RESUMO
BACKGROUND AND PURPOSE: This study aimed to investigate the effect of collateral circulation on the outcomes of thrombectomy versus medical management alone in basilar artery occlusion (BAO) patients with varying stroke severities. METHODS: Data from the ATTENTION cohort were used to perform a post-hoc analysis comparing the outcomes of thrombectomy with medical management in BAO patients with varying degrees of collateral circulation and stroke severity. Basilar Artery on Computed Tomography Angiography (BATMAN) scores were used to quantify the collateral circulation, and the effect was estimated through a primary outcome of 90-day functional independence (modified Rankin Scale score, mRS ≤2). Favorable versus unfavorable BATMAN scores were analyzed as both continuous and categorical variables, and an adjusted multivariate regression model was applied. RESULTS: Among 221 BAO patients, thrombectomy significantly improved functional independence compared to medical management in patients with favorable BATMAN scores (aOR 7.75, 95% CI 2.78-26.1), but not in those with unfavorable BATMAN scores (aOR 1.33, 95% CI 0.28-6.92; pinteraction = 0.028). When treated as a continuous variable, increased BATMAN score was found to be associated with a higher likelihood of functional independence in the thrombectomy group (aOR 1.97, 95% CI 1.44-2.81; pinteraction = 0.053). In severe stroke patients with higher BATMAN scores (National Institutes of Health Stroke Scale (NIHSS) ≥21), we identified a significant interaction for treatment effect with thrombectomy compared to medical management (pinteraction = 0.042). CONCLUSION: An increased BATMAN score was significantly associated with a higher probability of functional independence after thrombectomy than after medical management, particularly in patients with severe BAO.
Assuntos
Circulação Colateral , Trombectomia , Insuficiência Vertebrobasilar , Humanos , Trombectomia/métodos , Masculino , Circulação Colateral/fisiologia , Feminino , Idoso , Pessoa de Meia-Idade , Insuficiência Vertebrobasilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Resultado do Tratamento , Índice de Gravidade de Doença , Recuperação de Função Fisiológica/fisiologia , Idoso de 80 Anos ou mais , Estado Funcional , Angiografia por Tomografia Computadorizada , Artéria Basilar/cirurgia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologiaRESUMO
INTRODUCTION: Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the anterior circulation, the recurrence of ischemic strokes in territories supplied by the posterior circulation in the presence of vertebral artery occlusion is termed Vertebral Artery Stump Syndrome (VASS). MATERIAL AND METHODS: We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase. RESULTS: In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke. CONCLUSIONS: Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
Assuntos
Anticoagulantes , Procedimentos Endovasculares , AVC Isquêmico , Recidiva , Insuficiência Vertebrobasilar , Humanos , Procedimentos Endovasculares/efeitos adversos , AVC Isquêmico/etiologia , AVC Isquêmico/terapia , AVC Isquêmico/diagnóstico , AVC Isquêmico/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Resultado do Tratamento , Pessoa de Meia-Idade , Fatores de Risco , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/terapia , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/fisiopatologia , Feminino , Masculino , Idoso , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/diagnóstico , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , AVC Embólico/etiologia , AVC Embólico/diagnósticoRESUMO
Background: Differences in dominance and stenosis in the complex vertebral artery (VA) network pose challenges in diagnosing and treating cerebrovascular diseases crucial for brain nutrition. This research examines these intricacies, highlighting the importance of detailed diagnosis and treatment methods. Objective: To analyze the prevalence of the dominant VA, evaluate the influence of gender and age on steno-occlusion, and explore the correlation between the dominant VA and stenosed VA segments. Methods: A retrospective study of 249 angiograms from patients with VA stenosed at King Abdullah University Hospital between August 2019 and December 2022. The patients presenting symptoms of vertigo, migraines, headaches, or transient ischemic attacks (TIA) were included, 182 cases were classified based on VA dominance and stenosis severity. The data were analyzed using IBM SPSS 27. Results: Out of the 182 participants, 64.8% were male, with an average age of 61.3 years and 35.2% were female. The prevalence of stenosis was distributed as follows: 26.4% mild, 44.0% moderate, and 29.7% severe. Statistically significant correlations were observed between hypertension, smoking, hyperlipidemia, and the degree of stenosis (p < 0.05), but not with diabetes. The prevalence of left vertebral artery (VA) dominance was found to be 41.1%. Additionally, there was no gender connection observed in the distribution of steno-occlusion (p = 0.434). There is no notable correlation between the degree of stenosis and the dominant vertebral artery (p > 0.05). Conclusion: Angiographic findings reveal the complex relationship between the dominance of the VA, patterns of stenosis, and demographic factors. Individuals with a dominant VA had a greater likelihood of developing stenosis on the opposite non-dominant side. The high occurrence of severe stenosis highlights the need for tailored diagnostic and treatment approaches. Understanding vertebral stenosis as a multifaceted interaction of demographic, lifestyle, and anatomical variables is essential for enhancing treatment strategies.
Assuntos
Valor Preditivo dos Testes , Índice de Gravidade de Doença , Artéria Vertebral , Insuficiência Vertebrobasilar , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Idoso , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores Etários , Angiografia Cerebral , Adulto , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: To investigate the relationship between baseline computed tomography perfusion deficit volumes and functional outcomes in patients with basilar artery occlusion (BAO) undergoing endovascular therapy. METHODS: This was a single-center study in which the data of 64 patients with BAO who underwent endovascular therapy were retrospectively analyzed. All the patients underwent multi-model computed tomography on admission. The posterior-circulation Acute Stroke Prognosis Early Computed Tomography Score was applied to assess the ischemic changes. Perfusion deficit volumes were obtained using Syngo.via software. The primary outcome of the analysis was a good functional outcome (90-day modified Rankin Scale score ≤ 3). Logistic regression and receiver operating characteristic curves were used to explore predictors of functional outcome. RESULTS: A total of 64 patients (median age, 68 years; 72 % male) were recruited, of whom 26 (41 %) patients achieved good functional outcomes, while 38 (59 %) had poor functional outcomes. Tmax > 10 s, Tmax > 6 s, and rCBF < 30 % volume were independent predictors of good functional outcomes (odds ratio range, 1.0-1.2; 95 % confidence interval [CI], 1.0-1.4]) and performed well in the receiver operating characteristic curve analyses, exhibiting positive prognostic value; the areas under the curve values were 0.85 (95 % CI, 0.75-0.94), 0.81 (95 % CI, 0.70-0.90), and 0.78 (95 % CI, 0.67-0.89). CONCLUSION: Computed tomography perfusion deficit volume represents a valuable tool in predicting high risk of disability and mortality in patients with BAO after endovascular treatment.
Assuntos
Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Estado Funcional , Imagem de Perfusão , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Insuficiência Vertebrobasilar , Humanos , Masculino , Feminino , Idoso , Procedimentos Endovasculares/efeitos adversos , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/terapia , Imagem de Perfusão/métodos , Avaliação da Deficiência , Idoso de 80 Anos ou mais , Fatores de Tempo , Angiografia Cerebral , Fatores de Risco , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Tomografia Computadorizada Multidetectores , Curva ROCRESUMO
BACKGROUND: Some cases of cerebral ischemia have been attributed to dynamic flow limitation in neck vessels. It however remains unknown whether this represents the extreme end of a physiological response. METHODS: Eighteen healthy volunteers were recruited to this prospective study. Cervical blood flow (ml/min/m2) was assessed using phase-contrast MRI, and cerebral perfusion ratios were assessed using arterial spin labeling perfusion at neutral position, predefined head rotations, as well as flexion and extension. Inter-reader agreements were assessed using intraclass correlation coefficient. RESULTS: The mean age was 38.6 ± 10.8 (range = 22-56) years, for five male participants and 13 females. The means for height and weight were 168 cm and 73.2 kg, respectively. There were no significant differences in individual arterial blood flow with change in head position (P > 0.05). Similarly, the repeated-measures analysis of variance test demonstrated no significant difference in perfusion ratios in relation to head position movement (P > 0.05). Inter-reader agreement was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS: There is neither significant change in either individual cervical arterial blood flow nor cerebral perfusion within the normal physiological/anatomical range of motion in healthy individuals. It is therefore reasonable to conclude that any such hemodynamic change identified in a patient with ischemic stroke be considered causative.
Assuntos
Circulação Cerebrovascular/fisiologia , Movimentos da Cabeça/fisiologia , Imageamento por Ressonância Magnética , Fluxo Sanguíneo Regional/fisiologia , Insuficiência Vertebrobasilar/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Fatores de Risco , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/fisiopatologia , Adulto JovemRESUMO
Purpose/aim of the study: Posterior circulation stroke (PCS) accounts for 20% of ischemic stroke, and vertebrobasilar stenosis is an important cause of PCS. Notably, not all patients with artery stenosis progress to ischemic stroke, and one of the important reason is that collateral circulation construction plays important protection role in this process.Clinical presentation: Here, we present the case of a 71-year-old male who presented with lightheadedness and three episodes of loss of consciousness after bilateral subclavian artery stenting. Digital subtraction angiography (DSA) demonstrated severe stenosis of the left vertebral artery, and the bilateral subclavian artery was kept open. The patient was then given the left vertebral artery stenting in an effort to resolve the vascular stenosis. As expected, he achieved a complete remission after stenting. However, 6 months later the patient suffered from loss of consciousness again. Repeat DSA confirmed restenosis of the left vertebral artery, and revealed a collateral flow to the left vertebral artery which fed by external carotid collateral branches. Then DSA was performed after 12 months, and another collateral circulation involving thyrocervical trunk was also found supplying flow to the left vertebral artery. In this process, the frequency of loss of consciousness gradually decreased as the collateral circulation construction. Conclusion: Through this case, we observe the whole process of the collateral circulation construction. Moreover, this case serves as a testament to the variability and complexity of vertebrobasilar arteriopathies, suggesting promotion of collateral flow offers the opportunity for outcome improvement.
Assuntos
Circulação Colateral/fisiologia , Stents , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/terapia , Idoso , Constrição Patológica/terapia , Humanos , MasculinoRESUMO
The aim of research is to unveil the mechanisms of the beneficial effects of XYD on PCIV in a rabbit model. 40 New Zealand white rabbits were randomly divided into 5 groups,including normal control group (NC), model control group (MC), low-dose of XYD group (LXYD), high-dose of XYD group (HXYD) and Yang-Xue-Qin-Nao group (YXQN). PCIV rabbit model was established by feeding high-fat diet companied with paravertebral sclerotherapy and rotation exercise. The general observation, step-down test, rheoencephalogram, blood tests, histopathological detection and the plasma concentration of the effective component of XYD were investigated. After pharmacological intervening, the step-down time, REG, PL, IPL, blood viscosity, the levels of blood lipids, CRGP were significantly improved. Moreover, the vertebral artery showed the reduced stenosis of arterial lumen and less proliferation of fibrous tissue in the arterial wall in the LXYD, HXYD and YXQN group. Based on the LC-MS detection, the blood concentrations of puerarin in the LXYD and HXYD group were significantly increased after pharmacological intervening. XYD could ameliorate the symptoms of vertigo, Qi-deficiency and blood stasis in PCIV rabbits via effectively regulating the levels of blood lipids and vasoactive substances, decreasing blood viscosity, increasing CBF and protecting vestibular function.
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Comportamento Animal/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Potenciais Evocados Auditivos do Tronco Encefálico/efeitos dos fármacos , Artéria Vertebral/efeitos dos fármacos , Insuficiência Vertebrobasilar/fisiopatologia , Vertigem/fisiopatologia , Núcleos Vestibulares/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Hemorreologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Medicina Tradicional Chinesa , Coelhos , Artéria Vertebral/patologia , Artéria Vertebral/ultraestrutura , Núcleos Vestibulares/patologia , Núcleos Vestibulares/ultraestruturaRESUMO
RATIONALE: The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment. PATIENT CONCERNS: A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension. DIAGNOSES: An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94âmm. The length was >182âmm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall. INTERVENTIONS: Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug. OUTCOMES: The patient had no symptoms of neurological damage during 3-month follow-up. LESSONS: Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10âmm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.
Assuntos
Hematoma/etiologia , Insuficiência Vertebrobasilar/complicações , Idoso , Hemorragia Cerebral/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Hematoma/fisiopatologia , Humanos , Masculino , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
Objectives: To investigate the factors affecting the risk of recurrent stroke after intracranial artery stenting.Methods: This is a subgroup analysis of a prospective single-arm registry study with 20 participating sites. Patients aged 18-85 years old with symptomatic intracranial atherosclerotic stenosis caused by 70-99% stenosis combined with poor collaterals were included in this study. The median follow-up in this study was 26.4 months.Results: A total of 260 patients were recruited in this study. Ischemic stroke related to target vessel occurred in 11 patients (4.2%) from 30 days to the last follow-up. The multivariate analysis revealed age ≥60 years old (OR: 11.991, 95% CI: 1.400-102.716; p = 0.023), no smoking (OR: 0.087, 95% CI: 0.010-0.787; p = 0.030), and Mori C type (OR: 5.129, 95% CI: 1.242-21.178; p = 0.024) retained significance in the model. There was no significant difference in the ischemic stroke based on medical history of hypertension, diabetes, dyslipidemia, baseline percent stenosis, length of stenosis, residual stenosis, and different stent types.Conclusions: Recurrence of ischemic stroke after intracranial stenting may be associated with elderly age, non-smoking, and Mori C type lesion. These factors will need to be monitored in future trials of intracranial stenting.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01968122.
Assuntos
Isquemia Encefálica/fisiopatologia , AVC Isquêmico/fisiopatologia , Stents/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Estudos de Casos e Controles , China , Feminino , Humanos , Arteriosclerose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Insuficiência Vertebrobasilar/fisiopatologia , Adulto JovemRESUMO
AIM: Optimal blood pressure (BP) management in vertebrobasilar circulation stroke patients undergoing thrombectomy remains undetermined. We aimed to evaluate the impact of perioperative BP on clinical outcome after MT in acute basilar artery occlusion (BAO) patients. METHODS: We retrospectively analyzed all consecutive patients hospitalized with acute basilar artery occlusion administered endovascular treatment within 24 h from January 2012 to July 2018 in Beijing Tiantan Hospital. BP was measured at regular intervals during the first 24 h after stroke onset, during and after thrombectomy. The clinical outcomes assessed at 3-month follow up were functional independence (mRS score of 0-2) and mortality (mRS score of 6). RESULTS: Of the 187 treated patients, 157 were male; patient ages were 60±10 years. The median NIHSS on admission was 22. Totally in 179 patients had complete BP level assessment. In these individuals, univariate analysis revealed significant associations of postoperative Max SBP and Max MAP with mortality (all P < 0.05). Multivariate regression analysis also demonstrated that postoperative Max SBP (OR=0.964, 95% CI 0.941 to 0.987, P < 0.003) and Max MAP (OR=0.942, 95% CI 0.907 to 0.979, P < 0.002) were independent predictors of mortality. CONCLUSIONS: In acute BAO patients administered thrombectomy, Max SBP between 120 and 160 mmHg may be associated with better outcome, with a trend of reduced risk of mortality.
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Pressão Sanguínea , Procedimentos Endovasculares , Trombectomia , Insuficiência Vertebrobasilar/terapia , Idoso , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
Symptomatic vertebral artery stenosis is associated with high risk of early recurrent stroke. Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results. In this review we outline the framework for the diagnosis and management of vertebral artery disease with focus on the emerging benefits of angiography and endovascular interventions.
Assuntos
Angioplastia , Endarterectomia , Enxerto Vascular , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/terapia , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Endarterectomia/efeitos adversos , Humanos , Recidiva , Fatores de Risco , Stents , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
OBJECTIVE: Posterior circulation stroke, in contrast to anterior circulation stroke, has a greater complexity and variability of clinical symptoms. This could be responsible for delayed diagnosis and treatment time and, as a consequence, worse prognosis. Certain blame in this respect can also be attributed to the clinimetric scales used to assess stroke severity, which are characterized by significantly lower accuracy than with anterior strokes. The Israeli Vertebrobasilar Stroke Scale (IVBSS) was the first attempt dedicated to posterior strokes and was devised for better measurement of clinical condition. We aimed to develop a Polish version of the IVBSS (PL-IVBSS) to assess the reliability, validity and psychometric properties of the tool to confirm its clinical utility. METHODS: We enrolled 126 posterior circulation ischemic stroke subjects. Four researchers estimated stroke severity using appropriate and widely accepted devices (the modified Rankin Scale - mRS, the National Institutes of Health Stroke Scale - NIHSS, the Barthel Index, and the Glasgow Coma Scale - GCS) and compared with the PL-IVBSS. We analyzed inter- and intrarater agreements, repeatability, concurrent and predictive validity, internal consistency, scalability and homogeneity, reflecting the psychometric features of a validated instrument. RESULTS: Cronbach's alpha coefficient was 0.67, and the median inter-item correlation coefficient was 0.22, indicating moderate internal consistency and insufficient homogeneity. A total of 63.6% of the individual items obtained required discriminatory power (r > 0.3), showing moderate scalability. The PL-IVBSS achieved a good coefficient of repeatability (CR = 1.21 95%CI 1.08-1.38) and narrow limits of agreement in Bland-Altman analysis, emphasizing the accuracy and high reproducibility. Excellent intraclass correlation coefficients and weighted kappa values (all >0.90) underlined the high reliability of the PL-IVBSS. Highly significant correlations with other relevant devices (all r > 0.5, p < 0.0001) highlighted the satisfactory concurrent and predictive validity of a validated clinimetric tool. CONCLUSION: We devised a validated version of the IVBSS, indicating the high reproducibility, repeatability and accuracy of the PL-IVBSS and confirming its clinical utility. Despite moderate psychometric properties, our findings support the need for its clinical application and widespread use in stroke units for a reliable assessment of posterior stroke severity.
Assuntos
Infarto Encefálico/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Traduções , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
OBJECTIVE: We aimed to investigate characteristics and outcomes of patients receiving mechanical thrombectomy (MT) between minor to moderate stroke and severe stroke caused by acute basilar artery occlusion (BAO). METHODS: We retrospectively reviewed the data of all patients with BAO who underwent MT from three stroke centers between January 2016 and January 2020. The patients were dichotomized as minor to moderate or severe stroke group according to their admission National Institutes of Health Stroke Scale (NIHSS) score <21and ≥21. Patient characteristics, imaging findings, and outcomes were compared between the two groups. RESULTS: A total of 72 patients were included in this study. The posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) in the minor to moderate stroke patients were significantly higher than that of patients with severe stroke (P = 0.013). The good posterior circulation collateral scores (PC-CS) (6-10) were more commonly found in patients with minor to moderate stroke than in patients with severe stroke (58.14 % vs 10.34 %,P < 0.001). There were similar rates of successful recanalization between the two groups. Patients with minor to moderate stroke had a higher rate of favorable outcomes (mRS score 0-2, 60.47 % vs 20.69 %, P = 0.002) and a lower rate of periprocedural complications (4.65 % vs 31.03 %, P = 0.005) and mortality (4.65 % vs 24.14 %, P = 0.026) at 3 months after MT compared with the patients with severe stroke. CONCLUSIONS: Acute BAO patients with minor to moderate stroke had better posterior circulation collateral and had better outcomes after MT than those patients with severe stroke.
Assuntos
Procedimentos Endovasculares , AVC Isquêmico/cirurgia , Trombectomia , Insuficiência Vertebrobasilar/cirurgia , Idoso , Circulação Cerebrovascular , Circulação Colateral , Angiografia por Tomografia Computadorizada , Feminino , Estado Funcional , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mortalidade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
OBJECTIVE: To investigate the effect of superficial temporal artery-posterior cerebral artery (STA-PCA) bypass on chronic basilar artery occlusion (CBAO). METHODS: A total of 4 patients who underwent STA-PCA bypass between January 2018 and October 2019 were enrolled in this study. Cerebral blood perfusion, ischemic events, STA diameter and blood flow changes, modified Rankin scale score (mRS), and National Institutes of Health Stroke Scale (NIHSS) score changes were recorded before and after bypass surgery. RESULTS: The average time from basilar artery occlusion (confirmed by cerebral angiography or computed tomography angiography) to operation was 76 ± 38.89 days (range: 30-120 days). Average scores on the NIHSS were 6.8 ± 1.26 (5-8) and 5.2 ± 2.06 (3-7) before and after treatment, respectively. mRS scores averaged 1.8 ± 0.5 (1-2) and 1.5 ± 0.58 (1-2) points, respectively. There were no obvious complications or further stroke during the follow-up. The STA diameter and flow rate were significantly increased at 12 months after operation (P < 0.05). CONCLUSIONS: STA-PCA bypass can improve cerebral blood flow perfusion in CBAO patients. The diameter and flow of the superficial temporal artery can be increased to meet the demand of blood supply.
Assuntos
Revascularização Cerebral/métodos , Artéria Cerebral Posterior/cirurgia , Artérias Temporais/cirurgia , Insuficiência Vertebrobasilar/cirurgia , Idoso , Angiografia Cerebral , Circulação Cerebrovascular , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
An 83-year-old man experienced left upper limb uncontrolled movements preceded by intense gasping during night rest, which progressed to unconsciousness and respiratory arrest requiring intubation. He was diagnosed with acute stroke due to distal occlusion of the basilar artery and received indication for endovascular thrombectomy. Standard endovascular approach includes percutaneous puncture of the femoral or radial arteries; however, the presence of unfavourable vascular anatomies (stenotic origin and tortuosity) did not allow catheterisation of the intracranial vessels through conventional access, and based on the consistent time lapse from onset of symptoms and deterioration of the clinical condition, a direct right vertebral artery ultrasound-guided puncture was performed. After one attempt of a triaxial technique, a complete recanalisation of the basilar artery and of its distal branches was achieved. Direct percutaneous puncture of the vertebral artery represents a rescue access strategy for treatment of posterior circulation stroke when other routes are not feasible.
Assuntos
Procedimentos Endovasculares/métodos , Punções/métodos , Trombectomia/métodos , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/cirurgia , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Artéria Femoral , Humanos , Masculino , Cirurgia Assistida por Computador , Ultrassonografia , Dispositivos de Oclusão Vascular , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
OBJECTIVES: To clarify the relationship between early neurological symptoms and long-term functional outcomes of acute ischemic stroke, which would be beneficial for patient management and determining clinical study criteria of novel therapeutic interventions. MATERIALS AND METHODS: We retrieved data from the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) and investigated the association between 24- and 72-hour National Institutes of Health Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores, stratified by the site of occlusion (carotid or vertebrobasilar circulatory large arterial occlusion [ACO or PCO, respectively]) and endovascular recanalization therapy (EVT) performance. We examined the correlation using Spearman's rank correlation coefficient (rho). Predictive accuracies of 24- and 72-hour NIHSS scores for good outcomes at 90 days (defined as mRS score of 0-2) were evaluated by receiver operating characteristic (ROC) analyses and the corresponding areas under the curves (AUCs). RESULTS: Among the 2420 patients, 1745 had ACO (971 with EVT, 774 without EVT) and 263 had PCO (127 with EVT, 136 without EVT). The 24- and 72-hour NIHSS scores were significantly associated with 90-day mRS scores and accurately predicted good outcomes (all rhos ≥0.76, all AUCs ≥0.86). In the ACO group, there were differences in rho and AUC depending on EVT performance and the time from onset to NIHSS acquisition, but no differences were observed in the PCO group. CONCLUSIONS: EVT performance and time frame should be considered when determining the criteria of novel therapeutic interventions, especially for patients with ACO.
Assuntos
Estenose das Carótidas/diagnóstico , Avaliação da Deficiência , AVC Isquêmico/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , AVC Isquêmico/fisiopatologia , AVC Isquêmico/terapia , Japão , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/terapiaRESUMO
Beauty parlor stroke syndrome is characterized by the development of various neurological symptoms during cervical hyperextension, followed by inadequate blood flow through the posterior circulation of the brain. However, there are few reports of beauty parlor stroke syndrome wherein the cause of the posterior circulatory inadequacy has been directly identified. Here we report a case where we could directly detect the origin of the posterior circulatory inadequacy. A 76-year-old Japanese man with hypertension presented with presyncope following cervical retroflexion. Head magnetic resonance angiography revealed that the vertebrobasilar circulation was exclusively supplied by the right vertebral artery. Cervical spine computed tomography showed compression of the osteophytes on the right superior articular process of C6 into the right transverse foramen of C5. Moreover, computed tomography angiography and carotid duplex ultrasonography showed decreased blood flow in the right vertebral artery on gradual retroflexion of the neck. Based on the above findings, we speculate that the right vertebral artery was compressed by the osteophytes, with the decreased blood flow being the cause of presyncope following cervical retroflexion.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Movimentos da Cabeça , Osteófito/complicações , Síncope/etiologia , Insuficiência Vertebrobasilar/etiologia , Idoso , Circulação Cerebrovascular , Humanos , Osteófito/diagnóstico por imagem , Recidiva , Síncope/diagnóstico , Síncope/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: Dynamic susceptibility perfusion MR imaging (DSC MRP) has been used to assess changes in cerebral perfusion attributable to vascular stenosis or occlusion that may predict stroke risk. However, DSC MRP is not validated for identifying hemodynamic compromise in the posterior circulation. We investigated the clinical utility of DSC MRP in vertebrobasilar (VB) atherosclerotic disease in the observational VERiTAS study. METHODS: VERiTAS enrolled patients with symptomatic ≥50% VB stenosis/occlusion. Posterior circulation hemodynamic status was designated as low or normal based on large vessel flow measured using quantitative magnetic resonance angiography (QMRA) and was predictive of future stroke risk. In this study, DSC MRP conducted concurrently with QMRA was used to evaluate posterior circulation perfusion. The primary outcome was the mean transit time (MTT) and relative cerebral blood volume (rCBV) in the posterior circulation normalized to the anterior circulation, compared between patients with low and normal blood flow as determined on QMRA. RESULTS: Twenty-six subjects had 47 DSC MRP studies for review. There was no statistically or clinically significant difference in the rCBV ratio (1.02 vs. .96 P = .89), or MTT ratio (1.04 vs. 1.04 P = .96) relative to normal or low VB territory flow. CONCLUSIONS: In this study, we did not find that DSC MRP adequately distinguished between patients with low or normal flow status based on large-vessel flow measurements.
Assuntos
Hemodinâmica , Imageamento por Ressonância Magnética , Imagem de Perfusão , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Idoso , Circulação Cerebrovascular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.