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Urgent CAS
G. COPPI, R. MORATTO
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Lack of neuroimaging
Lack of patient selection
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conversion
(Wardlaw '92)
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(Cuming '92)
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Stopping embolisation Stopping growth of the thrombus Saving area of ischemic penumbra
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Minor stroke ( in evolution) Major stroke ( no coma , lesion at MR-diffusion < 2.5 cm)
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IMPENDING STROKE
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Duplex-scan
+ -
CEA in emergency
Lack of Neuroimaging
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Neurological exam
Stroke minor +
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Years 43
Intervention CEA
NIHSS pre 7
NIHSS post 2
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Recurrent TIAs
Unstable plaque
Sintomi appropriati
yes no
Immediate treatment
Within 12 hours
Within 36 hour
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Perfusional CT + Angio-CT or RM diffusion ( neuroradiologist) Stroke minor Lesion< 2,5 cm. No coma
yes
Treatment
no
Evaluation case by case
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Anatomy suitable for surgery (access, neck, bifurcation..) Young patients (at low risk)
yes no
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CEA
DISASTER
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High risk patients, elderly, with tortuos vessels and problematic accesses
Unstable plaque with vulnerability features
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High risk patients, elderly, anziani , with tortuos vessels and problematic accesses
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no
yes
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11 10 9 8
12
1 2 3 4
Avoiding sudden bradicardia or asystolia Avoiding scissoring effect in soft plaques Avoiding plaque suction with prolapse
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22 25 21 5
15 42 12 3
37 67 33 8
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73 (100%)
73( 100%)
12 61
STENTS
Closed or hybrid cells Open cells
84
60 24 6.8 min
54 min
4.1 min May 2005 April 2011
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STROKE
CEA 100% 0 CAS 100% 0 CEA 100% 0
CAS 100% 0
1/47
1 1
1/57
0 1
3/26
0 1 May 2005 April 2011
2/15
1 1
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Considerations
Urgent CAS represents a possible solution , complementary to the CEA , in a strategy of tailored treatment , based on anatomy, patients and lesion features , also in neurological unstable situations
CEA
CAS
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