Browsing by Author "Sundaram, S"

Now showing 1 - 4 of 4
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    Collateral Assessment by CT Angiography as a Predictor of Outcome in Symptomatic Cervical Internal Carotid Artery Occlusion
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 2017) Sundaram, S; Kannoth, S; Thomas, B; Sarma, PS; Sylaja, PN
    BACKGROUND AND PURPOSE: Cervical internal carotid artery occlusion can present with varied clinical manifestations such as transient ischemic attack, stroke, and chronic ocular ischemia, or can be asymptomatic. The outcome in these patients is considerably influenced by cerebral hemodynamic compensatory adaptation of the intracranial collateral pathways. Our aim was to study whether collateral circulation as assessed by CT angiography can predict 3-month outcome and initial stroke severity in patients with symptomatic cervical ICA occlusion. MATERIALS AND METHODS: This was a retrospective study of 65 patients with symptomatic cervical ICA occlusion from January 2011 to December 2013. The collateral vessels (anterior and posterior communicating arteries, ophthalmic artery, and leptomeningeal arteries) were assessed by CTA. The outcome at 3 months was defined as poor if the modified Rankin Scale score was >= 3. RESULTS: The mean age of subjects was 57 +/- 11.6 years (range, 32-80 years), and 92% were men. Thirty-three (50.8%) patients had poor outcome. Absence of the ipsilateral ophthalmic artery, poor leptomeningeal collaterals, and <2 collaterals were predictors of stroke severity at onset and poor 3-month outcome in univariate analysis. In the multiple logistic regression analysis, inadequate flow through the secondary collaterals.(ipsilateral ophthalmic artery or leptomeningeal collaterals; OR, 4.5; 95% CI, 1.4-14.9; P =.01) and higher NIHSS score at stroke onset (OR, 19.2; 95% CI, 2.2-166.2; P =.007) independently predicted poor outcome at 3 months. CONCLUSIONS: Assessment of collateral circulation with CTA can be a useful predictor of 3-month outcome in patients with symptomatic cervical ICA occlusion.
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    CT angiogram as a predictor of outcome in symptomatic ICA occlusion
    (INTERNATIONAL JOURNAL OF STROKE, 2014) Sundaram, S; Sylaja, PN; Kannoth, S; Thomas, B
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    Moyamoya disease: A comparison of long term outcome of conservative and surgical treatment in India
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2014) Sundaram, S; Sylaja, PN; Menon, G; Sudhir, J; Jayadevan, ER; Sukumaran, S; Sreedharan, SE; Sarma, S
    Background: Revascularization surgery (RS) is the therapy of choice in moyamoya disease (MMD). Due to rarity of disease and ethical concerns, randomized controlled trials about the treatment options are lacking. Very little information is available on the long-term outcome of conservatively treated moyamoya patients. Aim: We compared the long-term outcome of moyamoya patients treated conservatively to those who underwent RS. Methods: Our study population included all patients with moyamoya disease/syndrome from 2002 to 2012. The demographic, clinical characteristic and imaging details were reviewed. The outcome was obtained prospectively. Results: Of the 36 patients, 26 (72.2%) had MMD and 10 (27.8%) had moyamoya syndrome. The median age at onset of symptoms was 17.5 years (range, 10 months-55 years). Fifteen patients belonged to pediatric group and 21 were adults. All the pediatric patients had ischemic events at onset and 10 (47.6%) of the adults presented with hemorrhage. Twenty (55.6%) patients received conservative treatment and 16 (44.4%) underwent revascularization procedures. The median duration of follow-up was 28 months (range, 3-90 months). Three (18%) of the surgically treated patients had recurrent ischemic events on follow-up, but none of the conservatively treated patients had events. An excellent outcome (Modified Rankin Scale of <= 2) was seen in 12 (75%) surgically treated and 16 (94%) conservatively treated patients (p = 0.17). Conclusion: Compared to East Asians, our patients had a lower stroke recurrence rate and good functional outcome even with conservative treatment. Future studies should focus on clinical and imaging predictors of progression to select moyamoya patients for RS. (C) 2013 Elsevier B.V. All rights reserved.
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    Moyamoya Syndrome Comparison of Long Term Outcome of Conservative and Surgical treatment in India.
    (STROKE, 2013) Sylaja, PN; Sundaram, S; Menon, G; Jayadevan, ER; Sukumaran, S; Sreedharan, S