RESUMO
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions. RESULTS: Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3-5). Median delay from onset to baseline and follow-up MRI was 5 (2-10) hours and 6 (5-7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion. CONCLUSIONS: Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.
Assuntos
Infarto Encefálico/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Infarto Encefálico/etiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de TempoRESUMO
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Trombólise Mecânica/efeitos adversos , Síndrome do Roubo Subclávio/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/cirurgia , Trombectomia/efeitos adversos , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/cirurgiaRESUMO
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.