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1.
J Stroke Cerebrovasc Dis ; 29(2): 104488, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31787498

RESUMO

BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS: We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS: Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Cérebro/irrigação sanguínea , Imagem de Difusão por Ressonância Magnética , Extremidades/inervação , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Administração Intravenosa , Idoso , Artéria Cerebral Anterior/fisiopatologia , Circulação Cerebrovascular , Ensaios Clínicos como Assunto , Ensaios Clínicos Fase II como Assunto , Avaliação da Deficiência , Feminino , Glibureto/administração & dosagem , Humanos , Hipoglicemiantes/administração & dosagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Anterior/terapia , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
2.
World Neurosurg ; 133: e320-e326, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520758

RESUMO

BACKGROUND: Compared with intracranial aneurysms (IAs) at other locations, pericallosal artery aneurysms (PAAs) have demonstrated an extremely high risk of rupture. However, owing to their rarity, our understanding of their morphological characteristics has been limited, and whether the morphological characteristics of PAAs contribute to this high rupture risk has remained unexplored. In the present study, we aimed to provide a detailed description of the morphological characteristics of PAAs and investigate the association between its morphology and rupture risk compared with anterior circulation IAs at other locations. METHODS: A total of 40 patients with 45 PAAs and 348 patients with 392 anterior circulation IAs at other locations were recruited. The clinical and radiological data for these patients were retrospectively reviewed. The differences in the morphological parameters, including the aneurysm diameter, neck width, height, width, parent artery diameter, inflow angle, aspect ratio (AR), size ratio (SR), and aneurysm diameter/width ratio, between PAAs and other IA groups were compared. RESULTS: Of the 45 PAAs, 22 (48.9%) had ruptured. The proportion of ruptured aneurysms was greater for PAAs than for anterior circulation IAs at other locations. For both ruptured and unruptured anterior circulation IAs, PAAs had the highest AR and SR among all IA groups and had the largest inflow angle. CONCLUSION: The morphological characteristics of PAAs are unique. Compared with other anterior circulation IAs, PAAs have significantly increased ARs, SRs, and inflow angles, which, ultimately, promote their high propensity toward rupture.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Adolescente , Adulto , Idoso , Aneurisma Roto/epidemiologia , Aneurisma Roto/patologia , Artéria Cerebral Anterior/patologia , Corpo Caloso/irrigação sanguínea , Suscetibilidade a Doenças , Feminino , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 29(2): 104504, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761735

RESUMO

BACKGROUND: Accurate assessment of the frequency of large vessel occlusion (LVO) is important to determine needs for neurointerventionists and thrombectomy-capable stroke facilities. Current estimates vary from 13% to 52%, depending on acute ischemic stroke (AIS) definition and methods for AIS and LVO determination. We sought to estimate LVO prevalence among confirmed and suspected AIS patients at 2 comprehensive US stroke centers using a broad occlusion site definition: internal carotid artery (ICA), first and second segments of the middle cerebral artery (MCA M1,M2), the anterior cerebral artery, vertebral artery, basilar artery, or the proximal posterior cerebral artery. METHODS: We analyzed prospectively maintained stroke databases of patients presenting to the centers between January and December 2017. ICD-10 coding was used to determine the number of patients discharged with an AIS diagnosis. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) was reviewed to determine LVO presence and site. Percentages of patients with LVO among the confirmed AIS population were reported. RESULTS: Among 2245 patients with an AIS discharge diagnosis, 418 (18.6%:95% confidence interval [CI] 17.3%-20.0%) had LVO documented on CTA or MRA. Most common occlusion site was M1 (n=139 [33.3%]), followed by M2 (n=114 [27.3%]), ICA (n=69[16.5%]), and tandem ICA-MCA lesions (n=44 [10.5%]). Presentation National Institutes of Health Stroke Scale scores were significantly different for different occlusion sites (P=.02). CONCLUSIONS: The LVO prevalence in our large series of consecutive AIS patients was 18.6% (95% CI 17.3%-20.0%). Despite the use of a broad definition, this estimate is less than that reported in most previous studies.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Infarto da Artéria Cerebral Anterior/epidemiologia , Infarto da Artéria Cerebral Média/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
4.
World Neurosurg ; 133: 21-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526883

RESUMO

BACKGROUND: Giant serpentine aneurysms that occur in the distal anterior cerebral artery are extremely rare and challenging to manage because of their complex structure. In this case, we show an aneurysm resection performed after in situ side-to-side A3-A3 bypass to treat a giant serpentine distal anterior cerebral artery aneurysm. CASE DESCRIPTION: Here, we present the case of a 55-year-old man with a giant distal anterior cerebral artery serpentine aneurysm who presented with severe headache and progressive unconsciousness. Computed tomography and cerebral angiography revealed a giant serpentine aneurysm in the right A2 segment. Both the right pericallosal and callosal marginal arteries branched from the outflow tract. To relieve the mass effect and preserve distal blood flow, an in situ side-to-side A3-A3 anastomosis and a partial aneurysm resection were performed sequentially. Postoperative cerebral angiography revealed no aneurysm blood filling and good perfusion in both anterior cerebral artery territories. CONCLUSIONS: Anterior cerebral artery giant serpentine aneurysms are rare and usually present with headache and mass effect. Aneurysm resection and distal flow protection are issues that we must consider. The sequential procedure of anastomosis and aneurysm resection is a feasible and safe option.


Assuntos
Anastomose Cirúrgica/métodos , Artéria Cerebral Anterior/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Artigo em Russo | MEDLINE | ID: mdl-31577272

RESUMO

Are characterized by Distal giant aneurysms of the anterior cerebral artery are an extremely rare pathology. There are less than 40 cases of this disease described in literature. OBJECTIVE: The aim of the article is to present the clinical observation of a successfully treated giant aneurysm of the pericallosal artery in a 58-year-old man, and also analyze the publications on distal cerebral aneurysms. MATERIAL AND METHODS: The data of a patient hospitalized with a suspected tumor of the left brain hemisphere spreading to the left lateral ventricle is presented. Repeated MRI suggests a giant subtotal thrombotic aneurysm of the left perical artery, which was confirmed by SCT angiography. The patient underwent aneurysm treping-cliping with dissection of the aneurysm sac. In the analysis of the literature it was shown that the frequency of perical artery aneurysms varies from 5.3-6.0%, and giant aneurysms of this localization are extremely rare and occur in 1-4.5% of all perical artery aneurysms. Unlike distal anterior cerebral artery aneurysms of small and medium size, giant aneurysms are characterized by pseudotumorrhagic symptoms, which causes diagnostic difficulties. CONCLUSION: It is necessary to remember about the diagnostic difficulties caused by the pseudotumorrhosis of the giant aneurysms of the pericallosal artery and the frequent negative angiography data due to total thrombosis of the aneurysmal sac. The gold standard is microsurgical clipping with excision of the aneurysmal sac. The prognosis for this group of patients is favorable.


Assuntos
Artéria Cerebral Anterior , Aneurisma Intracraniano , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
6.
Artigo em Russo | MEDLINE | ID: mdl-31577273

RESUMO

The infraoptic anterior cerebral artery (ACA) is an abnormal vessel that usually is a bifurcation of the intradural part of the internal carotid artery (ICA) or near the site of discharge of the ophthalmic artery, which passes under the ipsilateral optic nerve and penetrates between the optic nerves into the prechiasm cistern, reaching the ACA-AcomA complex. The infra-optic ACA is an extremely rare anomaly, but it may be of great clinical significance in surgery of the arteries of the anterior sections of the Willis circle. The article describes the case of a combination of infra-optical ACA with an aneurysm of the ACA-AcomA complex. This observation is of interest both from the viewpoint of the rarity of the considered pathology and the associated increased risk of the formation of intracranial aneurysms.


Assuntos
Artéria Cerebral Anterior , Aneurisma Intracraniano , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Artéria Carótida Interna , Círculo Arterial do Cérebro , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Nervo Óptico/patologia
7.
World Neurosurg ; 132: 399-402, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505294

RESUMO

BACKGROUND: Infundibular dilations (IDs) are funnel-shaped enlargements located at the origin of cerebral arteries. Neuroradiologists and neurosurgeons are familiar with IDs of the posterior communicating artery, which are relatively common. Other locations, being unexpected sites of IDs, can pose diagnostic and therapeutic challenges. CASE DESCRIPTION: In this paper, we describe a case of infundibulum of the accessory anterior cerebral artery, diagnosed with 3-dimensional reconstructions of computed tomography angiography, which is to our knowledge the first report of an ID of this anatomic variant. CONCLUSIONS: Anterior communicating artery represents a rare location for infundibular dilations. Differential diagnosis between them and true aneurysms can be sometimes challenging, especially when associated with anatomic variants; thus neurosurgeons and radiologists must be aware of these pathologic entities.


Assuntos
Artéria Cerebral Anterior/anormalidades , Artéria Cerebral Anterior/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Malformações Arteriovenosas Intracranianas/cirurgia , Angiografia por Ressonância Magnética , Adulto Jovem
8.
World Neurosurg ; 131: e52-e64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31295621

RESUMO

BACKGROUND: Pure arterial malformations (PAMs) are rare intracranial vascular anomalies. As recently reported, PAMs have a benign natural history and can be treated conservatively. However, their etiology, natural history, and treatment have not yet been fully elucidated. METHODS: We present a rare case of the progression of a PAM involving the anterior cerebral artery. Magnetic resonance imaging showed a mass located in the suprasellar region associated with obstructive hydrocephalus. Digital subtraction angiography showed evolution of the arterial anomaly with progression compared with the studies 3 years earlier. Surgical trapping of the parent artery with electrophysiological monitoring was performed. Combined with previous data, the clinical features and therapeutic strategies for this unusual entity are discussed. RESULTS: The patient recovered uneventfully after surgery. Postoperative digital subtraction angiography confirmed complete obliteration of the lesion. Axial computed tomography also showed shrinkage of the aneurysm, with improvement of the hydrocephalus. Our review of the reported data showed only 4 patients with a definite or probable PAM who had undergone surgery. To the best of our knowledge, the present case represents the first report of changes in the vascular architecture of a PAM during the follow-up period. CONCLUSION: Whether the aneurysmal component of PAMs merits invasive treatment has remained controversial. The findings from our case raises the possibility of evolution for some patients with PAMs and stresses the importance of scheduled follow-up noninvasive imaging studies to rule out progression of these nosological entities, especially PAMs with an "aneurysm-like" component.


Assuntos
Artéria Cerebral Anterior/anormalidades , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Adulto , Angiografia Digital , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Progressão da Doença , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imageamento Tridimensional , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Masculino
9.
World Neurosurg ; 130: e513-e524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254698

RESUMO

OBJECTIVE: Vasospasm (VSP)-related ischemic complications have been associated with poor outcomes in patients with subarachnoid hemorrhage due to ruptured blood blister-like aneurysms (BBAs) in the communicating segment of the internal carotid artery (ICA). The purpose of the present study was to investigate the incidence of, and factors related to, VSP-related cerebral infarction (VSP-CI) in patients with surgically treated BBAs in the communicating segment of the ICA. METHODS: The medical records of 25 consecutive patients with surgically treated BBAs in the communicating segment of the ICA were reviewed. The preoperative angiographic findings, surgical methods, and patient outcomes, including VSP-CI, were evaluated. RESULTS: Of the 25 patients, 10 had undergone extracranial-intracranial (EC-IC) bypass with trapping and 15 had undergone clipping surgery. VSP-CI occurred in the ipsilateral hemisphere to the aneurysm in 4 patients with EC-IC bypass with trapping and in 6 patients who had undergone received clipping. Positive balloon test occlusion findings did not affect the occurrence of VSP-CI in the EC-IC bypass and trapping group. The occurrence of VSP-CI was significantly greater in the patients with a dominant anterior cerebral artery ipsilateral to the aneurysm on the preoperative angiogram (P = 0.023), with a hazard ratio of 14.14 (95% confidence interval, 1.57-127.68). CONCLUSIONS: The results of preoperative balloon test occlusion were less reliable for predicting postoperative ischemic complications of EC-IC bypass with trapping in patients with ruptured BBAs in the communicating segment of the ICA. However, anterior cerebral artery dominance ipsilateral to the ruptured aneurysm could be predictive for postoperative VSP-CI.


Assuntos
Aneurisma Roto/cirurgia , Artéria Cerebral Anterior/cirurgia , Isquemia Encefálica/etiologia , Artéria Carótida Interna/cirurgia , Embolização Terapêutica/efeitos adversos , Vasoespasmo Intracraniano/etiologia , Adulto , Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Revascularização Cerebral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vasoespasmo Intracraniano/diagnóstico por imagem
10.
No Shinkei Geka ; 47(5): 565-572, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31105081

RESUMO

We report an extremely rare case of a fenestration in the infracallosal(A2)segment of the right anterior cerebral artery(ACA)associated with an unruptured aneurysm at the proximal end of the fenestrated portion. A 70-year-old man was referred to our hospital for further examination and treatment of unruptured aneurysms at the A1/A2 junction of the right ACA and the distal end of the right vertebral artery that were incidentally detected on MR angiography. CT angiography and 3D-rotational angiography revealed a fenestration in the proximal A2 segment of the right ACA with a small(3.6×3.8mm)aneurysm arising from the proximal end of the fenestration. The dome of the aneurysm projected to the left anterior/inferior direction. He underwent aneurysm neck clipping surgery via the right pterional approach without complications, while the vertebral artery aneurysm was managed conservatively. An extensive review of the literature revealed that only a small number of cases of A2 fenestration have been reported to date. To our knowledge, this is the first report of an A2 fenestration associated with an aneurysm at the fenestrated segment. Embryologically, the A2 fenestration may represent a remnant of plexiform arterial channels that constitute the primitive ACA system including the primitive olfactory artery, median artery of the corpus callosum and anterior communicating plexus.


Assuntos
Artéria Cerebral Anterior , Aneurisma Intracraniano , Idoso , Angiografia , Artéria Cerebral Anterior/diagnóstico por imagem , Artérias , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino
11.
J Neurointerv Surg ; 11(11): 1118-1122, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30975737

RESUMO

BACKGROUND: Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable. METHODS: All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment. RESULTS: We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3). CONCLUSION: Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the 'I technique' is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Prótese Vascular , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
World Neurosurg ; 127: e761-e767, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30951911

RESUMO

BACKGROUND: Proximal anterior cerebral artery (A1) aneurysms are difficult to clip because of their frequent proximity to perforators, location behind the parent artery, or adherence to surrounding structures. METHODS: We retrospectively reviewed a consecutive series of patients with A1 aneurysms and report the clinical status, radiologic findings, treatment methods, and outcome. RESULTS: This series included 19 male and 12 female patients with a mean age of 50 years. The morphology of the A1 aneurysms was fusiform in 2 patients and saccular in the remaining 29 patients. Multiple aneurysms were presented in 9 patients (29.0%). On admission, 26 patients (83.9%) presented with subarachnoid hemorrhage, 3 of whom had an additional intracerebral hematoma. All surgeries were performed with a standard pteriomal craniotomy. The mean Glasgow Outcome Scale score at final follow-up was 4.8 (interquartile range, 5, 5), with 26 patients (83.9%) rated as 5. The mean follow-up time was 38.5 months (range, 12-60 months). CONCLUSIONS: A1 aneurysms are rare but have their own complex characteristics and are difficult to treat. Meticulous analysis of the relevant angiographs is needed for their diagnosis. An important consideration in surgery is the preservation of perforators and prevention of rupture. Wide opening of the sylvian fissure and temporary control of the parent artery can facilitate dissection of the A1 aneurysms dome. Multiple intraoperative monitoring methods, such as microvascular Doppler ultrasonography and somatosensory and motor evoked potential monitoring, can reduce the relevant complications of surgery.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Gerenciamento Clínico , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Eur Radiol ; 29(11): 6309-6318, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30989348

RESUMO

OBJECTIVES: We decided to perform computer-aided analysis of the anterior cerebral artery (ACA) to check for a potential correlation with anterior communicating artery (ACoA) aneurysm presence and growth. METHODS: We retrospectively analyzed the ACA anatomy of 121 patients with ACoA aneurysms along with 121 age, risk factors, and vessel side-matched control patients without an ACoA aneurysm. We obtained their medical history and digital subtraction angiography (DSA) data from their medical records. For each patient's DSA, we extracted curve representing the course of their ACA and calculated its relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS: Patients with ACoA aneurysm had significantly higher RL (0.64 ± 0.23 vs. 0.56 ± 0.22; p < 0.01), SOAM (0.27 ± 0.19 vs. 0.18 ± 0.15; p < 0.01), PAD (0.12 ± 0.13 vs. 0.09 ± 0.11; p = 0.02), and TI (0.57 ± 0.14 vs. 0.44 ± 0.15; p < 0.01). In multivariate logistic regression analysis, after adjustment for possible confounders, SOAM (OR, 1.34; 95% CI, 1.12-1.63; p < 0.01) and TI (OR, 1.84; 95% CI, 1.47-2.35; p < 0.01) remained independently associated with higher risk of ACoA aneurysm. Additionally, we found significant negative correlations between TI and aneurysm dome size (R = - 0.194; p = 0.047). CONCLUSIONS: Increased tortuosity of ACA might increase the risk of ACoA aneurysm development and decrease the risk of aneurysm growth. KEY POINTS: • Anterior cerebral artery's sum of angle metrics is associated with hypertension as well as with history of ischemic stroke and myocardial infarction. • Increased tortuosity of anterior cerebral artery might be associated with anterior communicating artery aneurysm development. • Tortuosity of anterior cerebral artery is negatively correlated with anterior communicating artery aneurysm dome size.


Assuntos
Artéria Cerebral Anterior/anatomia & histologia , Aneurisma Intracraniano/patologia , Adulto , Idoso , Algoritmos , Angiografia Digital/métodos , Artéria Cerebral Anterior/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia Cerebral/métodos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
14.
J Neurointerv Surg ; 11(7): 723-727, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30852525

RESUMO

PURPOSE: The aim of our study was to assess the technical success and the safety of this new low-profile flow diverter Silk Vista Baby (SVB) by evaluating the intraprocedural and periprocedural complication rate. MATERIAL/METHODS: Clinical, procedural, and angiographic data were analyzed. RESULTS: 41 consecutive patients (28 women; age average 50.5 years) with 43 aneurysms were treated with SVB. Aneurysm sizes were classified by their maximum diameter, with an average size of 9.5 mm (range 2-30 mm). Thirty-four cases were unruptured. five aneurysms previously ruptured, had recurrence after the initial coiling. There were two ruptured cases. Aneurysms' locations were: M1 segment (five cases), M2 segment (three cases), M3 segment (one case), middle cerebral artery (MCA) bifurcation (six cases), carotid-T (two cases), anterior communicating artery/A1/A2 (11 cases), pericallosal artery (four cases), supraclinoid ICA (two cases), PCom (one case), V4 segment (three cases), PCA (three cases), SCA (one case), and PICA (one case). We had five intraprocedural complications which resolved without clinical consequences and three events postprocedural events. Initial occlusion rates were: eight aneurysms (18.6%) were completely occluded, five aneurysms (11.6%) showed near-complete occlusion, four cases (9.3%) showed incomplete filling, and 26 cases (60.4%) showed persisting filling. The mRS score at discharge from the hospital did not change from the admission mRS score. CONCLUSION: Our study demonstrated that the use of the new low-profile flow diverter, SVB device, for the treatment of intracranial aneurysms is feasible and technically safe.


Assuntos
Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Assistência Perioperatória/tendências , Stents Metálicos Autoexpansíveis/tendências , Adulto , Idoso , Angiografia/métodos , Angiografia/tendências , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/cirurgia , Assistência Perioperatória/métodos , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
15.
World Neurosurg ; 126: 537-540, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30844531

RESUMO

BACKGROUND: This report discusses the risks and complications of using the extended endoscopic endonasal transsphenoidal approach (EEETA) in a special craniopharyngioma case to caution neurosurgeons. CASE DESCRIPTION: A 38-year-old woman with craniopharyngioma underwent EEETA surgery. Her anterior cerebral artery was punctured intraoperatively and clipped using an aneurysm clip through the nose in an emergency procedure. CONCLUSIONS: The coexistence of severe calcified craniopharyngiomas, especially with sharp calcified spurs, a narrow distance between the anterior communicating artery and the planum sphenoidale, and a narrow distance between the bilateral internal carotid arteries is a significant warning signal during EEETA for craniopharyngiomas. In this circumstance, it may be preferable to use open microsurgical approaches. If the anterior communicating artery or anterior cerebral artery is punctured during EEETA, another method is available to fix the problem using an aneurysm clip through the nose, and not only endovascular embolization.


Assuntos
Artéria Cerebral Anterior/lesões , Calcinose/cirurgia , Craniofaringioma/cirurgia , Complicações Intraoperatórias/etiologia , Neuroendoscopia/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Ruptura/etiologia , Adulto , Artéria Cerebral Anterior/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/patologia , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/patologia , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Imagem por Ressonância Magnética , Cavidade Nasal , Neuroendoscopia/métodos , Neuroimagem , Neuronavegação , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Seio Esfenoidal , Tomografia Computadorizada por Raios X
17.
Interv Neuroradiol ; 25(4): 364-370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30803332

RESUMO

BACKGROUND: Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality. METHODS: We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016. We assessed the leptomeningeal circulation by the Tan, Miteff and Maas validated scoring systems on pre-treatment computed tomographic angiography scans and looked at collateral flow through anterior and posterior communicating arteries. The results were good functional outcomes at 3 months (modified Rankin scale 0-2) and mortality. RESULTS: A total of 147 consecutive acute stroke patients treated with the Embotrap device were included with a median National Institutes of Health stroke scale of 15 (range 2-26). On multivariate analysis only younger age (odds ratio (OR) 0.96/year, 95% confidence interval (CI) 0.94-0.99, P = 0.026), lower National Institutes of Health stroke scale score (OR 0.87/point, 95% CI 0.80-0.93, P < 0.001), number of attempts (OR 0.80/attempt, 95% CI 0.65-0.99, P = 0.043) and the presence of a patent anterior communicating artery (OR 14.03, 95% CI 1.42-139.07, P = 0.024) were associated with good functional outcomes. The number of attempts (OR 1.66/attempt, 95% CI 1.21-2.29, P = 0.002) was significantly associated with mortality and the presence of a patent posterior communicating artery (OR 0.098, 95% CI 0.016-0.59, P = 0.011) was inversely associated with mortality. CONCLUSIONS: Our study shows that the presence of anterior and posterior communicating arteries is significantly associated with good functional outcomes and reduced mortality, respectively, independent of the leptomeningeal circulation status.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Circulação Colateral , Angiografia por Tomografia Computadorizada , Meninges/irrigação sanguínea , Meninges/diagnóstico por imagem , Artéria Cerebral Posterior/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Prospectivos , Acidente Vascular Cerebral/mortalidade , Resultado do Tratamento
18.
J Neurointerv Surg ; 11(8): 790-795, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30655359

RESUMO

BACKGROUND: Recanalization rates after coil embolization are known to be higher in cerebral aneurysms of the posterior (vs anterior) circulation. Although often grouped with anterior lesions, aneurysms of the posterior communicating artery (PcoA) may nevertheless behave differently. OBJECTIVE: We performed a comparative analysis to explore differences in recanalization rates of PcoA and anterior communicating artery (AcoA) aneurysms, both integral to the circle of Willis. METHODS: Between October 2012 and July 2017, 699 AcoA (n=427) and PcoA (n=272) aneurysms were treated by endovascular coil embolization, monitoring 667 (95.4%) via radiologic imaging for ≥ 6 months. Cumulative recordings of medical and imaging data were retrospectively reviewed, conducting propensity score matching and binary logistic regression analysis. RESULTS: In the 667 aneurysms followed longer term, recanalization occurred in 111 (16.6%; minor 72; major 39) and was significantly more frequent in PcoA (25.5%) than in AcoA (11.0%; P<0.01) aneurysms during similar follow-up periods. After 1:1 propensity score matching, an even greater proclivity for recanalization was evident at PcoA sites (PcoA 23.0%; AcoA 12.2%; P<0.01). Although A1 segment dominance was linked to recanalization in AcoA aneurysms (18.2% vs 7.6%; P=0.01), the PcoA counterpart had no bearing on recanalization (27.7% vs 24.1%; P=0.51). CONCLUSIONS: Despite a clear preponderance of AcoA aneurysms, recanalization of PcoA aneurysms proved significantly greater, attesting to posterior circulation behavior.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Embolização Terapêutica/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Artéria Cerebral Posterior/diagnóstico por imagem , Adulto , Idoso , Prótese Vascular , Angiografia Cerebral/métodos , Círculo Arterial do Cérebro/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
World Neurosurg ; 121: e379-e388, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30266713

RESUMO

OBJECTIVE: To investigate hemodynamic stresses on anterior cerebral artery bifurcation apex and possible mechanism of the optimality principle in protecting bifurcation wall from supercharged hemodynamic stresses. METHODS: Three-dimensional angiographic datasets of 122 patients with anterior communicating artery (Acom) aneurysms, 21 patients with non-Acom aneurysms, and 220 control subjects with no aneurysms were used. Radii of parent (r0) and daughter branches (r1 and r2) were measured, and bifurcations obeying the optimality principle required optimal caliber control of r0n = r1n + r2n, with the junction exponent n approximating 3. Radius ratio = r03/(r13 + r23) and n were compared between aneurysmal and control bifurcations. Blood flow was simulated for analysis of hemodynamic stresses. RESULTS: Acom bifurcations in subjects without Acom aneurysms displayed optimal caliber radius, with mean radius ratio of 0.99 and n of 3.25, whereas Acom aneurysmal bifurcations had significantly lower radius ratio, 0.62 (P < 0.05), but higher n, 4.23 (P < 0.05). Peak wall shear stress and corresponding total pressure were significantly smaller for bifurcations obeying than disobeying the optimality principle (P < 0.001 and P < 0.05, respectively). Total pressures in the direct impinging center, peak wall shear stress distance, and anterior cerebral artery bifurcation angle all were significantly smaller for bifurcations obeying than disobeying the optimality principle (P < 0.05 and P < 0.001, respectively). CONCLUSIONS: Normal anterior cerebral artery bifurcations obey the optimality principle whereas bifurcations with Acom aneurysms do not. Disobeying the optimality principle presents significantly enhanced hemodynamic stresses to possibly damage the bifurcation wall for aneurysm initiation.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Hemodinâmica/fisiologia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Artéria Cerebral Média/fisiopatologia , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Hidrodinâmica , Imageamento Tridimensional , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Estatísticas não Paramétricas , Estresse Mecânico , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia
20.
World Neurosurg ; 123: 86-88, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30537546

RESUMO

BACKGROUND: Endovascular therapy has been increasingly recommended for the treatment of acute ischemic stroke with large vessel occlusion of the anterior circulation. However, occlusions of the distal cerebral artery are not uncommon and may cause clinical deficits, especially when combined with ipsilateral chronic large vessel occlusion. Therefore in this patient population, the recognition of chronic occlusion and recanalization of the distal occlusive artery might be of great value for flow compensation. CASE DESCRIPTION: A 59-year-old male with a history of stroke was transferred to the emergency department with a severe right hemiplegia and aphasia syndrome. Head computed tomography demonstrated an old infarction focus of the left basal ganglia, and digital subtraction angiography revealed an occlusion of the left middle cerebral artery (MCA). After careful attempts, the microguidewire could not pass through the left MCA. On consideration of the patient's previous stroke history and the angiographic neovascularization, the left MCA was recognized as a chronic occlusion and its territory was supposed to be partly compensated by the ipsilateral anterior cerebral artery (ACA). A super-selective angiography of the left ACA demonstrated an occlusion of the callosomarginal artery. After a mechanical thrombectomy with a stent retriever, an angiogram showed complete recanalization and good antegrade reperfusion of the ACA supplying the partial MCA territory. The patient had a positive prognosis. CONCLUSIONS: The recognition of chronic occlusion is crucial during acute mechanical thrombectomy, and distal thrombectomy may be beneficial after a careful full-scale assessment.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Angiografia Digital , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Isquemia Encefálica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/patologia , Acidente Vascular Cerebral/diagnóstico por imagem
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