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1.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
2.
Khirurgiia (Mosk) ; (12): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825337

RESUMO

The review is devoted to analysis of current trends in interdisciplinary approach to the differential diagnosis of patients' conditions on the first day after cardiac, ascending aortic and aortic arch surgery and repair of internal carotid arteries (neurological disorders, delirium, cognitive dysfunction, psycho-emotional disorders, postoperative sedation). This approach is valuable to determine the prognosis and timely treatment. The basic concepts reflecting the discussion between neurologists, cardiovascular surgeons, anesthetists, radiation diagnostics specialists and rehabilitators are summarized. The authors concluded that timely and correct differential diagnosis of the states on the first postoperative day using current tests and interdisciplinary approach to the treatment of patients with postoperative impaired consciousness or neurological/psycho-emotional dysfunction can improve their quality of life and efficiency of medical care.


Assuntos
Aorta/cirurgia , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Doenças do Sistema Nervoso/diagnóstico , Transtornos Neurocognitivos/diagnóstico , Aorta Torácica/cirurgia , Artéria Carótida Interna/cirurgia , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso/etiologia , Transtornos Neurocognitivos/etiologia , Prognóstico , Fatores de Tempo
3.
Angiol Sosud Khir ; 25(4): 41-52, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855200

RESUMO

AIM: The study was aimed at demonstrating efficacy and feasibility of intravascular ultrasound during internal carotid artery stenting for assessment of atheromatous plaque protrusion through a stent. PATIENTS AND METHODS: Over the period from October to December 2018, the specialists of our Centre performed a total of 90 internal carotid artery stenting procedures in 83 patients (of these, 7 patients underwent bilateral staged stenting of both internal carotid arteries) using intravascular ultrasound in order to assess intraoperative protrusion of an atherosclerotic plaque through the implanted stent. The patients' age varied from 42 to 87 (mean 68.6±6.9) years. Symptomatic lesions of internal carotid arteries were revealed in 14 (16.9%) operated patients and asymptomatic lesions in 69 (83.1%). The degree of stenosis varied from 60% to 90% according to the findings of preliminary duplex ultrasonography and was subsequently confirmed by the results of multislice computed tomography or selective angiography. The assessment of the patients' neurological status, as well as duplex ultrasonography of brachiocephalic arteries were performed at a scheduled follow-up visit on day 30 after discharge from hospital. RESULTS: The technical success of stenting was achieved in 100% of patients. According to the findings of intravascular ultrasound, plaque protrusion was observed in eight (8.8%) stented patients. Among them, six (6.6%) were free from angiographic signs of protrusion and only two (2.2%) had apparent angiographic signs of protrusion. During the early postoperative period, transient ischaemic attack was identified in four (4.4%) cases. One (1.1%) patient was found to develop ST-segment elevation acute myocardial infarction 24 hours after internal carotid artery stenting, followed by large hemispheric stroke on the side of stenting revealed on postoperative day 3. Nine (10%) patients according to the findings of intravascular ultrasound were diagnosed as having incomplete stent apposition after postdilatation, with the absence of such signs on angiography. CONCLUSION: Intravascular ultrasound during carotid stenting provides a more accurate assessment of such an event as atherosclerotic plaque protrusion through a stent's cells. At the same time, IVUS-guided assessment of the intraoperative outcome may prevent the risk for the development of stroke in the early postoperative period. Besides, intravascular ultrasound allows a more detailed assessment of stent apposition and the degree of stent expansion in order to optimize and improve the remote results of the operation.


Assuntos
Implante de Prótese Vascular , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
4.
Angiol Sosud Khir ; 25(4): 83-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855204

RESUMO

The authors carried out a prospective study aimed at revealing predictors of acute embolic lesions of cerebral vessels during angioplasty with stenting of the internal carotid artery. The study enrolled a total of 54 patients who between May 2015 and December 2018 underwent carotid angioplasty with stenting performed at the Department of Vascular and Endovascular Surgery of the Research Centre of Neurology. The procedure of internal carotid artery stenting may be accompanied by intraoperative acute embolic lesions. In order to reveal intraoperative acute embolic lesions of cerebral vessels all patients before and 24 hours after the intervention were subjected to diffusion-weighted magnetic resonance imaging. Thirty-six patients received classical carotid stents (Xact and Acculink) and 18 patients received Casper stents. The patients of both groups were comparable by 24 characteristics studied, including the incidence of intraoperative acute cerebral embolic lesions (18/36 for the classical stents and 10/18 for the Casper stent), which made it possible to unite them into one group in order to increase the power of the study. All acute embolic lesions detected by the diffusion-weighted magnetic resonance imaging (prior to stenting and 24 hours thereafter) were clinically, asymptomatic with no perioperative stroke observed. In order to reveal predictors of intraoperative acute embolic lesions of cerebral vessels we analysed 22 characteristics of the patients, with the obtained findings demonstrating the following signs: a low-intensity (below 20 dB) ultrasonographic signal reflected from fragments of an atherosclerotic plaque during ultrasound examination prior to stenting (p=0.001) - a sign strongly associated with acute embolic lesions (sensitivity - 75%, specificity - 92%); symptomatic stenosis according to the anamnestic data (p=0.02) - a sign significantly associated with acute embolic lesions; female gender (p=0.06) - a sign moderately associated with acute embolic lesions; a history previously endured (according to the anamnestic data) operations on coronary and/or carotid arteries (p=0.09) - a sign weakly associated with acute embolic lesions. Based on the obtained findings we proposed a prognostic scale to assess the risk of acute embolic lesions of cerebral vessels during internal carotid artery stenting. Knowing the factors associated with intraoperative acute embolic lesions will allow the endovascular surgeon to single out the patients at increased risk of acute embolic lesions.


Assuntos
Angioplastia/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Embolia Intracraniana/etiologia , Stents/efeitos adversos , Doença Aguda , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Dispositivos de Proteção Embólica , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
5.
Angiol Sosud Khir ; 25(4): 124-130, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855209

RESUMO

AIM: The purpose of this study was to investigate the natural course of stenosis of the common carotid artery (CCA) after carotid endarterectomy, as well as the long-term outcomes of various methods of reconstruction of the internal carotid artery (ICA) in patients with extended atherosclerotic lesions. PATIENTS AND METHODS: Presented herein are the remote retrospective and prospective results of carotid endarterectomy in a total of 78 patients with concomitant atherosclerotic lesions of carotid arteries. Depending on the degree of CCA stenosis, the patients were divided into 2 groups. Group One (n=25): stenosis of the internal carotid artery (ICA) of more than 70% and haemodynamically insignificant (30-35% stenosis) but extended (from 3.0 to 5.0 cm (Q1, Me, Q3); 3.5 cm, 4.0 cm, 5.0 cm) stenosis of the CCA. These patients underwent carotid endarterectomy (CEA) from the ostium of the ICA, during which an atherosclerotic plaque was not completely removed from the CCA because the stenosis was extended but haemodynamically insignificant. Group Two (n=53): stenosis of the ICA of more than 70% and haemodynamically significant, extended (from 7.0 to 10.0 cm (Q1, Me, Q3); 7.5 cm, 8.0 cm, 9.0 cm) stenosis of the CCA. The patients of this group were subjected to various methods of operative intervention on the ICA and CCA: carotid endarterectomy (ECA) combined with open endarterectomy from the CCA with plasty using the primary suture (n=23); carotid endarterectomy and alloreconstruction of the CCA (n=10); simultaneous eversion endarterectomy from the ICA and CCA (n=20). The remote period of follow up of patients ranged from 14 to 24 months ((Q1, Me, Q3; 19 months, 22 months, 24 months). The differences were statistically insignificant (Mann-Whitney U-test, p=0.881). RESULTS: In the remote postoperative period, 32% of Group One patients after previously performed carotid endarterectomy were found to have an increase in the degree of stenosis of the CCA up to a haemodynamically significant one (70% and more), thus suggesting progression of the atherosclerotic process. In Group Two patients, after plasty of the CCA with the primary suture, 21.7% of patients were diagnosed as having restenosis of the reconstruction zone up to 30%, with no neurological deficit. 20% of patients after carotid endarterectomy and alloreconstruction of the CCA were diagnosed as having restenosis of the reconstruction zone more than 70% and acute impairment of cerebral circulation with a lethal outcome. The patients after simultaneous eversion endarterectomy form the ICA and CCA in the intraoperative and postoperative periods had neither restenosis of the reconstruction zone nor neurological deficit. CONCLUSION: 32% of patients after previously performed carotid endarterectomy with the presence of extended, but haemodynamically insignificant stenosis of the CCA (30-35% stenosis) in the postoperative period were found to have progression of the atherosclerotic lesion in the form of an increased degree of stenosis up to haemodynamically significant (more than 70%), thus requiring repeat reconstructive operation. Therefore, in patients presenting with concomitant atherosclerotic lesions of the carotid arteries it is appropriate to carry out operative intervention simultaneously on the ICA and CCA, which would make it possible to considerably improve the remote postoperative results of reconstructive interventions on the carotid basin in this cohort of patients. A comparative study of the outcomes of various methods of reconstruction of carotid arteries in patients with concomitant atherosclerotic lesions of the ICA and CCA demonstrated that simultaneous eversion endarterectomy from the ICA and CCA resulted in good postoperative parameters: absence of restenosis and neurological deficit in the remote period of follow up.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Artéria Carótida Interna/cirurgia , Endarterectomia das Carótidas/métodos , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Estenose das Carótidas/cirurgia , Progressão da Doença , Humanos , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
6.
Angiol Sosud Khir ; 25(4): 131-138, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855210

RESUMO

Presented in the article are the results of surgical management of a patient with an extremely rare pathology - a saccular arterial aneurysm of the cavernous-ophthalmic segment of the left internal carotid artery. We performed multistage open surgical intervention in the following scope: osteoplastic pterional craniotomy on the left, creation of a wide-lumen anastomosis between the left external carotid artery and M2 segment of the left middle cerebral artery with the use of the radial artery, ligation of the cervical portion of the left internal carotid artery and clipping of its supraclinoid portion. The chosen surgical policy made it possible to create sufficient volumetric blood flow through the shunt, comparable to the blood flow through the internal carotid artery, which helped avoid ischaemic stroke after exclusion of the aneurysm from circulation. A conclusion was drawn on efficacy of this method of treatment.


Assuntos
Artéria Carótida Externa/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Anastomose Cirúrgica , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Humanos , Aneurisma Intracraniano/complicações , Ligadura , Artéria Radial/transplante , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos
7.
Medicine (Baltimore) ; 98(39): e17152, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574821

RESUMO

RATIONALE: Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump. PATIENT CONCERNS: A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted to evaluate collateral circulation, intraluminal composition, and shape of the carotid stump. DIAGNOSES: The patient was diagnosed with cerebral infarction and right carotid stump syndrome. INTERVENTION: The patient underwent interventional recanalization of the occluded internal carotid artery, which relieved his symptoms and led to satisfactory therapeutic outcomes during the clinical follow-up. OUTCOMES: A 9-month clinical follow-up revealed no stroke recurrence. LESSONS: Interventional recanalization for the carotid artery stump syndrome is feasible. Accurate preoperative evaluation including collateral circulation, intraluminal composition, and shape of the carotid stump can assure a successful vascularization and guided management.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Trombose das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Intervenção Coronária Percutânea/métodos , Idoso , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Trombose das Artérias Carótidas/etiologia , Trombose das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Circulação Colateral , Humanos , Masculino , Síndrome , Resultado do Tratamento
8.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(3): 233-240, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31496153

RESUMO

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.


Assuntos
Isquemia Encefálica , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Isquemia Encefálica/cirurgia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/tendências , Humanos , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
9.
World Neurosurg ; 131: 209-212, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31442658

RESUMO

BACKGROUND: Antiplatelet agents are typically administered before and after treatment using flow-diverter stents (FDS) to prevent thrombotic complications, but the effects of anticoagulants are unclear. We present a patient with a giant aneurysm treated with an FDS. The thrombus within the aneurysm was dissolved when a direct factor Xa inhibitor was administered to treat lower limb venous thrombosis that occurred secondary to steroid use. CASE DESCRIPTION: A 60-year-old woman with a 30-mm giant thrombosed aneurysm in the cavernous segment of the right internal carotid artery presenting with headache and right abducens nerve palsy was treated by placing an FDS. Diplopia and increased pain in her right eye appeared on postoperative day 7, and both were alleviated by continuous oral administration of prednisolone. Angiography 3 months postoperatively revealed that the aneurysm thrombosis had progressed, and there were signs of healing. However, at the same time, lower limb venous thrombosis occurred, which was treated by continuous edoxaban. Six months after surgery, her headaches worsened and angiography showed that the aneurysm was again contrast enhanced and that the thrombus within the aneurysm had dissolved. After discontinuing edoxaban 9 months after surgery, the aneurysmal thrombosis had again rapidly progressed. CONCLUSIONS: Administration of a direct factor Xa inhibitor during healing after placing an FDS may cause dissolution of an existing thrombus; therefore factor Xa inhibitors must be used with caution.


Assuntos
Doenças das Artérias Carótidas/etiologia , Inibidores do Fator Xa/uso terapêutico , Aneurisma Intracraniano/etiologia , Trombose Intracraniana/tratamento farmacológico , Piridinas/uso terapêutico , Stents/efeitos adversos , Tiazóis/uso terapêutico , Doenças do Nervo Abducente/cirurgia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Trombose Venosa/tratamento farmacológico
10.
Zhonghua Nei Ke Za Zhi ; 58(8): 599-601, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365983

RESUMO

Carotid web is a rare risk factor of ischemic stroke. A total of 32 (0.54%) patients with carotid web were finally diagnosed in 5 943 patients who underwent carotid computerized tomography angiography (CTA) in two hospitals. Only one patient received carotid endarterectomy that pathological findings were fibrous tissue hyperplasia of vascular wall with mucinous degeneration. Stent implantation was administrated in two cases. Among 13 asymptomatic patients, the observational follow-up period was (20.9±12.4) months without strokes. Carotid web is a rare aberration. Asymptomatic patients with carotid web are usually silent. Large sized cohort and long-term follow-up are further needed.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Stents/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Estudos de Coortes , Endarterectomia das Carótidas/métodos , Displasia Fibromuscular/complicações , Seguimentos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
11.
Vasc Endovascular Surg ; 53(7): 617-622, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31339471

RESUMO

OBJECTIVE: Spontaneous multiple artery dissection is a relatively rare phenomenon. Early clinical signs are often nonspecific, making it difficult to diagnose. CASE REPORT: This is a case of a 51-year-old female who presented with spontaneous dissection of 4 visceral arteries, both iliac arteries, and of the right internal carotid artery. The patient underwent urgent successful endovascular repair. Later complications included acute respiratory distress syndrome and pneumonia after massive blood transfusion. She recovered gradually and was discharged after 21 days. Due to this rare presentation, genetic investigation was performed in search of a connective tissue disorder. Results revealed a new COL3A1 subtype mutation. The pathogenicity of this variant remains unclear. CONCLUSION: We recommend a high index of suspicion for visceral artery dissection in the differential diagnosis for abdominal pain with concurrent uncontrolled hypertension. Early diagnosis and intervention are crucial to reducing the mortality rate.


Assuntos
Aneurisma Dissecante , Artéria Carótida Interna , Aneurisma Ilíaco , Vísceras/irrigação sanguínea , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/genética , Aneurisma Dissecante/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Colágeno Tipo III/genética , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Feminino , Predisposição Genética para Doença , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/genética , Aneurisma Ilíaco/cirurgia , Pessoa de Meia-Idade , Mutação , Fenótipo , Fatores de Risco , Resultado do Tratamento
13.
Rinsho Shinkeigaku ; 59(8): 509-514, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341125

RESUMO

This is a case of a 71 years old man. Hemichorea appeared in the left half of his body in the middle of November, 2014. Minute hyperintense areas in the white matter near the posterior horn of the right lateral ventricle and in the right parasagittal frontal cortex was shown in MRI diffusion weighted image. Severe stenosis was seen in the right internal carotid artery, and reduction in cerebral blood flow of the right cerebral hemisphere including the basal ganglia was shown in single photon emission computed tomography (SPECT). After having carotid endarterectomy of the right internal carotid artery in January, 2015, hemichorea disappeared, and the cerebral blood flow of the right cerebral hemisphere improved. It is known that hemichorea is caused by the infarction of the basal ganglia. In recent years, some hemichorea cases are reported around East Asia caused by internal carotid artery stenosis with reduction in cerebral blood flow.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Coreia/etiologia , Endarterectomia das Carótidas , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
14.
J Craniofac Surg ; 30(5): e388-e392, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299787

RESUMO

OBJECTIVES: We investigated unilateral and bilateral cervical internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST). METHODS: We retrospectively investigated ICA stenosis on Head&Neck Computed Tomography Angiography (CTA); and their simultaneous brain computed tomography images were also evaluated. In unilateral ICA stenosis group (n=36), 17 of them had right ICA stenosis and 19 left ICA stenosis. In bilateral stenosis group, there were 24 patients. ICA stenosis was evaluated according to NASCET and ECST methods. We also evaluated vertebral artery dimension, plaque density and cerebral infarct (Cerebral kortex, white matter, basal ganglion-thalamus). RESULTS: Unilateral ICA stenosis according to the NASCET was 70.64% to 73.68% (right-left) and according to the ECTS was 65.52% to 71.15% (right-left). For bilateral stenosis, ICA stenosis according to the NASCET was 67.70 to 67.91 (right-left); according to the ECTS was 62.45% to 62.15% (right-left). Vertebral artery dimensions were 3.26 to 3.72 mm (right-left) in unilateral ICA stenosis; and 3.52 to 3.71 mm (right-left) in bilateral ICA stenosis. In bilateral stenosis group, mixt plaque; and in unilateral stenosis group, hard plaque was detected. In unilateral stenosis, white matter and basal ganglion-thalamus infarcts; in bilateral ICA stenosis, cerebral cortical infarct was detected. Left-vertebral artery diameter increased in higher L-ECTS ICA stenosis (unilateral) group. CONCLUSION: Increase in left vertebral artery diameter in unilateral L-ECTS ICA stenosis may be related to increase of the collateral flow by vertebral arteries to support brain blood-flow.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Endarterectomia das Carótidas , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Artéria Vertebral
15.
World Neurosurg ; 130: e899-e907, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301443

RESUMO

BACKGROUND: There has been no effective method to predict ischemic intolerance to temporary internal carotid artery (ICA) occlusion during carotid artery reconstruction. Pencil beam presaturation (BeamSAT) pulse suppresses the flow signal of the target vessel in magnetic resonance angiography (MRA). Applying this method, we constructed ICA-selective MRA images. The aim of this study was to identify patients at risk for ischemic intolerance by ICA-selective MRA. METHODS: By evaluating flow of anterior communicating artery (Acom) and A1 portion of anterior cerebral artery with ICA-selective MRA and posterior communicating artery (Pcom) with conventional MRA, we investigated associations of these collateral flow patterns with ischemic intolerance and decrease of regional cerebral oxygen saturation. RESULTS: The study included 58 patients who underwent carotid endarterectomy or carotid artery stenting. Six of 7 patients without Acom flow and Pcom flow demonstrated ischemic intolerance, whereas all patients (n = 51) with Acom and/or Pcom flow demonstrated tolerance. The accuracy of this prediction model according to Acom and Pcom flow patterns for ischemic intolerance was 0.98 (P = 0.01, binomial test). Regional cerebral oxygen saturation decrease after ICA occlusion was significantly larger in patients without Acom flow and Pcom flow (12.0% ± 6.0%) than in patients with Acom flow and Pcom flow (3.0% ± 3.1%, P < 0.01) and in patients with Acom flow but no Pcom flow (2.4% ± 5.2%, P < 0.01). CONCLUSIONS: These findings support the importance of Acom flow as a collateral route. ICA-selective MRA enables prediction of ischemic intolerance to temporary ICA occlusion during carotid endarterectomy or carotid artery stenting. This method provides valuable information regarding probability of an ischemic complication.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Endarterectomia das Carótidas/métodos , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Fatores de Risco
16.
J Clin Neurosci ; 68: 151-157, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307854

RESUMO

Carotid-ophthalmic aneurysms are indication for endovascular treatment. Coil embolization is associated with a high recanalization rate and thus usage of flow diverter (FD) could constitute the treatment of choice. Although implementation of FD is very effective, it carries a significant risk of complications. The goal of our study was to find a radiological recanalization marker in order to facilitate decision process which would result in fewer treatment-related complications and in this way, to personalize endovascular therapy. We made a retrospective analysis of seventy-five patients with saccular carotid-ophthalmic aneurysms treated endovascularly. Morphometric measurements were performed in CTA 3D aneurysm models. The aneurysm size and volume were measured on the base of digital subtraction angiography (DSA) images. The treatment effectiveness was determined visually using the modified Raymond Roy classification after embolization and on the 6- and 12-month follow-up DSA. Statistica 13.1 software was used. Multivariate analyses showed that the aneurysm neck size (OR 2.51; 95%CI: 1.20-5.26), aspect ratio (OR 2.60; 95%CI: 1.27-5.21) and neck to parent artery ratio (OR 2.68; 95%CI: 1.26-5.70) were risk factors for carotid-ophthalmic aneurysms recanalization after 6 months. Of those factors, aneurysm neck size remained the only significant risk factor for carotid-ophthalmic aneurysms recanalization after 12 months (OR 5.23, 95%CI: 1.71-15.93). Various factors seem to influence recanalization. Preoperatively, if the above-mentioned predictors of recanalization are present, coiling is burdened with a high recanalization rate. In those cases, FD embolization should be considered.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Prótese Vascular , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
BMJ Case Rep ; 12(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31278200

RESUMO

Pipeline embolisation device (PED) 'twisting' is an intra-operative complication that manifests with the appearance of a 'figure-8' in perpendicular planes on digital subtraction angiography. A twisted PED causes narrowing and/or complete occlusion of the vessel lumen and poses significant risks for thrombus formation and downstream ischaemia. Here, we present a case in which three unique PED implants become twisted during pipeline embolisation of a large fusiform internal carotid artery aneurysm. The twists were remediated by balloon angioplasty and a combination of techniques that allowed the PED to rotate and restore its original axis. Six-month and twelve-month follow-up angiography demonstrated complete aneurysm occlusion with preservation of the parent vessel, proving that proper remediation of PED twisting can still result in successful long-term outcomes.


Assuntos
Angiografia Digital/efeitos adversos , Angioplastia com Balão/métodos , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/cirurgia , Angiografia Digital/instrumentação , Artéria Carótida Interna/cirurgia , Embolização Terapêutica/instrumentação , Humanos , Pessoa de Meia-Idade
18.
World Neurosurg ; 130: 358-363, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279107

RESUMO

BACKGROUND: Use of angioscopy to directly observe the stent lumen in the chronic phase after carotid artery stenting (CAS) has not been reported to date. Here we report 3 patients in whom angioscopy helped confirm the stent lumen during retreatment after CAS. CASE DESCRIPTION: Case 1 required retreatment for stent shortening that occurred 1 month after the first CAS. Preprocedure angioscopy showed the presence of neointima, which could not be revealed by intravascular ultrasound (IVUS). In case 2, which required repeat CAS for distal progressive stenosis of the internal carotid artery, the neointima was observed on the stent surface and was more pronounced on the distal side. In case 3, retreatment was necessary for recurrent ischemic stroke caused by stent restenosis; preprocedure angioscopy showed an unstable plaque, which was not detected as vulnerable by IVUS, protruding into the stent lumen, with partial ulceration and bleeding. CONCLUSIONS: Compared with IVUS, angioscopy enables a more detailed observation of the stent lumen. Although angioscopy is relatively invasive, its use in evaluating changes in the stent lumen after CAS should be clarified by accumulation of reported cases.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/patologia , Estenose das Carótidas/patologia , Angiografia por Tomografia Computadorizada , Humanos , Angiografia por Ressonância Magnética , Masculino , Neointima , Reoperação , Adulto Jovem
19.
World Neurosurg ; 130: e760-e764, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284065

RESUMO

BACKGROUND: The transfemoral approach is a common technique for carotid artery stenting (CAS) but is sometimes limited by aortic or peripheral arterial conditions. The purpose of this study is to report the initial experiences with CAS using a novel sheath guide for transradial carotid cannulation. METHODS: A sheath guide designed specifically for transradial carotid cannulation was developed. The transradial approach for CAS was started in April 2016, and data were collected prospectively. Patients who underwent transradial elective CAS from April 2016 to June 2018 were included in the analysis. Every CAS procedure was started through the right radial route with a 6-French (internal diameter) sheath guide specifically designed for the radial approach under local anesthesia. Technical success, periprocedural complications, and 30-day major vascular events (stroke, myocardial infarction, and/or death) were investigated. RESULTS: Twenty-six patients underwent transradial CAS. Procedures performed via the radial route were successful in every case. A periprocedural complication (transient ischemic attack after CAS) occurred in 1 patient. The patient returned to the preoperative state within a few days and had no neurologic deficits. No access site-related complications occurred. Patients who underwent transradial CAS could walk immediately after CAS, even during hemostasis. No major cardiovascular events occurred within 30 days after CAS. CONCLUSIONS: The herein-described sheath guide specifically designed for transradial carotid cannulation was useful for CAS.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Cateterismo/métodos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Cateterismo/instrumentação , Feminino , Humanos , Masculino , Estudos Prospectivos
20.
BMJ Case Rep ; 12(6)2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31196972

RESUMO

We present a previously unreported case of endovascular therapy in the acute setting of ischaemic stroke in a patient with bilateral carotid occlusion (BCO). A 54-year-old man presents with sudden onset of right-sided weakness, difficulty speaking and left-sided gaze, with National Institute of Health Stroke Scale of 22 and no abnormalities on plain CT head. CT angiography showed BCO and CT perfusion demonstrated extensive area of penumbra in both hemispheres. The patient was sent for cerebral angiography that confirmed BCO. Since symptomatology was a left middle cerebral arteries syndrome, decision was made to angioplasty and stent the left internal carotid artery emergently, which was performed successfully and the patient had complete resolution of symptoms. Acute stroke with BCO represents a challenge in decision making regarding acute management and individual assessment must be made.


Assuntos
Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Infarto da Artéria Cerebral Média/cirurgia , Acidente Vascular Cerebral/cirurgia , Angioplastia/métodos , Arteriopatias Oclusivas/complicações , Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Humanos , Infarto da Artéria Cerebral Média/complicações , Masculino , Pessoa de Meia-Idade , Stents , Acidente Vascular Cerebral/etiologia
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