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1.
J Neurointerv Surg ; 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34857667

RESUMO

BACKGROUND: Mechanical thrombectomy is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation. This trial aimed to indicate whether Skyflow, a new thrombectomy device, could achieve the same safety and efficacy as Solitaire FR in the treatment of AIS. METHODS: This study was a prospective, multicenter, randomized, single blind, parallel, positive controlled, non-inferiority clinical trial. Patients with intracranial anterior circulation LVO within 8 hours from onset were included to receive thrombectomy treatment with either the Skyflow or Solitaire FR stent retriever. The primary endpoint was the rate of successful reperfusion (modified Treatment In Cerebral Infarction (mTICI) ≥2b) after the operation. The safety endpoints were the rate of symptomatic intracranial hemorrhage (sICH) and subarachnoid hemorrhage (SAH) at 24 hours after operation. RESULTS: A total of 95 and 97 patients were involved in the Skyflow group and Solitaire FR group, respectively. A successful reperfusion (mTICI ≥2b) was finally achieved in 84 (88.4%) patients in the Skyflow group and 80 (82.5%) patients in the Solitaire FR group. Skyflow was non-inferior to Solitaire FR in regard to the primary outcome, with the criterion of a non-inferiority margin of 12.5% (p=0.0002) after being adjusted for the combined center effect and the National Institutes of Health Stroke Scale (NIHSS) score. The rate of periprocedural sICH and SAH did not differ significantly between the two groups. CONCLUSION: Endovascular thrombectomy with the Skyflow stent retriever was non-inferior to Solitaire FR with regard to successful reperfusion in AIS due to LVO (with a pre-specified non-inferiority margin of 12.5%).

2.
Interv Neuroradiol ; 26(1): 83-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31333051

RESUMO

PURPOSE: To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. MATERIALS AND METHODS: One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. RESULTS: Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly (P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant (P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant (P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. CONCLUSION: Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.


Assuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/psicologia , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/psicologia , Adulto , Artéria Carótida Interna , Estenose das Carótidas/terapia , Fístula Carotidocavernosa/terapia , Angiografia Cerebral , Embolização Terapêutica , Feminino , Seguimentos , Cefaleia/etiologia , Síndrome de Horner/complicações , Síndrome de Horner/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Qualidade de Vida , Recidiva , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
3.
World Neurosurg ; 113: e446-e452, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29462732

RESUMO

PURPOSE: To investigate characteristics of the posterior cerebral artery anterior temporal branch aneurysm and the safety and efficacy of endovascular management. MATERIALS AND METHODS: A total of 6 patients with anterior temporal branch aneurysms were enrolled. All 6 patients had concurrent occlusion of the ipsilateral anterior circulating arteries. The aneurysms ranged from 2.5 to 5.0 mm. All patients were treated and followed up. RESULTS: Four unruptured aneurysms were treated with coil embolization of the aneurysm sac only, with the parent artery maintained in 2 patients, slow flow in the parent artery in one and thrombosis at the aneurysm neck leading to parent artery occlusion in the last one. One patient with subarachnoid hemorrhage was treated with coil embolization of both the aneurysm and the parent artery, and the last patient with subarachnoid hemorrhage was treated with the Glubran 2 glue to embolize both the aneurysm and the parent artery. One patient with subarachnoid hemorrhage died of lung complication after embolization. Followed up for 3 months to 1 year, the 4 patients with unruptured aneurysms had no symptoms, including 1 patient with slow flow in the anterior temporal artery and 1 patient with thrombosis and parent artery occlusion. The remaining patient with parent artery occlusion had a good recovery. CONCLUSIONS: The anterior temporal artery aneurysm is a special subtype of aneurysm and can be readily misdiagnosed as on the posterior cerebral artery trunk or the superior cerebellar artery. Endovascular management has a greater success rate, good effect, and fewer complications but with greater difficulties.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Angiografia Digital , Angiografia Cerebral , Embolização Terapêutica/instrumentação , Feminino , Adesivo Tecidual de Fibrina , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem
4.
World Neurosurg ; 111: e927-e932, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29325952

RESUMO

PURPOSE: To investigate the effect and safety of endovascular treatment of intracranial aneurysms concomitant with severe adjacent atherosclerotic stenosis. MATERIALS AND METHODS: Twenty-six patients with aneurysms and adjacent stenosis were prospectively enrolled. The characteristics of the aneurysm, parent artery, atherosclerotic stenosis and endovascular treatment methods were analyzed. RESULTS: All aneurysms were successfully embolized (100%), with stent-assisted coiling in 14 (53.8%) cases, coiling alone in 10 (38.5%), double microcatheter coiling in 1 (3.8%), and balloon-assisted coiling in the remaining 1 (3.8%). Immediately after embolization, complete occlusion was achieved in 10 cases (38.5%), nearly complete occlusion in 6 (23.1%) and non-complete occlusion in 10 (38.5%). Ten aneurysms were type I and were managed with coiling alone in 8 cases and stent-assisted coiling in the remaining 2 cases, with complete occlusion achieved in 6 cases (60%), nearly complete in 2 (20%), and noncomplete in the other 2 (20%). Sixteen aneurysms were type II and treated with stent-assisted coiling in 12 cases (75%), single coiling in 2 (12.5%), double microcatheters in 1 (6.3%), and balloon-assisted coiling in the remaining aneurysm (6.3%). Aneurysm occlusion was complete in 4 cases (25%), nearly complete in 4 (25%), and noncomplete in the other 8 (50%). Clinical follow-up of 2 months to 5 years (mean 26 ± 11 months) demonstrated no rebleeding, with the modified Rankin scale score of 0-2 in 20 patients, 3 in 4, and 6 in the remaining 2. CONCLUSIONS: Intracranial aneurysms concomitant with severe adjacent atherosclerotic stenosis can be successfully treated endovascularly, and careful evaluation of the characteristics of the aneurysm, parent artery, stenosis and collateral circulation can help reducing complications.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Arteriosclerose Intracraniana/complicações , Adulto , Idoso , Implante de Prótese Vascular , Angiografia Cerebral , Constrição Patológica , Embolização Terapêutica , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents , Resultado do Tratamento
5.
J Interv Med ; 1(2): 77-81, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-34805833

RESUMO

Purpose: Retrievable stents are widely used in acute ischemic stroke (AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS. Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia (TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed. Results: The 73 patients enrolled included 39 males and 34 females (median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42% (39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04% (65/73). Perioperative embolization events and symptomatic intracranial hemorrhage (sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients (42.47%), NIHSS score decreased by >8. Good functional independence (mRS score≤2) was achieved in 39 patients (53.42%) at 90 days; 12 patients (16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages. Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.

6.
Diagn Interv Radiol ; 22(2): 178-83, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26809831

RESUMO

PURPOSE: We aimed to investigate the safety and effectiveness of intracranial stenting in a population with severe (≥ 70%) symptomatic intracranial internal carotid artery (ICA) atherosclerotic stenosis. METHODS: Fifty-eight patients with severe intracranial ICA atherosclerotic stenosis were prospectively enrolled. The baseline data, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up were prospectively analyzed. RESULTS: All patients had successful intracranial stenting (100%), and the mean degree of stenosis was improved from 84.3% ± 7.5% to 23.5% ± 5.1% after the stent procedure. During the 30-day perioperative period, only one patient (1.7%) had ischemic stroke. Seven patients (12.1%) had headache and dysphoria. Thirty-six patients (62.1%) had clinical follow-up for 6-68 months after stenting. Five female patients (13.9%) had ipsilateral stroke including one death, but no disabling stroke, while three other patients (8.3%) had ipsilateral temporary ischemic attack (TIA). The recurrent stroke rate was higher in patients presenting with stroke (4/17, 23.5%) than in patients presenting with TIA (1/19, 5.3%), with no statistical significance (P = 0.33). Thirteen patients (22.4%) had imaging follow-up of 5-12 months following stenting, five of whom (38.5%) had in-stent restenosis. CONCLUSION: Intracranial stenting for patients with intracranial ICA atherosclerotic stenosis has a low perioperative stroke rate and decent outcome on long-term follow-up, despite a relatively high in-stent restenosis rate.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/patologia , Estenose das Carótidas/patologia , Angiografia Cerebral , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
7.
Interv Neuroradiol ; 22(3): 318-24, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26823331

RESUMO

OBJECTIVE: To investigate the safety and long-term effect of using the Wingspan stent for severe symptomatic atherosclerotic basilar artery stenosis (≥70%). MATERIALS AND METHODS: Between July 2007 and April 2013, we had 91 consecutive patients (age range 41-82 years old) with symptomatic severe basilar stenosis (70-99%) who underwent Wingspan stenting at our center. All patients had stenosis-related temporary ischemic attack or strokes. We analyzed the demographic data, pre- and post-procedural cerebral angiography, technical success rate, peri-procedural complications, and clinical and imaging follow-ups. RESULTS: The Wingspan stenting procedure was successful in all patients: The stenosis was reduced from 82.2% ± 5.8% pre-stenting to 15.9% ± 5.7% post-stenting. The 30-day peri-operative rate for stroke or death was 14.3%, which included ischemic stroke in 12 cases (12/91 = 13.2%) and subarachnoid hemorrhage in one case (1/91 = 1.1%), with a fatal or disabling stroke rate of 2.2%. Among the 77 patients with clinical follow-up assessment within 7-60 months (mean 31.3 ± 15.1 months) after stenting, four patients (5.2%) had posterior ischemia, including one patient with disabling ischemic stroke (1.3%) and three patients (3.9%) with temporary ischemic attack. The 2-year cumulative stroke rate was 16% (95% CI: 8.2-23.8%). Among 46 patients with imaging assessments at 3-45 months (mean, 9.5 ± 8.3) post-stenting, six (13.0%) patients had restenosis, including two (2/46 = 4.3%) with symptomatic restenosis. CONCLUSIONS: The benefit of stenting for patients with severe basilar artery stenosis (> 70%) may lie in lowering the long-term fatal and disabling stroke rate; and as long as the peri-operative stroke rate can be kept at a relatively lower level, patients with severe basilar stenosis can benefit from basilar artery stenting.


Assuntos
Arteriosclerose Intracraniana/complicações , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Insuficiência Vertebrobasilar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
J Neurointerv Surg ; 8(11): 1148-1153, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26614492

RESUMO

BACKGROUND: Coil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication. OBJECTIVE: To determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms. METHODS: Tirofiban was administered as an intravenous bolus (8.0 µg/kg over 3 min) followed by a maintenance infusion (0.10 µg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded. RESULTS: Tirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found. CONCLUSIONS: Tirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.


Assuntos
Aneurisma Roto/terapia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Cuidados Intraoperatórios/métodos , Profilaxia Pré-Exposição/métodos , Tirosina/análogos & derivados , Administração Intravenosa , Administração Oral , Adulto , Idoso , Aneurisma Roto/diagnóstico por imagem , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Aneurisma Intracraniano/diagnóstico por imagem , Cuidados Intraoperatórios/efeitos adversos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Stents , Tirofibana , Resultado do Tratamento , Tirosina/administração & dosagem
9.
Neuroradiology ; 58(2): 161-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26515072

RESUMO

INTRODUCTION: This study was to investigate the periprocedural stroke rates, safety, and long-term effect of Wingspan stenting for symptomatic severe stenosis of the middle cerebral artery (MCA) at a high-volume center. METHODS: Between July 2007 and April 2013, 196 consecutive patients with severe MCA atherosclerotic stenosis (≥70%) who were treated with Wingspan stenting were retrospectively studied. All patients had arterial stenosis-related temporary ischemic attack or strokes. The demographic data, cerebral angiography, technical success rate, periprocedural complications, and clinical and imaging follow-up were analyzed. RESULTS: The successful stenting rate was 98.0%, and the stenosis rate was improved from pre-stenting (80.6 ± 8.3 %) to post-stenting (15.5 ± 6.8%). The 30-day periprocedural stroke or death rate was 7.1%, with a disabling or fatal rate of 2.6%. The perioprocedural stroke rate was significantly (P < 0.01) greater in the early learning stage (16.0%) than in the later technical maturation stage (4.1%). The total periprocedural ischemic and perforator stroke rates were greater in patients with the most stenosis in the distal MCA 1/3 segment (6.8 and 5.7%, respectively) than in the proximal and middle 2/3 segments (0.9 and 0%, respectively). The ipsilateral stroke or death rate beyond 30 days (6-69 months, mean 30 ± 16) was 4.8%, with the 1- and 2-year cumulative stroke rates of 9.6 and 12.1%, respectively. Imaging follow-up 6-69 months (mean 10.9 ± 8.5) revealed restenosis in 21 cases (20.4 %). CONCLUSION: Intracranial stenting of MCA stenoses may have the potential of better clinical outcomes if patients are properly selected and treated by an experienced operator at a high-volume center.


Assuntos
Prótese Vascular/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Infarto da Artéria Cerebral Média/mortalidade , Infarto da Artéria Cerebral Média/cirurgia , Complicações Pós-Operatórias/mortalidade , Stents/estatística & dados numéricos , Adulto , Idoso , Angioplastia/instrumentação , Angiografia Cerebral/estatística & dados numéricos , China/epidemiologia , Análise de Falha de Equipamento , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
10.
PLoS One ; 10(9): e0139377, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26422692

RESUMO

PURPOSE: To investigate the safety and outcome of intracranial stenting for intracranial atherosclerotic stenosis (IAS). MATERIALS AND METHODS: Between July 2007 and April 2013, 433 consecutive patients with IAS > 70% underwent intracranial Wingspan stenting, and the data were prospectively analyzed. RESULTS: Intracranial stenting was successful in 429 patients (99.1%), and the mean stenosis rate was improved from prestenting (82.3 ± 7.6)% to poststenting (16.6 ± 6.6)%. During the 30-day perioperative period, 29 patients (6.7%) developed stroke. The total perioperative stroke rate was significantly (P < 0.01) higher in the basilar artery area than in others, whereas the hemorrhagic stroke rate was significantly (P < 0.05) greater in the middle cerebral artery area than in others. The experience accumulation stage (13%) had a significantly (P < 0.05) higher stroke rate than the technical maturation stage (4.8%). Clinical follow-up 6-69 months poststenting revealed ipsilateral stroke in 20 patients (5.5%). The one- and two-year cumulative stroke rates were 9.5% and 11.5%, respectively; the two-year cumulative stroke rate was significantly (P < 0.05) greater in the experience accumulation stage (18.8%) than in the technical maturation stage (9.1%). CONCLUSION: Wingspan stenting for intracranial atherosclerotic stenosis is safe and the long-term stroke rate after stenting is low in a Chinese subpopulation.


Assuntos
Arteriosclerose Intracraniana/terapia , Stents , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
11.
Eur J Radiol ; 84(9): 1801-4, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26119803

RESUMO

PURPOSE: To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70-99%) concurrent with contralateral vertebral artery atherosclerotic diseases. MATERIALS AND METHODS: Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. RESULTS: The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9±6.8)% to poststenting (17.2±5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3±17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5-54 months (mean 9.9±9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P<0.05) affect instent restenosis. CONCLUSION: Wingspan stenting in the intracranial vertebral artery atherosclerotic stenosis combined with contralateral vertebral artery atherosclerotic diseases has a low perioperative stroke rate and a good preventive effect on long-term ischemic stroke, but the instent restenosis rate is a little high.


Assuntos
Arteriosclerose Intracraniana/cirurgia , Stents/estatística & dados numéricos , Insuficiência Vertebrobasilar/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Angiografia Cerebral , China , Feminino , Seguimentos , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/prevenção & controle , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico , Adulto Jovem
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