
Context 1
... after these procedures, we started treatment with dual-agent antiplatelet therapy (aspirin 100 mg/day and clopi- dogrel 75 mg/day) and cilostazol 200 mg/day was added on the following day. The patient was restless with neurological abnor- malities, and 123 I IMP-single photon emission tomography (SPECT) (Fig. 4A) and INVOS-3100 revealed hyperperfusion in the territory of the right ICA. Strict control of blood pressure under dexmedeto- midine anesthesia allowed effective prevention of HPS. Carotid ultrasonography and three-dimensional computed tomographic angiography at 14 days ( Fig. 4B and C) revealed no further obstruc- tion to flow, and the ...
Context 2
... malities, and 123 I IMP-single photon emission tomography (SPECT) (Fig. 4A) and INVOS-3100 revealed hyperperfusion in the territory of the right ICA. Strict control of blood pressure under dexmedeto- midine anesthesia allowed effective prevention of HPS. Carotid ultrasonography and three-dimensional computed tomographic angiography at 14 days ( Fig. 4B and C) revealed no further obstruc- tion to flow, and the patient was discharged 3 weeks after surgery with mild left motor weakness. ...
Citations
... Dexmedetomidine also has been used successfully during angioplasty and stent placement in patients with acute cerebrovascular events. [106][107][108] In a retrospective study, Whalin et al concluded that dexmedetomidine is a suitable alternative to general anesthesia in these procedures. Patients undergoing sedation with dexmedetomidine had a better hemodynamic profile, a lower incidence of aspiration pneumonia, and smaller final infarction volumes. ...
... Patients undergoing sedation with dexmedetomidine had a better hemodynamic profile, a lower incidence of aspiration pneumonia, and smaller final infarction volumes. 109 Another promising indication is the postoperative use of dexmedetomidine for preventing cerebral hyperperfusion syndrome after CEA, angioplasty, or stenting, 108,110,111 even though additional studies are needed in this regard. 110 ...
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus. At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
Carotid stenosis is responsible for approximately 15% of ischemic strokes. Carotid revascularization significantly decreases patients' stroke risk. Carotid endarterectomy has first-line therapy for moderate-to-severe carotid stenosis after a series of pivotal randomized controlled trials were published almost 30 years ago. Revascularization with carotid stenting has become a popular and effective alternative in a select subpopulation of patients. We review the current state of the literature regarding revascularization indications, patient selection, advantages of each revascularization approach, timing of intervention, and emerging interventional techniques, such as transcarotid artery revascularization.
