Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.779
Filtrar
1.
Artigo em Chinês | MEDLINE | ID: mdl-33472298

RESUMO

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.


Assuntos
Artéria Carótida Interna , Aneurisma Intracraniano , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Adulto Jovem
2.
J Stroke Cerebrovasc Dis ; 30(2): 105521, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310073

RESUMO

INTRODUCTION: Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting. MATERIAL AND METHODS: Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure. RESULTS: Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups. CONCLUSION: When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Inibidores da Agregação de Plaquetas/administração & dosagem , Stents , Abciximab/administração & dosagem , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/análogos & derivados , Administração Intravenosa , Idoso , Aspirina/administração & dosagem , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Esquema de Medicação , Emergências , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , /diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Semin Vasc Surg ; 33(3-4): 36-46, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308594

RESUMO

Before the development of the first prototype duplex ultrasound scanner at the University of Washington in the late 1970s, the only noninvasive tests available for extracranial carotid artery disease were indirect methods, such as the periorbital Doppler examination and oculoplethysmography. The duplex scanner combined real-time two-dimensional B-mode imaging and pulsed-Doppler flow detection in a single instrument and provided Doppler spectral waveforms from discrete sites within the vessel lumen. Spectral waveforms allowed characterization of the flow patterns and velocity changes associated with normal and diseased arteries. In a series of validation studies, Dr. D. Eugene Strandness, Jr. and colleagues compared various spectral waveform parameters obtained from internal carotid arteries to independently read carotid arteriograms and established quantitative threshold criteria for classification of carotid artery disease. These criteria were based on peak systolic velocity and end-diastolic velocity, as well as features such as spectral broadening and flow separation. Internal carotid arteries were classified as normal, 1% to 15% diameter reduction, 16% to 49% diameter reduction, 50% to 79% diameter reduction, 80% to 99% diameter reduction, and occluded. Since the 1980s, the University of Washington carotid duplex criteria have been widely used and modified in vascular laboratories throughout the world. Additional clinically relevant criteria have also been developed, such as a threshold for the 70% to 99% North American Symptomatic Carotid Endarterectomy Trial (NASCET) stenosis. Validation of carotid criteria has always depended on comparing spectral waveform parameters to the "gold standard" of contrast arteriography. However, experience has shown that the relationship between velocity and arteriographic stenosis is subject to significant variability. Based on these observations, standardization of carotid duplex criteria should lead to more consistent reporting among vascular laboratories, but it is unlikely to result in improved correlation with arteriography.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/história , Estenose das Carótidas/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Valor Preditivo dos Testes , Prognóstico , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Ultrassonografia Doppler Dupla/história
4.
Semin Vasc Surg ; 33(3-4): 47-53, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308595

RESUMO

Duplex ultrasound testing after open or endovascular extracranial carotid artery interventions is a clinical practice guideline with a strong recommendation from the Society for Vascular Surgery. Neurologic outcomes are improved by the recognition of repair site stenosis or atherosclerotic disease progression in the unoperated carotid artery. The benefit of surveillance outweighs its risk because duplex testing is free of complications and accurate in the detection of internal carotid artery (ICA) stenosis or occlusion. Surveillance for >70% ICA stenosis is recommended within 30 days of the procedure, then every 6 months for 2 years, and annually thereafter. Repair site and contralateral ICA stenosis classification should be based on angle-corrected pulsed Doppler measurements of peak systolic velocity (PSV), end-diastolic velocity (EDV), and the ratio of PSV at the stenosis to a proximal, nondiseased common carotid artery (CCA) segment (ICA/CCA ratio). Interpretation criteria of PSV >300 cm/s, EDV >125 cm/s, and ICA/CCA ratio >4 predicts >70% repair site stenosis. Endovascular intervention is recommended for a carotid repair site stenosis based on the occurrence of an ipsilateral neurologic event and appropriate anatomy for angioplasty. For asymptomatic restenosis, intervention is based on stenosis progression to elevated PSV and EDV >70% stenosis threshold values and the patient is deemed high risk for stroke due to contralateral ICA occlusion or incomplete functional patency of the circle of Willis.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Procedimentos Endovasculares/instrumentação , Stents , Ultrassonografia Doppler Dupla , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Endarterectomia das Carótidas/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Valor Preditivo dos Testes , Recidiva , Fluxo Sanguíneo Regional , Resultado do Tratamento
5.
Angiol Sosud Khir ; 26(4): 79-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332309

RESUMO

AIM: The purpose of this study was to analyse the world literature dedicated to the problem concerning treatment of a combination of internal carotid artery stenosis at the extracranial level and an arterial aneurysm of the brain, as well as to demonstrate own results of surgical treatment of patients presenting with this concomitant pathology of the carotid basin. PATIENTS AND METHODS: From 2013 to 2019, a clinical course of combined pathology of the basin of the internal carotid artery (an intracranial aneurysm and stenosis of the internal carotid artery at the extracranial level) was revealed in 35 of 1638 examined patients. There were ten men and 25 women, with a mean age of 66±7 years. In all the 35 patients, intracranial aneurysms appeared to be asymptomatic and were revealed during diagnosis of an atherosclerotic lesion of the internal carotid artery. Fifteen (43%) of the 35 patients were operated on. A two-stage surgical approach was used in 2 patients with ipsilateral location of the cerebral aneurysm and stenosis of the internal carotid artery: the first stage consisted in clipping of the arterial aneurysm, with stage 2 being carotid endarterectomy. A vascular stage alone (carotid endarterectomy or stenting of the internal carotid artery) was carried out in 9 patients, with a neurosurgical stage alone (clipping of the aneurysm) in 4 patients. RESULTS: The incidence of internal carotid artery stenosis with an arterial cerebral aneurysm, according to our findings, amounted to 2.1%. In the group of surgical treatment, in 1 case (6.7%) after stenting of the symptomatic stenosis of the internal carotid artery a female patient with an ipsilateral asymptomatic aneurysm of the middle cerebral artery intraoperatively developed 'minor' ischaemic stroke. Neither perioperative aneurysmal ruptures nor lethal outcomes were observed in the group of patients subjected to surgical interventions. CONCLUSION: An individual tactical approach to patients presenting with a combination of a cerebral aneurysm and internal carotid artery stenosis at the extracranial level made it possible at this stage of the work to avoid both intracranial haemorrhagic complications and lethal outcomes. The frequency of perioperative ischaemic cerebral events amounted to 6.7%. Further collection of the clinical material is needed to work out an optimal surgical policy in a combined lesion of the extra- and intracranial basin of the internal carotid artery.


Assuntos
Isquemia Encefálica , Estenose das Carótidas , Aneurisma Intracraniano , Acidente Vascular Cerebral , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Constrição Patológica , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade
6.
Angiol Sosud Khir ; 26(4): 86-89, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332310

RESUMO

The article deals with the results of surgical treatment of a male patient presenting with bilateral restenosis of stents in the internal carotid arteries 11 years after carotid angioplasty with stenting. Described herein are literature reports reflecting the state of the art of the problem, scarcity of studies, as well as some important issues still unresolved. Defined are the main indications for and contraindications to performing this type of reconstruction. The main stages of the operation are demonstrated. This is followed by describing a method of intraoperative protection of the brain, including invasive measurement of retrograde pressure. Besides, the most optimal terms of carrying out the second stage of treatment were determined, eventually demonstrating efficacy and safety of carotid endarterectomy for correction of this condition.


Assuntos
Angioplastia com Balão , Estenose das Carótidas , Endarterectomia das Carótidas , Angioplastia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Humanos , Masculino , Recidiva , Stents , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370953

RESUMO

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy's triad-chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves-oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.


Assuntos
Doenças do Nervo Abducente/etiologia , Fístula Carotidocavernosa/diagnóstico , Exoftalmia/etiologia , Traumatismos Cranianos Fechados/complicações , Angiografia Digital , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/cirurgia , Seio Cavernoso/diagnóstico por imagem , Criança , Procedimentos Endovasculares , Exoftalmia/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
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
11.
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
12.
Angiol. (Barcelona) ; 72(5): 265-268, sept.-oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195496

RESUMO

Los aneurismas de la arteria carótida extracraneal son raros y representan una minoría de la cirugía carotídea en la mayoría de las unidades vasculares. Se presenta un caso clínico de un aneurisma sacular de la arteria carótida interna en un paciente joven, sin causa aparente. La mayoría de estos aneurismas son asintomáticos, aunque, en este paciente debutó como ictus por embolización distal. El manejo consistió en un abordaje quirúrgico abierto a las 4 semanas tras el episodio inicial. En la intervención se extirpó el aneurisma con sutura termino-terminal de la arteria carótida interna


Aneurysms of the extracranial carotid artery are rare and represent a minority of the carotid surgery in most vascular units. A clinical case of a saccular aneurism of the internal carotid artery, in a young patient without apparent cause, is showcased. They are often asymptomatic, but they also may show (as it was in this patient) stroke from distal embolisation as a debut. The management consisted in an open surgical approach (by meaning, aneurysm excision with termino-terminal suture of the internal carotid artery, without shunt), 4 weeks after the initial episode


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Angiografia por Tomografia Computadorizada/métodos
14.
Medicine (Baltimore) ; 99(35): e21922, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871929

RESUMO

RATIONALE: Cancer-related stroke has been regarded as an emerging subtype of ischemic event. Acute treatment for this subtype may include the antiplatelet agents, anticoagulants, or endovascular intervention. PATIENT CONCERNS: A 63-year-old woman with sudden-onset right hemiparesis and conscious change was sent to our emergency department. The patient had underlying sigmoid adenocarcinoma and received chemotherapy FOLFIRI (FOL, folinic acid; F, fluorouracil; and IRI, irinotecan) with targeted therapy cetuximab following lower anterior resection since the diagnosis was made. DIAGNOSES: Brain magnetic resonance angiography revealed a filling defect in left carotid bulb, and neurosonography showed a thick atherosclerotic plaque (size 4.9 mm) in the left internal carotid artery on day 5 after the onset of stroke. INTERVENTIONS: During the first three hours after onset, administration of IV tissue plasminogen activator did not resolve the thrombus. Dabigatran (110 mg bid) started on day 7. OUTCOMES: The atherosclerotic plaque dissolved on day 24. The patient recovered her muscle strength but still had nonfluent speech in mild extent. LESSONS: Thrombolytic and anticoagulant medications in this patient suggested the thrombus formation with fibrin-rich content which may be attributable to both cancer and chemotherapy. Dabigatran, an oral anticoagulant, had a benefit for this subtype of ischemic stroke among patients with cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Antitrombinas/uso terapêutico , Trombose das Artérias Carótidas/terapia , Artéria Carótida Interna , Infarto da Artéria Cerebral Média/induzido quimicamente , Terapia Trombolítica , Adenocarcinoma/complicações , Adenocarcinoma/tratamento farmacológico , Administração Oral , Trombose das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Dabigatrana/uso terapêutico , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/terapia , Neoplasias do Colo Sigmoide/complicações , Neoplasias do Colo Sigmoide/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico
15.
Medicine (Baltimore) ; 99(39): e22309, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991437

RESUMO

The safety and feasibility of transradial approach for cerebral angiography has been confirmed previously. However, this approach has been limited used due to the difficulty during the procedure. This study aimed to introduce a pigtail catheter tailing and long-wire swapping technique to improve the success rate without increasing complications.From August 2015 to December 2018, 560 patients who underwent cerebral angiography via transradial approach were recruited. The data including the type of aortic arch, type of Simmon catheter were collected.The loop was successfully constructed in 553 patients using Simmon-2 or Simmon-1 catheter. Of these patients, 72 patients successfully underwent cerebral and renal angiography, while 481 patients underwent cerebral angiography. The time for angiography was 52.87 ±â€Š11.23 minutes and 47.8 ±â€Š11.8 minutes, respectively. There were 369 (66.7%), 135 (24.4%), and 49 (8.9%) patients with type I, type II, and type III aortic arches, respectively, and their success rates of looping using Simmon-2 catheter were 97.8%, 97.0%, and 89.8%, respectively. The success rates of angiography in the right internal carotid artery, right vertebral artery, left internal carotid artery, and left vertebral artery were 100%, 100%, 98.9%, and 98.9%, respectively. No serious complications were observed in all patients.The pigtail catheter tailing and long guidewire swapping is considered as a safe procedure with high success rate for loop construction using a Simmon-2 catheter through the right radial artery, subsequently improving the success rate as well as the efficiency of angiography.


Assuntos
Cateteres Cardíacos/efeitos adversos , Angiografia Cerebral/instrumentação , Utilização de Procedimentos e Técnicas/normas , Artéria Radial/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Cateteres Cardíacos/tendências , Artéria Carótida Interna/diagnóstico por imagem , Cateterismo Periférico/métodos , Angiografia Cerebral/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem
16.
BMC Neurol ; 20(1): 334, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883220

RESUMO

BACKGROUND: Common carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways. Based on the diagnostic results of digital subtraction angiography (DSA), head and neck computed tomography angiography (CTA) was used to find the internal carotid artery stealing pathway after CCAOD. METHODS: The clinical and imaging data of 18 patients with CCAOD were retrospectively analyzed. DSA and CTA was used to evaluate internal carotid artery steal pathways. RESULTS: Of the 18 patients with CCAOD, 10 patients found internal carotid artery steal pathways. There were 7 males and 3 females. Vascular ultrasound examination of all patients: The affected side had no blood flow in common carotid artery (CCA), and had retrograde blood flow in the external carotid artery (ECA). The blood flow of the affected side was decreased in the internal carotid artery (ICA), but it was antegrade. DSA diagnosed 10 cases of CCA occlusion and CTA diagnosed 10 cases of CCA occlusion. DSA and CTA found 6 internal carotid artery blood stealing pathways: ① Vertebral artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ② Thyrocervical trunk → ascending cervical artery → occipital artery → external carotid artery → internal carotid artery (7 cases); ③ Costocervical trunk → deep cervical artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ④ Affected side thyroid neck trunk → inferior thyroid artery → superior thyroid artery → external carotid artery → internal carotid artery (2 cases); ⑤ Contralateral external carotid artery → contralateral superior thyroid artery → affected superior thyroid artery → external carotid artery → neck Internal artery (2 cases); ⑥ Parathyroid neck → superficial cervical artery → occipital artery → external carotid artery → internal carotid artery (1 case). CONCLUSIONS: The patients with CCAOD can find the internal carotid artery blood stealing pathway through CTA.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Idoso , Angiografia Digital/métodos , Artéria Carótida Externa/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia , Artéria Vertebral
17.
J Cardiovasc Magn Reson ; 22(1): 67, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912285

RESUMO

BACKGROUND: The posterior wall of the proximal internal carotid artery (ICA) is the predilection site for the development of stenosis. To optimally prevent stroke, identification of new risk factors for plaque progression is of high interest. Therefore, we studied the impact of carotid geometry and wall shear stress on cardiovascular magnetic resonance (CMR)-depicted wall thickness in the ICA of patients with high cardiovascular disease risk. METHODS: One hundred twenty-one consecutive patients ≥50 years with hypertension, ≥1 additional cardiovascular risk factor and ICA plaque ≥1.5 mm thickness and < 50% stenosis were prospectively included. High-resolution 3D-multi-contrast (time of flight, T1, T2, proton density) and 4D flow CMR were performed for the assessment of morphological (bifurcation angle, ICA/common carotid artery (CCA) diameter ratio, tortuosity, and wall thickness) and hemodynamic parameters (absolute/systolic wall shear stress (WSS), oscillatory shear index (OSI)) in 242 carotid bifurcations. RESULTS: We found lower absolute/systolic WSS, higher OSI and increased wall thickness in the posterior compared to the anterior wall of the ICA bulb (p < 0.001), whereas this correlation disappeared in ≥10% stenosis. Higher carotid tortuosity (regression coefficient = 0.764; p < 0.001) and lower ICA/CCA diameter ratio (regression coefficient = - 0.302; p < 0.001) were independent predictors of increased wall thickness even after adjustment for cardiovascular risk factors. This association was not found for bifurcation angle, WSS or OSI in multivariate regression analysis. CONCLUSIONS: High carotid tortuosity and low ICA diameter were independent predictors for wall thickness of the ICA bulb in this cross-sectional study, whereas this association was not present for WSS or OSI. Thus, consideration of geometric parameters of the carotid bifurcation could be helpful to identify patients at increased risk of carotid plaque generation. However, this association and the potential benefit of WSS measurement need to be further explored in a longitudinal study.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Hemodinâmica , Angiografia por Ressonância Magnética , Idoso , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Risco , Estresse Mecânico
18.
J Stroke Cerebrovasc Dis ; 29(10): 105134, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912530

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) caused by large vessel occlusion of the anterior circulation within 6 hours of symptoms onset and can be performed with an extended window up to 24 hours in selected patients. Nevertheless, the outcomes of MT with extended window are unknown in developing countries. OBJECTIVE: Explore the safety and efficacy of MT for AIS performed beyond 6 hours from symptoms onset in Brazil. METHODS: We reviewed data from AIS patients treated with MT beyond 6 hours of stroke onset, from 2015 to 2018 in a Brazilian public hospital. Patients had an occlusion of the intracranial internal carotid artery and/or proximal segment of the middle cerebral artery. CT Perfusion mismatch was evaluated using the RAPID® software. We evaluated the modified Rankin scale (mRS) and mortality at 90 days, and rate of symptomatic intracranial hemorrhage (sICH). RESULTS: Fifty-four patients were included, with a mean age of 65.6 ± 16.1 years, 55.6% were male, and the median NIHSS score at presentation was 17. Successful recanalization (TICI 2b to 3) was obtained in 92.6% of patients and sICH rate was 11.1%. Overall, 34% of the patients had a good outcome (mRS ≤2) at 90 days and the mortality rate was 20.3%. CONCLUSION: Our study, the first series of MT for AIS treated with extended window reported in Latin America, shows that MT can be performed with safety and lead to adequate functional outcomes in this context. Further studies should explore the barriers to broad implementation of MT for AIS in Latin America.


Assuntos
Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/terapia , Circulação Cerebrovascular , Infarto da Artéria Cerebral Média/terapia , Artéria Cerebral Média/fisiopatologia , Trombectomia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Brasil , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/fisiopatologia , Avaliação da Deficiência , Feminino , Hospitais Públicos , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Imagem de Perfusão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Centros de Atenção Terciária , Trombectomia/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 29(10): 105116, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912568

RESUMO

BACKGROUND: A neck size >4.0 mm is a risk factor for recanalization after coil embolization. The high inflow magnitude of pretreatment wide-neck aneurysms may be correlated to recanalization. We aimed to elucidate the effect of the neck size on the inflow magnitude evaluated on four-dimensional (4D) flow magnetic resonance imaging (MRI) in pretreatment unruptured internal carotid artery (ICA) aneurysms. METHODS: Thirty-three untreated ICA aneurysms were subjected to 4D flow MRI to evaluate the inflow magnitude parameters including the maximum spatially-averaged inflow velocity (MSAIV), maximum inflow velocity, maximum inflow rate (MIR), and their ratios to each corresponding flow parameter in the parent artery. RESULTS: The neck size was linearly correlated to all inflow parameters investigated in this study. A strong correlation was observed between the neck size and the following: MSAIV (r = .755, p < .0001), MIR (r = .715, p < .0001), MSAIV ratio (r = .724, p < .0001), and MIR ratio (r = .741, p < .0001). The predicted value of MIR ratio of an aneurysm with the neck size of 4.0 mm was 23.0% and 20.6%, based on the linear regression equation of all aneurysms and on that of aneurysms with the neck size >4.0 mm, respectively. CONCLUSIONS: The neck size was linearly correlated with the inflow magnitude of unruptured ICA aneurysms. Inflow magnitude evaluation using 4D flow MRI may help to hemodynamically identify aneurysms with a high risk of recanalization after endovascular coil embolization.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Circulação Cerebrovascular , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Imagem de Perfusão/métodos , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Feminino , Humanos , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA