Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.872
Filtrar
2.
Angiol Sosud Khir ; 26(3): 167-171, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063764

RESUMO

Extracranial carotid artery aneurysms belong to uncommon and dangerous vascular diseases. Reported herein are the results of successive surgical treatment of a patient presenting with an extracranial aneurysm of the internal carotid artery. Given anatomical peculiarities (large dimensions of the aneurysm, tortuosity of the internal carotid artery), it was decided to perform resection of the aneurysm with an end-to-end anastomosis established. The patient examined at 12 months postoperatively was found to be free from the syncopal states, with no restenosis of the zone of the anastomosis revealed. The chosen therapeutic policy provided effective prevention from the development of ischaemic stroke and aneurysmal rupture, as well as improved the patient's quality of life. An open reconstructive operation is an optimal method of treatment of patients presenting with extracranial carotid artery aneurysms.


Assuntos
Isquemia Encefálica , Doenças das Artérias Carótidas , Acidente Vascular Cerebral , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Humanos , Qualidade de Vida
3.
No Shinkei Geka ; 48(10): 957-961, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071233

RESUMO

A 77-year-old man presented with a 6-month history of progressive right optic neuropathy secondary to compression by the ipsilateral internal carotid artery(ICA). We performed anterior clinoidectomy and optic canal unroofing. Subsequently, we wrapped the ICA with a polytetrafluoroethylene tape, pulled the vessel laterally, and sutured the tape to the dura mater at the anterior skull base for optimal decompression. An inflammatory mass lesion was observed around the ICA, which led to further compression of the optic nerve. Histopathological examination of the resected specimen showed an inflammatory granuloma. The patient's visual field deficit showed partial improvement postoperatively. Transposition using a tape might be an effective surgical alternative for compressive optic neuropathy.


Assuntos
Artéria Carótida Interna , Doenças do Nervo Óptico , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Descompressão Cirúrgica , Granuloma/complicações , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Humanos , Masculino , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/cirurgia
4.
Yonsei Med J ; 61(8): 736-738, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734739

RESUMO

Remote intracerebral hemorrhage (ICH) is defined as an ICH that occurs at a distant site from the treated lesion and is a considerable post-neurointerventional complication. Because such a life-threatening complication should not be neglected, we report our experience with delayed remote ICH in a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) treated by Wingspan stenting following on-label usage guidelines. A middle-aged person suffered a lobar-type subcortical hemorrhage on the left temporal lobe 22 days after Wingspan stenting in the left internal carotid artery. The present case seemed to correspond with a previous report in which remote ICH tended to occur as an ipsilateral lobar-type hemorrhage in patients with unruptured intracranial aneurysm on the internal carotid artery undergoing treatment with stents or flow diverters. Delayed remote ICH should be considered as a potential risk of using a Wingspan stent covering the carotid siphon for ICAS.


Assuntos
Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Hemorragia Cerebral/etiologia , Stents/efeitos adversos , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
No Shinkei Geka ; 48(8): 733-738, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32830139

RESUMO

We experienced a case of unruptured internal carotid artery aneurysm improved endocrinological function after the treatment. A 68-year-old woman was admitted to our hospital complaining of general fatigue, dizziness, and decreased visual acuity. Radiological examination revealed unruptured large aneurysm at the right anterior carotid artery compressing on the pituitary gland. We underwent right STA-MCA bypass and trapping of right internal carotid artery. Post-operative course was uneventful. Although visual function was not improved, her endocrinological function was improved 8 months after surgery by thrombosed and shrunken aneurysm. The mechanism of panhypopituitarism due to aneurysm has been suggested to involve mechanical compression on the pituitary gland, pituitary stalk, or hypophyseal artery. Although it was unclear about the improvement of endocrine function after the treatment of aneurysm, some cases could recover the hypopituitarism after enough follow-up period.


Assuntos
Doenças das Artérias Carótidas , Revascularização Cerebral , Hipopituitarismo , Aneurisma Intracraniano , Idoso , Artéria Carótida Interna/cirurgia , Feminino , Humanos
6.
Angiol Sosud Khir ; 26(2): 124-132, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597893

RESUMO

AIM: The study was aimed at developing a surgical policy for patients presenting with acute ischaemic stroke induced by lesions of the intra- and extracranial arteries. PATIENTS AND METHODS: The patients were enrolled into the study resulting from the current practice of the Department of Emergency Neurosurgery of the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. Sampling of patients was carried out from 1st January, 2014 to 10th October, 2017, eventually comprising all those (n=160) operated on for verified pathology of brachiocephalic arteries and acute impairment of cerebral circulation. RESULTS: During the examination, 101 (63.1%) patients were found to have unilateral or bilateral stenosis of the internal carotid artery, 22 (10.7%) patients were diagnosed with occlusion of the internal carotid artery, and 36 (17.6%) had acute thrombosis of the internal carotid artery. All this was the cause of acute impairment of cerebral circulation. Also, 1 patient was found to have occlusion of the 1st segment of the vertebral artery. Depending on the type of the lesion to the internal carotid artery, the patients were subdivided into 3 groups: 1) patients with internal carotid artery stenosis who received carotid endarterectomy; 2) patients with occlusion of the internal carotid artery, subjected to creation of an extra-intracranial microanastomosis, and 3) those with thrombosis of the internal carotid artery, who depending on the degree of occlusion of the internal carotid artery and patency of the intracranial arteries underwent thrombintimectomy or an extra-intracranial microanastomosis. The indications for and contraindications to interventions were defined based on the existing symptomatic pathology of brachiocephalic arteries, the terms of acute impairment of cerebral circulation, perfusion of the brain, the risk for the development of malignant stroke and cerebral oedema, possible haemorrhagic transformation of the focus of ischaemia, the rehabilitational potential of the patient and the analysis of the current literature. The results of our work demonstrated that surgical treatment of patients in the cute period of ischaemic stroke makes it possible to improve the neurological outcomes in patients as compared with the preoperative status and is not accompanied by a high risk of surgical complications (with the haemorrhagic complication rate amounting to 0.6%). CONCLUSION: Surgical revascularization of the brain in the acute period of ischaemic stroke is a safe and effective method of treatment in patients with different haemodynamically significant damage of brachiocephalic arteries, once the patients were correctly selected for the operation.


Assuntos
Isquemia Encefálica/etiologia , Estenose das Carótidas/cirurgia , Revascularização Cerebral/efeitos adversos , Endarterectomia das Carótidas/efeitos adversos , Acidente Vascular Cerebral/etiologia , Encéfalo/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Humanos
7.
J Clin Neurosci ; 78: 397-399, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402613

RESUMO

We report the case of a patient with an anterior ischemic stroke due to tandem occlusion of the left M2 segment and ipsilateral internal carotid artery (ICA), with concomitant severe stenosis of the ipsilateral external carotid artery (ECA) and contralateral ICA, and moderate stenosis of the left vertebral artery (VA); as thrombectomy was not possible, stenting of the right ICA was performed. Two days after significant recovery, the patient showed neurological deterioration when in upright position, and brain magnetic resonance imaging confirmed decreased cerebral blood flow on the left hemisphere. Stenting of the left ECA and balloon angioplasty of the ipsilateral VA were performed in order to increase collateral flow, with an almost complete resolution of symptoms. This case highlights the importance of assessing the collateralization pattern when an ICA occlusion is present, and the potential need to revascularize an ipsilateral stenotic ECA.


Assuntos
Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna/patologia , Estenose das Carótidas/cirurgia , Stents/efeitos adversos , Angioplastia com Balão/métodos , Artéria Carótida Interna/cirurgia , Circulação Cerebrovascular , Circulação Colateral/fisiologia , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Artéria Vertebral/cirurgia
9.
World Neurosurg ; 139: 419-422, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360918

RESUMO

OBJECTIVE: To describe a case of an adult female Filipino with hypereosinophilia and bilateral carotid artery aneurysms who subsequently developed bilateral cerebral hemisphere strokes following aneurysm stenting. CASE DESCRIPTION: A 57-year-old female patient with persistent hypereosinophilia presented with progressively enlarging bilateral neck masses, revealed to be carotid artery aneurysms on computed tomography angiography. Following surgical exploration, she later developed right-sided hemiplegia, aphasia, and right hemianopia. Cranial computed tomography revealed infarcts on both middle cerebral artery territories. Bone marrow biopsy and fluorescent in situ hybridization revealed findings suggestive of hypereosinophilic syndrome. She was started on standard aspirin and statin therapy and was discharged sixteen days after the procedure. Partial improvement of neurologic deficits was noted two months later on follow up. Chemotherapy with imatinib was initiated. CONCLUSIONS: This patient's prothrombotic state from FIP1L1-PDGFRA-positive hypereosinophilia may have led to large carotid artery aneurysm formation and intramural thrombosis. This case demonstrates a possible and heretofore undocumented neurovascular sequela of hypereosinophilic syndrome.


Assuntos
Aneurisma/complicações , Procedimentos Endovasculares/efeitos adversos , Síndrome Hipereosinofílica/complicações , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Aneurisma/cirurgia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Síndrome Hipereosinofílica/genética , Pessoa de Meia-Idade , Proteínas de Fusão Oncogênica , Receptor alfa de Fator de Crescimento Derivado de Plaquetas , Stents , Fatores de Poliadenilação e Clivagem de mRNA
10.
World Neurosurg ; 139: 401-404, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360920

RESUMO

BACKGROUND: We present a patient who underwent left superior temporal artery (STA)-to-right middle cerebral artery (MCA) bypass using a radial artery (RA) graft with resection of a giant right cervical common carotid artery (CCA) pseudoaneurysm after carotid artery stenting (CAS) and discuss the treatment strategy and surgical procedure in detail. CASE DESCRIPTION: An 86-year-old male presented with sudden onset of altered consciousness and complete left hemiparesis. Magnetic resonance angiography and catheter angiography of the brain revealed occlusion of the right cervical ICA. Endovascular thrombectomy and stenting of the cervical segment of the ICA were performed. Thirty-two days after CAS, the patient developed a high fever and rapid swelling of the neck. Catheter angiography showed a giant right CCA pseudoaneurysm that had a fistula just proximal to the carotid stent, and the aneurysm extended to the neck entirely. Because of the expanding neck infection, stent placement long lesion, and lack of distal collateral flow on angiography, we performed aneurysm and stent removal and left STA-to-right MCA bypass using an RA graft. The harvested RA graft was anastomosed side to end to both the M2 segment of the right MCA and the left STA. Bypass patency was confirmed before neck exposure. The pseudoaneurysm and proximal portion area of the stent were resected. The patient recovered well postoperatively, and follow-up catheter angiography showed patency of the bypass. CONCLUSIONS: Left STA-RA-right MCA bypass with aneurysm resection is a good treatment option for giant CCA pseudoaneurysms that occur after CAS.


Assuntos
Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Revascularização Cerebral/métodos , Artéria Radial/transplante , Idoso de 80 Anos ou mais , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Stents , Trombectomia/efeitos adversos
11.
J Stroke Cerebrovasc Dis ; 29(7): 104859, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389557

RESUMO

No previous study has reported endovascular treatment (EVT) in a patient with hemophilia who had an acute ischemic stroke (AIS). Herein, we report the case of a patient with hemophilia A who presented with hyperacute stroke due to a near occlusion of the proximal internal carotid artery (ICA). A 54-year-old man was admitted to our emergency department with a sudden onset of left-sided weakness that occurred 4 hours prior to admission. He had been diagnosed with congenital hemophilia A during his childhood. Although brain computed tomography revealed no evidence of hemorrhage, we did not consider intravenous thrombolysis because of his bleeding-prone condition. Diffusion-weighted imaging revealed a restricted diffusion in the right anterior and middle cerebral artery territories. Magnetic resonance angiography revealed that the right proximal ICA was nearly occluded and had a residual stump. Digital subtraction angiography revealed a near occlusion of the right proximal ICA with a thread-like lumen. Balloon angioplasty was performed in the proximal ICA, and distal flow was restored, but residual stenosis was observed. Stepwise revascularization by carotid endarterectomy (CEA) was planned instead of immediate carotid stenting. He underwent CEA with preoperative and postoperative coverage of factor VIII and recovered without any bleeding complication.


Assuntos
Angioplastia com Balão , Isquemia Encefálica/etiologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Hemofilia A/complicações , Acidente Vascular Cerebral/etiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Coagulantes/administração & dosagem , Esquema de Medicação , Fator VIII/administração & dosagem , Hemofilia A/diagnóstico , Hemofilia A/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
13.
Rozhl Chir ; 99(3): 136-139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32349498

RESUMO

INTRODUCTION: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. METHODS: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. CONCLUSION: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.


Assuntos
Arteriopatias Oclusivas , Isquemia Encefálica , Trombose das Artérias Carótidas , Acidente Vascular Cerebral/etiologia , Trombose , Artéria Carótida Interna/cirurgia , Humanos , Pessoa de Meia-Idade
14.
J Clin Neurosci ; 78: 222-227, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32336632

RESUMO

The purpose of this study was to retrospectively analyse the clinical and angiographic outcomes of Willis covered stent placement for unruptured aneurysms in internal carotid artery. Forty-six consecutive patients with internal carotid artery aneurysms (49 cases) were included to evaluate clinical and angiographic outcomes. Covered stent placement was successful in 47 cases, whereas stent navigation failed in 2 cases. Of the 49 aneurysms (mean aneurysm size, 7.9 mm), 5, 6, and 38 were located in the petrous, cavernous, and ophthalmic segments, respectively. Immediate angiography revealed complete aneurysm exclusion in 36 (76.6%) cases, whereas minimal endoleak was observed in 11 cases. Four patients had procedure-related complications, including 1 patient with acute in-stent thrombosis, 2 with a post-operative subarachnoid haemorrhage, and 1 with artery rupture. Angiographic and clinical follow-up was available for 36 patients (38 aneurysms). Complete aneurysm occlusion was achieved in 34 (89.5%) cases, endoleak was present in 2 cases, and aneurysm recurrence occurred in 2 cases. Asymptomatic in-stent stenosis was observed in 3 patients. No hemorrhagic or ischemic events occurred during the follow-up period. At follow-up, the modified Rankin scores were 0-2 for 35 patients and >2 for 1 patient. Satisfactory angiographic outcomes were achieved in our study. However, the risks of stent navigation failure, endoleak after balloon re-inflation, procedure-related complications and coverage of side branches should be considered when choosing the best therapeutic option for internal carotid artery aneurysms.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Angiografia Cerebral , Procedimentos Endovasculares , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Pós-Operatória , Período Pós-Operatório , Estudos Retrospectivos , Hemorragia Subaracnóidea , Resultado do Tratamento
15.
Vasc Endovascular Surg ; 54(4): 378-381, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270756

RESUMO

Extracranial internal carotid artery (ICA) aneurysms account for <1.0% all aneurysms and a rare indication for carotid intervention. Causes include atherosclerotic degeneration, trauma, dissection, previous carotid surgery, connective tissue disorders, and infection. Authors report a case of a middle-aged male found to have a large aneurysm of the left ICA who underwent repair by resection and reconstruction with end-to-end anastomosis under neuroprotection with flow reversal. Our discussion includes a recommendation for this particular surgical repair. The patient in this case report has granted the authors consent for review of records and subsequent publication submission.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Dispositivos de Proteção Embólica , Procedimentos Cirúrgicos Vasculares/instrumentação , Anastomose Cirúrgica , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Angiol Sosud Khir ; 26(1): 96-101, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240143

RESUMO

The purpose of this study was to assess efficacy of cerebral protection during carotid endarterectomy by means of controlled systemic hypertension in patients presenting with various levels of retrograde pressure in the internal carotid artery. The study enrolled a total of 150 patients subjected to carotid endarterectomy. The operation was carried out under general anaesthesia with artificial pulmonary ventilation and was accompanied by haemodynamic monitoring with invasive control of arterial pressure, as well as primary and additional correction of central haemodynamics. Cerebral perfusion was assessed by measuring retrograde pressure in the internal carotid artery. The retrograde pressure index was calculated, according to which the patients were subdivided into three groups: those with values less than 30, with values from 30 to 39, and with values of 40 and more. Controlled systemic arterial hypertension was used as cerebral protection during the period of cross-clamping of the internal carotid artery, with phenylephrine and norepinephrine administered for this purpose. The parameters of central haemodynamics, time intervals of the operation, and the duration of internal carotid artery cross-clamping in the groups did not statistically differ (p>0.05). A statistically significant difference was revealed in the level of systolic arterial pressure necessary for cerebral protection (p<0.05). There were no cerebral circulation impairments, myocardial infarctions, nor lethal outcomes. A conclusion was drawn that individualized correction of central haemodynamics ensured a sufficient level of collateral compensation of the cerebral blood flow, thus making it possible to refuse from using intraluminal shunts.


Assuntos
Endarterectomia das Carótidas/efeitos adversos , Hipertensão , Artérias Carótidas , Artéria Carótida Interna/cirurgia , Circulação Cerebrovascular , Endarterectomia , Hemodinâmica , Humanos
17.
Stroke ; 51(5): 1539-1545, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32268851

RESUMO

Background and Purpose- We aimed to compare functional and procedural outcomes of patients with acute ischemic stroke with none-to-minimal (modified Rankin Scale [mRS] score, 0-1) and moderate (mRS score, 2-3) prestroke disability treated with mechanical thrombectomy. Methods- Consecutive adult patients undergoing mechanical thrombectomy for an anterior circulation stroke were prospectively identified at 2 comprehensive stroke centers from 2012 to 2018. Procedural and 90-day functional outcomes were compared among patients with prestroke mRS scores 0 to 1 and 2 to 3 using χ2, logistic, and linear regression tests. Primary outcome and significant differences in secondary outcomes were adjusted for prespecified covariates. Results- Of 919 patients treated with mechanical thrombectomy, 761 were included and 259 (34%) patients had moderate prestroke disability. Ninety-day mRS score 0 to 1 or no worsening of prestroke mRS was observed in 36.7% and 26.7% of patients with no-to-minimal and moderate prestroke disability, respectively (odds ratio, 0.63 [0.45-0.88], P=0.008; adjusted odds ratio, 0.90 [0.60-1.35], P=0.6). No increase in the disability at 90 days was observed in 22.4% and 26.7%, respectively. Rate of symptomatic intracerebral hemorrhage (7.3% versus 6.2%, P=0.65), successful recanalization (86.7% versus 83.8%, P=0.33), and median length of hospital stay (5 versus 5 days, P=0.06) were not significantly different. Death by 90 days was higher in patients with moderate prestroke disability (14.3% versus 40.3%; odds ratio, 4.06 [2.82-5.86], P<0.001; adjusted odds ratio, 2.83 [1.84, 4.37], P<0.001). Conclusions- One-third of patients undergoing mechanical thrombectomy had a moderate prestroke disability. There was insufficient evidence that functional and procedural outcomes were different between patients with no-to-minimal and moderate prestroke disability. Patients with prestroke disability were more likely to die by 90 days.


Assuntos
Atividades Cotidianas , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Pessoas com Deficiência , Infarto da Artéria Cerebral Média/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral , Comorbidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Acidente Vascular Cerebral/cirurgia , Terapia Trombolítica/métodos , Resultado do Tratamento
18.
Stroke ; 51(5): 1428-1434, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32295503

RESUMO

Background and Purpose- It is unclear which factors predict acute neurological deterioration in patients with large vessel occlusion and mild symptoms. We aim to evaluate the frequency, timing, and potential predictors of acute neurological deterioration ≥4 National Institutes of Health Stroke Scale (NIHSS) points in medically managed patients with large vessel occlusion and mild presentation. Methods- Single-center retrospective study of patients with consecutive minor stroke (defined as NIHSS score of ≤5 on presentation) and large vessel occlusion from January 2014 to December 2017. Primary outcome was acute neurological deterioration ≥4 NIHSS points during the hospitalization. Secondary outcomes included ΔNIHSS (defined as discharge minus admission NIHSS score). Results- Among 1133 patients with acute minor strokes, 122 (10.6%) had visible occlusions on computed tomography angiography/magnetic resonance angiography. Twenty-four (19.7%) patients had ≥4 points deterioration on NIHSS at a median of 3.6 (1-16) hours from arrival. No clinical or radiological predictors of acute neurological deterioration ≥4 NIHSS points were observed on multivariable analysis. Rescue endovascular thrombectomy was performed more often in the ones with acute neurological deterioration ≥4 NIHSS points compared with patients with no deterioration (54% versus 0%; P<0.001). Acute neurological deterioration ≥4 NIHSS points was associated with ΔNIHSS ≥4 points (33% versus 4.9%; P<0.01) and a trend toward lower independence rates at discharge (50% versus 70%; P=0.06) compared with the group with no deterioration. In patients with any degree of neurological worsening, patients who underwent rescue thrombectomy were more likely to be independent at discharge (73% versus 38%; P=0.02) and to have a favorable ΔNIHSS (-2 [-3 to 0] versus 0 [-1 to 6]; P=0.05) compared with the ones not offered rescue thrombectomy. Conclusions- Acute neurological deterioration ≥4 NIHSS points was observed in a fifth of patients with large vessel occlusion and mild symptoms, occurred very early in the hospital course, impacted functional outcomes, and could not be predicted by any of the studied clinical and radiological variables. Rescue thrombectomy was associated with improved clinical outcomes at discharge in patients with neurological deterioration.


Assuntos
Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/fisiopatologia , Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombectomia/métodos , Resultado do Tratamento
19.
Ann Vasc Surg ; 67: 568.e13-568.e18, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32234395

RESUMO

Extracranial carotid artery aneurysms (ECAAs) have a low incidence between 0.4% and 4% of all peripheral artery aneurysms and involving 0.1-2% of all carotid artery procedures. Some form of repair is generally warranted as nonoperative management has shown mortality as high as 71%. However, to date a standard method for ECAA repair has not been suggested. Generally, open surgical repair is the preferred technique; however, it has its own limitations and risks. Recently, endovascular approach is increasingly being used not only for the elective repair of unruptured ECAA but also for the management of ruptured ECAA. Herein we present 3 cases of distal extracranial internal carotid artery aneurysms treated with placement of stent grafts.


Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Dispositivos de Proteção Embólica , Procedimentos Endovasculares/instrumentação , Embolia Intracraniana/prevenção & controle , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fluxo Sanguíneo Regional , Resultado do Tratamento
20.
Ann Vasc Surg ; 67: 557-562, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32243906

RESUMO

Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall, leading to cerebral embolism. Proximal protection devices used in carotid artery stenting reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique, and we report its successful application in 2 high-risk patients with a soft and friable type 4 ICA plaque: a 62-year-old male patient presenting with crescendo transient ischemic attacks and a 61-year-old male patient presenting with a major stroke. Both were operated in the acute period. Once the reverse flow has been established, the surgeon can freely manipulate the carotid and perform a fast blunt dissection without the risk that the disturbance of the arterial wall may lead to cerebral embolism. A video recording of the procedure has been made and presented with this article. Despite the various limitations, including increased clamping time, transient intolerance to reverse flow, and increased blood loss, this technique may improve clinical outcomes, especially in symptomatic patients with friable plaque. A clinical trial is warranted to further study the results of the flow-reversal CEA.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Infarto Cerebral/prevenção & controle , Dispositivos de Proteção Embólica , Endarterectomia das Carótidas/instrumentação , Embolia Intracraniana/prevenção & controle , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Endarterectomia das Carótidas/efeitos adversos , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fluxo Sanguíneo Regional , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA