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1.
Medicine (Baltimore) ; 103(10): e37343, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38457578

RESUMO

RATIONALE: Unconsciousness is a nonfocal symptom of transient ischemic attack (TIA) that is frequently observed in patients with vertebrobasilar artery stenosis or occlusion. Conversely, loss of consciousness due to anterior circulation involvement (e.g., middle cerebral artery [MCA]) is a rare occurrence in TIA. PATIENT CONCERNS: This report describes a rare case in a 59-year-old woman who experienced recurrent episodes of altered consciousness because of the occlusion or stenosis of her MCAs. DIAGNOSES: The diagnosis of the case was updated from TIA to acute cerebral infarction, finally. Following initial loss of consciousness, cranial magnetic resonance imaging (MRI) did not reveal any evidence of acute cerebral infarction. However, following the second and third episodes of unconsciousness, the MRI revealed multiple new acute cerebral infarcts affecting both the cerebral hemispheres. Further evaluation through digital subtraction angiography disclosed complete occlusion of the left MCA and severe stenosis of the right MCA. INTERVENTIONS: Early in her illness, the patient was treated with vasodilators, aspirin and atorvastatin. Finally, 2 stents in her right and left MCAs were placed respectively, followed by treatment with aspirin, clopidogrel, and double-dosed atorvastatin calcium. Meanwhile, the patient focused on avoiding conditions which may lead to dehydration in her daily life routine. OUTCOMES: The episodes of unconsciousness of this patient were completely resolved. During the 1-year postoperative follow-up, the patient remained clinically stable without any symptoms of unconsciousness, limb numbness or weakness, or dizziness. LESSONS: These findings suggested that hypoperfusion in the bilateral cerebral hemispheres played a pivotal role in precipitating the patient episodes of unconsciousness. This case underscores the possibility that occlusion or severe stenosis in both MCAs can contribute to recurrent episodes of unconsciousness due to hypoperfusion. Moreover, it emphasizes the association between these episodes of unconsciousness and an increased risk of subsequent ischemic stroke.


Assuntos
Isquemia Encefálica , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Feminino , Pessoa de Meia-Idade , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/complicações , Constrição Patológica/complicações , Isquemia Encefálica/complicações , Aspirina , Insuficiência Vertebrobasilar/complicações , Doença Aguda , Inconsciência/etiologia , Acidente Vascular Cerebral/complicações , Infarto Cerebral/complicações
2.
J Am Heart Assoc ; 13(6): e032107, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38471827

RESUMO

BACKGROUND: This study aimed to establish and validate a nomogram model for predicting 90-day mortality in patients with acute basilar artery occlusion receiving endovascular thrombectomy. METHODS AND RESULTS: A total of 242 patients with basilar artery occlusion undergoing endovascular thrombectomy were enrolled in our study, in which 172 patients from 3 stroke centers were assigned to the training cohort, and 70 patients from another center were assigned to the validation cohort. Univariate and multivariate logistic regression analyses were adopted to screen prognostic predictors, and those with significance were subjected to establish a nomogram model in the training cohort. The discriminative accuracy, calibration, and clinical usefulness of the nomogram model was verified in the internal and external cohorts. Six variables, including age, baseline National Institutes of Health Stroke Scale score, Posterior Circulation-Alberta Stroke Program Early CT (Computed Tomography) score, Basilar Artery on Computed Tomography Angiography score, recanalization failure, and symptomatic intracranial hemorrhage, were identified as independent predictors of 90-day mortality of patients with basilar artery occlusion and were subjected to develop a nomogram model. The nomogram model exhibited good discrimination, calibration, and clinical usefulness in both the internal and the external cohorts. Additionally, patients were divided into low-, moderate-, and high-risk groups based on the risk-stratified nomogram model. CONCLUSIONS: Our study proposed a novel nomogram model that could effectively predict 90-day mortality of patients with basilar artery occlusion after endovascular thrombectomy and stratify patients with high, moderate, or low risk, which has a potential to facilitate prognostic judgment and clinical management of stroke.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar , Nomogramas , Resultado do Tratamento , Estudos Retrospectivos , Trombectomia/métodos , Acidente Vascular Cerebral/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Medição de Risco , Procedimentos Endovasculares/métodos
4.
Clin Neurol Neurosurg ; 237: 108133, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38340428

RESUMO

OBJECTIVE: Although consensus has been reached regarding the use of mechanical thrombectomy for acute large anterior circulation occlusion, its effectiveness in patients with posterior circulation occlusion remains unclear. This study aimed to establish the determining factors for good clinical outcomes of mechanical thrombectomy for posterior circulation occlusion. METHODS: We extracted cases of acute large vessel occlusion (LVO) in the posterior circulation from a database comprising 536 patients who underwent mechanical thrombectomy at our hospital between April 2015 and March 2021. RESULTS: Fifty-two patients who underwent mechanical thrombectomy for LVO in the posterior circulation were identified. Five patients with simultaneous occlusion of the anterior and posterior circulation were excluded; finally, 47 patients were included in this study. The median patient age was 78 years, and 36% of the patients were women. The median National Institutes of Health Stroke Scale (NIHSS) score on admission was 31, the median posterior circulation-Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS) was 8, and the median Basilar Artery on Computed Tomography Angiography (BATMAN) score was 6. The rate of good recanalization (Thrombolysis in Cerebral Infarction scale grades 2b and 3) was 96%, and a good prognosis (modified Rankin Scale score of 0-2 at 90 days) was achieved in 19 patients (40%). The median pc-ASPECTS was significantly higher in the good prognosis group than in the poor prognosis group (10 vs. 7; p = 0.007). The median NIHSS score at presentation was significantly lower in the good prognosis group than in the poor prognosis group (17 vs. 34; p = 0.02). The median BATMAN score was significantly higher in the good prognosis group than in the poor prognosis group (8 vs. 3.5; p = 0.0002). Multivariate analysis showed that an NIHSS score ≦ 20 at presentation was the only independent factor for good prognoses. CONCLUSION: The prognosis of mechanical thrombectomy for posterior circulation LVO was better in patients with lower NIHSS scores at presentation.


Assuntos
Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Estados Unidos , Humanos , Feminino , Idoso , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos
5.
AJNR Am J Neuroradiol ; 45(2): 176-182, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38238095

RESUMO

BACKGROUND AND PURPOSE: Vertebrobasilar dolichoectasia aneurysm is a rare type of cerebrovascular disorder with a poor natural history, and endovascular treatment is widely accepted. Whether a high-profile braided stent (flow diverter) could promote occlusion of vertebrobasilar dolichoectasia aneurysm without increasing the complications rather than a low-profile braided stent remains uncertain. The aim of the study was to present a single-center experience of the safety and efficacy of a low-profile braided stent versus a flow diverter in treating patients with vertebrobasilar dolichoectasia aneurysms. MATERIALS AND METHODS: The retrospective review was conducted on a total of 432 consecutive patients diagnosed with posterior circulation aneurysms who underwent endovascular treatment in our center from August 2013 to December 2021. Among these patients, 47 individuals with vertebrobasilar dolichoectasia aneurysms who were treated with low-profile braided stents or flow diverters were included. Vertebrobasilar dolichoectasia aneurysms involving only the vertebral artery were excluded. Patients were divided into 2 groups: the low-profile braided stent group and the flow diverter group based on the device used. Safety and efficacy outcomes were subsequently analyzed. RESULTS: There were 25 total patients enrolled in low-profile braided stent group and 22 patients in flow diverter group. The safety of low-profile braided stents and flow diverters in the treatment of vertebrobasilar dolichoectasia aneurysms was evaluated by clinical outcome, a new neurologic deficit due to procedural complications, and neurologic death. The rates of good clinical outcome were similar between the 2 groups (low-profile braided stent, 56%, versus flow diverter, 59.1%; P = .831), and the rates of neurologic death were also similar (low-profile braided stent, 12%, versus flow diverter, 9.1%; P = .747). Higher rates of new neurologic deficits due to procedural complications were observed in the flow diverter group, but the difference was not significant (low-profile braided stent, 24%, versus flow diverter, 40.9%; P = .215). The efficacy was evaluated by angiographic occlusion of vertebrobasilar dolichoectasia aneurysms and progression of mass effect resulting from these aneurysms. Significantly higher rates of complete occlusion of vertebrobasilar dolichoectasia aneurysms were shown in the flow diverter group (41.2%; P = .028) than in the low-profile braided stent group (10%). CONCLUSIONS: Both low-profile braided stents and flow diverters have similar high risks in reconstructive techniques in the treatment of vertebrobasilar dolichoectasia aneurysms, while a flow diverter is more effective in promoting complete occlusion of vertebrobasilar dolichoectasia aneurysm than a low-profile braided stent. A flow diverter may be a better alternative for carefully selected patients with vertebrobasilar dolichoectasia aneurysms.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Insuficiência Vertebrobasilar , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Seguimentos , Resultado do Tratamento , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Stents , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Estudos Retrospectivos
7.
Intern Med ; 63(2): 327-331, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-37286508

RESUMO

Hidden bow hunter's syndrome (HBHS) is a rare disease in which the vertebral artery (VA) occludes in a neutral position but recanalizes in a particular neck position. We herein report an HBHS case and assess its characteristics through a literature review. A 69-year-old man had repeated posterior-circulation infarcts with right VA occlusion. Cerebral angiography showed that the right VA was recanalized only with neck tilt. Decompression of the VA successfully prevented stroke recurrence. HBHS should be considered in patients with posterior circulation infarction with an occluded VA at its lower vertebral level. Diagnosing this syndrome correctly is important for preventing stroke recurrence.


Assuntos
Mucopolissacaridose II , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Masculino , Humanos , Idoso , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia , Angiografia Cerebral/efeitos adversos , Mucopolissacaridose II/complicações , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Acidente Vascular Cerebral/complicações
9.
J Stroke Cerebrovasc Dis ; 33(1): 107454, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37931481

RESUMO

OBJECTIVES: To assess whether vertebrobasilar artery ischemia (VBI) affects cortical cerebral blood flow (CBF) regulation. MATERIAL AND METHODS: 107 consecutive patients (mean age 65 ± 15 years; women 21) with VBI underwent structured stroke care with assessment of dynamic cerebral autoregulation (dCA) in both middle cerebral arteries (MCAs) by transfer function analysis using spontaneous oscillations of blood pressure (BP) and CBF velocity that yields by extraction of phase and gain information in the very low (0.02-0.07 Hz), low (0.07-0.15 Hz) and high frequency (0.15-0.5 Hz) ranges. Additionally, power spectrum analysis of BP and heart rate variability (HRV) was performed. The control group consists of 29 age- and sex-matched healthy persons. RESULTS: Compared to controls, phase in the VBI patients was significantly reduced and gain increased in the very low frequencies (VLF), in the low (LF), phase was significantly reduced only ipsilaterally. In the high frequencies (HF), phase reduction was only marginally significant. BP power spectral density (PSD) was much higher in the patients than in the controls across all frequencies. In the PSD of heart rate variability the controls but not the patients exhibited a strong peak around 0.11Hz, while the patients, but not the controls, exhibit a strong peak around 0.36 Hz. In regression analysis, patient's phase and gain results were not related to age, sex, arterial hypertension, diabetes mellitus, renal dysfunction, heart failure as indicated by left ventricular ejection fraction, stroke subtype, presence or absence of cerebral small vessel disease. CONCLUSION: Patients with VBI exhibit bilateral cortical autoregulation impairment in association with an autonomic nervous system disbalance. GOV IDENTIFIER: NCT04611672.


Assuntos
Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiologia , Volume Sistólico , Velocidade do Fluxo Sanguíneo/fisiologia , Função Ventricular Esquerda , Pressão Sanguínea/fisiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Circulação Cerebrovascular/fisiologia , Homeostase/fisiologia
10.
Neurol Sci ; 45(1): 365-367, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37792110

RESUMO

A 27-year-old female patient suffered from recurrent episodes of dizziness, visual rotation, and intermittent right-hand numbness over one month. Symptoms persisted and were triggered by rotating the head to the right or left for more than 10 seconds. Neurological examination showed that the symptoms were most pronounced when the head was rotated over 45 degrees to the right. Dynamic digital subtraction angiography (dDSA) was performed to confirm the diagnosis. Leftward head rotation caused occlusion of the right vertebral artery(VA) . However, the symptoms were mild, owing to sufficient compensation by the right posterior communicating artery (PCA) . Rightward head rotation exceeding 45 degrees resulted in occlusion of the left VA. The resultant symptoms were pronounced due to inadequate compensation of the left PCA. CT angiographic reconstruction showed bilateral vertebral arteries with tortuous loops of vessels at the level of the C2 vertebrae . CT images showed no cleavage between the left VA and the anterior surface of the left C2 transverse foramen. Conservative treatment was recommended considering the patient's young age and limited severity of her symptoms. Bow Hunter's syndrome is a rare neurovascular disorder characterized by dynamic occlusion of the VAs during head rotation, leading to inadequate blood flow to the posterior cerebral circulation. Bow hunter syndrome, where bilateral dynamic occlusion occurs without a discernible dominant side of the VA, is uncommon. The medical community must acknowledge cervical vertigo as a distinct disorder. dDSA remains the gold standard for its diagnosis.


Assuntos
Mucopolissacaridose II , Insuficiência Vertebrobasilar , Humanos , Feminino , Adulto , Insuficiência Vertebrobasilar/diagnóstico por imagem , Mucopolissacaridose II/complicações , Angiografia Digital/efeitos adversos , Angiografia Cerebral , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia
11.
J Thromb Thrombolysis ; 57(1): 124-131, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37605064

RESUMO

OBJECTIVE: This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. METHODS: Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. RESULTS: A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. CONCLUSION: Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.


Assuntos
Arteriopatias Oclusivas , Aterosclerose , Embolia , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar , Insuficiência Vertebrobasilar/cirurgia , Insuficiência Vertebrobasilar/etiologia , Trombectomia/efeitos adversos , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Aterosclerose/terapia , Aterosclerose/etiologia , Estudos Retrospectivos
12.
World Neurosurg ; 182: 135, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37797682

RESUMO

The differential for vertebrobasilar insufficiency is wide and can be caused by posterior circulation infarcts, steal-type phenomena, or other systemic causes. In the absence of imaging findings explaining symptomology, the utility of appropriate history gathering and dynamic angiography cannot be understated in identifying Bow Hunter's syndrome, a rare cause of dynamic vertebrobasilar insufficiency. We present a case of a 69-year-old man who complained of presyncope and severe dizziness when turning his head towards the right. On examination he had no radiculopathy but did have objective evidence of myelopathy. Computed tomography imaging and dynamic angiography demonstrated C3-C4 right uncovertebral joint hypertrophy and near complete stenosis of the right vertebral artery with dynamic head position towards the right. Given vertebrobasilar insufficiency and myelopathy, he was taken to the operating room for C3-C4 anterior cervical discectomy and fusion with vertebral artery decompression (Video 1). The patient provided consent for the procedure. Standard anterior cervical neck dissection was undertaken with additional platysmal undermining to facilitate exposure of the right uncovertebral joint and transverse processes. The vertebral artery was first decompressed above and below the area of most significant stenosis at the respective transverse foramina before the hypertrophied uncovertebral joint was removed. Next, discectomy and posterior osteophyte removal were completed in typical fashion followed by graft, plate, and screw placement. Postoperatively the patient had immediate resolution of symptoms and continued so at eight month follow-up. Imaging demonstrated return to normal caliber of the right vertebral artery and successful decompression.


Assuntos
Mucopolissacaridose II , Doenças da Medula Espinal , Insuficiência Vertebrobasilar , Masculino , Humanos , Idoso , Mucopolissacaridose II/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Constrição Patológica/complicações , Angiografia Cerebral/métodos , Descompressão Cirúrgica/métodos , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia , Doenças da Medula Espinal/cirurgia
13.
J Neurointerv Surg ; 16(2): 217, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-37221037

RESUMO

Patients with stroke symptoms due to acute basilar artery occlusion can benefit from endovascular thrombectomy.1 2 Several papers have reported unwanted events during thrombectomy procedures such as breakage, fragmentation, or even intravascular migration of the devices or catheter pieces. These papers also presented methods or techniques to retrieve defective devices such as a snare, retrievable stents, or balloons.3-6 Video 1 presents a case of basilar thrombectomy that was complicated with fragmentation and then distal migration of a Marksman microcatheter tip into the left posterior cerebral artery. The video shows the bailout technique that was used to retrieve the migrated catheter tip using a gentle/simple and posterior circulation-friendly technique-a technique based on fundamental neurointerventional concepts. neurintsurg;16/2/217/V1F1V1Video 1 This video demonstrates the use of a bailout technique to retrieve a migrated microcatehter tip after basilar artery thrombectomy.


Assuntos
Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Insuficiência Vertebrobasilar/complicações , Trombectomia/métodos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Procedimentos Endovasculares/métodos , Stents , Resultado do Tratamento
14.
Khirurgiia (Mosk) ; (12): 95-102, 2023.
Artigo em Russo | MEDLINE | ID: mdl-38088846

RESUMO

Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.


Assuntos
Aterosclerose , Síndrome do Roubo Subclávio , Insuficiência Vertebrobasilar , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Qualidade de Vida , Síndrome do Roubo Subclávio/diagnóstico , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia , Stents , Resultado do Tratamento
15.
Medicine (Baltimore) ; 102(51): e36691, 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38134117

RESUMO

RATIONALE: Sudden bilateral deafness is often associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury, but very rarely to cerebrovascular disease. This is a rare case of sudden bilateral deafness in a patient with the vertebrobasilar artery occlusion. PATIENT CONCERNS: A 46-year-old man was admitted to a local hospital for sudden bilateral deafness, the patient suffered inarticulate speech and walking unsteadily 6 days later. DIAGNOSES: Difusion-weighted magnetic resonance imagin demonstrated acute cerebral infarction in the pons and bilateral cerebellum; Magnetic resonance angiography showed vertebrobasilar artery occlusion. INTERVENTIONS: Aspirin and clopidogrel were given for antiplatelet therapy, revascularization was obtained by endovascular treatment. OUTCOMES: The symptoms of dysarthria, ataxia and weakness gradually improved and were discharged 14 days after admission revascularization. After 3 months telephone followed-up the patient was self-cared. LESSONS: Deafness sometimes can be an early warning sign of impending vertebrobasilar ischemic stroke. Early recognition of deafness with acute ischemic stroke should allow special management, and misdiagnosis may result in significant morbidity, or even mortality.


Assuntos
Arteriopatias Oclusivas , Surdez , Perda Auditiva Súbita , AVC Isquêmico , Insuficiência Vertebrobasilar , Masculino , Humanos , Pessoa de Meia-Idade , Perda Auditiva Bilateral/etiologia , AVC Isquêmico/complicações , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico , Perda Auditiva Súbita/etiologia , Perda Auditiva Súbita/complicações , Arteriopatias Oclusivas/complicações , Artérias
16.
Sci Rep ; 13(1): 22395, 2023 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-38104225

RESUMO

To investigate the incidence and impact of superior cerebellar artery (SCA) occlusion remaining after thrombectomy for acute basilar artery occlusion (BAO). We retrospectively analyzed data from 116 patients who underwent thrombectomy for BAO. The patency of SCA was assessed on final angiograms. Clinical and radiologic data of the patients were retrieved from a prospectively collected database and analyzed. All patients underwent pretreatment and follow-up DWI to detect new infarctions in SCA territory. Ten patients (8.6%) had SCA occlusions on final angiograms. Of these, two patients had bilateral occlusions. A new infarction with a diameter ranged from 4 to 11 mm in corresponding SCA territory occurred in 5 of 10 patients. No patients with SCA occlusions experienced symptomatic cerebellar hemorrhage or malignant cerebellar infarction. Nine of 12 SCA occlusions showed spontaneous recanalization on follow-up CT angiography. Four of 10 patients showed 90-day favorable outcome (mRS 0-3) and 90-day mortality occurred in one patient. SCA occlusions remaining after thrombectomy for acute BAO had a benign clinical course. Most of these lesions recanalized spontaneously. Our study suggests that attempts to recanalize remnant SCA occlusion may be unnecessary after basilar artery thrombectomy.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Insuficiência Vertebrobasilar/etiologia , Estudos Retrospectivos , Procedimentos Endovasculares/efeitos adversos , Resultado do Tratamento , Trombectomia/efeitos adversos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Arteriopatias Oclusivas/etiologia , Infarto/etiologia , Acidente Vascular Cerebral/etiologia
17.
Zh Nevrol Psikhiatr Im S S Korsakova ; 123(12): 109-115, 2023.
Artigo em Russo | MEDLINE | ID: mdl-38147390

RESUMO

OBJECTIVE: To develop indications for surgical treatment for positional disorders of blood flow in the vertebral-basilar territory caused by the damage to the V2-V3 segment of the vertebral artery (VA). MATERIAL AND METHODS: One hundred and fourteen patients with systemic and non-systemic dizziness were studied. To assess the state of the VA, blood circulation of the posterior cranial fossa and the base of the brain, ultrasound duplex scanning of blood vessels, selective angiography, MRI, single photon emission computed tomography (SPECT) of the brain and neuropsychological testing were performed. Patients were divided into three groups according to the severity of clinical manifestations of vertebrobasilar insufficiency (VBI). RESULTS: According to ultrasound data, patients of the third group with severe VBI had signs of extravasal compression in 94.3% of cases. In the same group, there was an increase in the systolic-diastolic (S/D) ratio by more than 2.5-3 times, as well as an increase in the resistive index (RI) by more than 1.75 units and pulsation index (PI) more than 2.2 units in V2-V3 segments of VA. In 42.9% of patients of the third group, zones of a decrease in the accumulation of 99mTc-ECD by more than 20% were found in the occipital region during the De Klein test. A direct correlation was established between the clinical manifestations of VBI and a decrease in perfusion during SPECT by 20% or more with the De Klein test (r=0.7). We developed an algorithm for diagnosing high-grade VBI with subsequent identification of a causal relationship with extravasal component effects on VA in the second segment. Indications for surgical intervention were determined in 33 patients with clinical manifestations of blood flow decompensation in the posterior cranial fossa. CONCLUSION: Decreased blood flow velocity in the vertebral or basilar artery by more than 50% with a decrease in PI, breath holding index <0.7 in the hypercapnic test, and no increase in blood flow velocity in a phototest and, in addition, the >20% defect of 99mTc-ECD accumulation in the posterior parts of the brain during SPECT with a De Klein test are the criteria for decompensation of blood flow in the vertebral-basilar territory, requiring surgical correction.


Assuntos
Artéria Vertebral , Insuficiência Vertebrobasilar , Humanos , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Compostos de Organotecnécio , Algoritmos
18.
Brain Behav ; 13(12): e3297, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37957826

RESUMO

BACKGROUND: The evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online. METHODS: BAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web-based calculators were constructed to provide convenient access. RESULTS: A total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24 h, and pc-ASPECTS. CONCLUSION: Dynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar/cirurgia , Nomogramas , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Trombectomia/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Arteriopatias Oclusivas/etiologia , Estudos Retrospectivos
20.
Altern Ther Health Med ; 29(8): 255-261, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37573598

RESUMO

Objective: The purpose of this pilot study is to explore the difference in safety and effectiveness after stenting in patients with extracranial or intracranial vertebral artery stenosis. Methods: The study involved 26 patients treated with stents for ≥70% stenosis between January 1, 2017, and September 8, 2020. The patients were divided into intracranial and extracranial groups based on the location of the target vessel stenosis. The incidence of stroke or death within 30 days, long-term recurrence of ischemic symptoms, and restenosis during follow-up were monitored. Results: Within 30 days, no stroke or death was observed in the 26 patients, During the follow-up period, the risk of recurrence of posterior circulation stroke or transient ischemic attack was 23.1% (6/26). Vascular-related complications were 5.6% vs. 12.5% (P = .529) in the intracranial vs. extracranial stenosis group. After 1 year, stroke or transient ischemic attack of posterior circulation was observed in 12.5% (1/8) vs. 16.7% (3/18) in the intracranial and extracranial stenosis group, respectively. The restenosis rate in the intracranial stenosis group was higher than the extracranial stenosis group (37.5% vs. 28.6%, P > .05). This trend was also found in the asymptomatic restenosis rate (25% vs. 7.1%, P = .527). Conclusions: The study results showed that there was no significant difference in the safety and effectiveness after stenting in extracranial and intracranial vertebral artery stenosis, but intracranial vertebral artery stenosis has a low rate of symptomatic restenosis. Symptomatic restenosis may be an important problem that limits the efficacy of extracranial vertebral artery stenting.


Assuntos
Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Ataque Isquêmico Transitório/cirurgia , Ataque Isquêmico Transitório/complicações , Constrição Patológica/complicações , Projetos Piloto , Acidente Vascular Cerebral/complicações , Insuficiência Vertebrobasilar/cirurgia , Insuficiência Vertebrobasilar/complicações , Stents/efeitos adversos , Resultado do Tratamento
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