Traitement endovasculaire des sténoses carotidiennes

STRASBOURG-Medecine (674822101) / SudocSTRASBOURG-Sc. et Techniques (674822102) / SudocSudocFranceF

Détection des plaques d’athérome carotidien sur les téléradiographies de profil. Enquête dans une population de patients présentant des troubles respiratoires lors du sommeil

La téléradiographie est une investigation radiologique courante en odontologie. Cet examen peut fortuitement révéler l’existence de pathologies qui ne sont pas toujours du ressort de l’odontologiste. C’est le cas pour les dépôts d’athérome de la bifurcation carotidienne qui, si leur état de calcification est suffisant, peuvent apparaître sur le cliché céphalométrique. Cette lésion siège en général au niveau de la quatrième vertèbre cervicale, en dessous de la corne hyoïdienne. Elle est de forme diffuse, peu contrastée, souvent un peu allongée avec des contours flous. L’objectif de ce travail a été d’évaluer la prévalence de ces images dans une population déterminée. Une étude rétrospective a été menée sur les téléradiographies de 1980 individus présentant des troubles respiratoires lors du sommeil, population réputée pour avoir un risque vasculaire. Tous les individus de l’étude avaient été examinés et traités dans le même Service d’Exploration du Sommeil. Les documents céphalométriques ont été soumis à une triple lecture. Il ressort de cette étude que 4,5 % des patients présentaient des images nettes de dépôts d’athérome suffisamment calcifiés pour être observables sur une téléradiographie de profil. L’âge moyen de ces patients était de 58 ans, pour un indice de masse corporelle de 32. L’odontologiste doit être attentif à l’existence de ce type de lésions sur les clichés radiographiques qu’il est amené à examiner, en particulier s’il s’agit d’un patient à risque. Il peut être le premier acteur de santé à détecter une telle lésion et il pourra ainsi favoriser une prise en charge rapide et appropriée du malade

A Systematic Review of the Complex Effects of Cannabinoids on Cerebral and Peripheral Circulation in Animal Models

While cannabis is perceived as a relatively safe drug by the public, accumulating clinical data suggest detrimental cardiovascular effects of cannabinoids. Cannabis has been legalized in several countries and jurisdictions recently. Experimental studies specifically targeting cannabinoids' effects on the cerebral vasculature are rare. There is evidence for transient vasoconstrictive effects of cannabinoids in the peripheral and cerebral vasculature in a complex interplay of vasodilation and vasoconstriction. Vasoreactivity to cannabinoids is dependent on the specific molecules, their metabolites and dose, baseline vascular tone, and vessel characteristics as well as experimental conditions and animal species. We systematically review the currently available literature of experimental results in in vivo and in vitro animal studies, examining cannabinoids' effects on circulation and reactive vasodilation or vasoconstriction, with a particular focus on the cerebral vascular bed

Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction: a prospective study in 48 consecutive young patients.: Ischemic Stroke and Cannabis

International audienceBACKGROUND AND PURPOSE: Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population. METHODS: Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months. RESULTS: In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (n=10). CONCLUSIONS: Multifocal angiopathy associated with cannabis consumption could be an important cause of ischemic stroke in young people

Image_1_A Systematic Review of the Complex Effects of Cannabinoids on Cerebral and Peripheral Circulation in Animal Models.pdf

<p>While cannabis is perceived as a relatively safe drug by the public, accumulating clinical data suggest detrimental cardiovascular effects of cannabinoids. Cannabis has been legalized in several countries and jurisdictions recently. Experimental studies specifically targeting cannabinoids' effects on the cerebral vasculature are rare. There is evidence for transient vasoconstrictive effects of cannabinoids in the peripheral and cerebral vasculature in a complex interplay of vasodilation and vasoconstriction. Vasoreactivity to cannabinoids is dependent on the specific molecules, their metabolites and dose, baseline vascular tone, and vessel characteristics as well as experimental conditions and animal species. We systematically review the currently available literature of experimental results in in vivo and in vitro animal studies, examining cannabinoids' effects on circulation and reactive vasodilation or vasoconstriction, with a particular focus on the cerebral vascular bed.</p

Postprocedural Antiplatelet Treatment after Emergent Carotid Stenting in Tandem Lesions Stroke: Impact on Stent Patency beyond Day 1

8115381BACKGROUND AND PURPOSE: Postprocedural dual-antiplatelet therapy is frequently withheld after emergent carotid stent placement during stroke thrombectomy. We aimed to assess whether antiplatelet regimen variations increase the risk of stent thrombosis beyond postprocedural day 1. MATERIALS AND METHODS: Retrospective review was undertaken of all consecutive thrombectomies for acute stroke with tandem lesions in the anterior circulation performed in a single comprehensive stroke center between January 9, 2011 and March 30, 2020. Patients were included if carotid stent patency was confirmed at day 1 postprocedure. The group of patients with continuous dual-antiplatelet therapy from day 1 was compared with the group of patients with absent/discontinued dual-antiplatelet therapy. RESULTS: Of a total of 109 tandem lesion thrombectomies, 96 patients had patent carotid stents at the end of the procedure. The early postprocedural stent thrombosis rate during the first 24 hours was 14/96 (14.5%). Of 82 patients with patent stents at day 1, in 28 (34.1%), dual-antiplatelet therapy was either not initiated at day 1 or was discontinued thereafter. After exclusion of cases without further controls of stent patency, there was no significant difference in the rate of subacute/late stent thrombosis between the 2 groups: 1/50 (2%) in patients with continuous dual-antiplatelet therapy versus 0/22 (0%) in patients with absent/discontinued dual-antiplatelet therapy (P = 1.000). In total, we observed 88 patient days without any antiplatelet treatment and 471 patient days with single antiplatelet treatment. CONCLUSIONS: Discontinuation of dual-antiplatelet therapy was not associated with an increased risk of stent thrombosis beyond postprocedural day 1. Further studies are warranted to better assess the additional benefit and optimal duration of dual-antiplatelet therapy after tandem lesion stroke thrombectomy