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1.
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
2.
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
3.
J Stroke Cerebrovasc Dis ; 29(4): 104590, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31883780

RESUMO

Bihemispheric ischemic strokes secondary to unilateral vessel disease are uncommon. We present the case of a 70-year-old man with multiple acute/subacute bilateral infarcts. The patient was found to have stenosis of the left internal carotid artery secondary to herpes zoster ophthalmicus vasculopathy, with involvement of the left proximal middle and anterior cerebral arteries. Angiographic studies also revealed A1 segment aplasia of the right anterior cerebral artery (ACA), thus indicating dependence on the left-sided circulation for perfusion of the bilateral ACA vascular territory. This case illustrates how A1 segment aplasia, an anatomic variant of the circle of Willis detected by angiographic studies, can contribute to bilateral infarction in the ACA vascular territory.


Assuntos
Artéria Cerebral Anterior/anormalidades , Artéria Carótida Interna , Estenose das Carótidas/complicações , Cérebro/irrigação sanguínea , Círculo Arterial do Cérebro/anormalidades , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Média/etiologia , Artéria Cerebral Média , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Círculo Arterial do Cérebro/diagnóstico por imagem , Círculo Arterial do Cérebro/fisiopatologia , 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 , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia
4.
J Neuroradiol ; 46(5): 319-326, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254561

RESUMO

PURPOSE: To determine the impact of vessel variation and anatomical features on technical and clinical success. MATERIALS AND METHODS: In vitro blood clots (n=100) were introduced into a silicon carotid-T flow model of 2, 3 or 4mm. The ICA/M1angle varied at 45°, 90°, 135° and 180°. Peripheral embolism was measured. In vivo 50 pat. (73.5 yrs.,±15) with MCA occlusion were examined for siphon variation, ICA morphology, vessel diameter and angles. The patients were divided according to the clinical success (mRS): group A: mRS≤2 after 90 day and group B: mRS≥3. Furthermore the technical success (TICI) and number of retrieval (n) were analysed. RESULTS: In vitro with larger vessel diameter the migrated thrombus load decreased (P=.001). The steeper the M1/ICA angles, the higher thrombus weighs (180°: 2.94mg; 135°: 6.32mg; 90°: 8.65mg, 45°: 10.69mg; P<.001). In vivo patients with mRS≤2 had significantly lower NIHSS (16.5 vs 20, P=.009) and higher ASPECTS (9 vs 6, P<.05). TICI≥2b was more often achieved (86.6 vs 40% P=.002). The procedure time was lower (45 vs. 80min, P<.05) with smaller number of retrieval (1.5 vs 4, P<05). Proximal ICA stenosis offers a trend to unfavourable outcome (P=.073). Siphon variation "D" is associated with less retrieval manoeuvre. CONCLUSION: While in vitro there is a close correlation between embolism and vascular anatomy, in vivo carotid artery stenosis and siphon variation influence clinical and technical success.


Assuntos
Artéria Cerebral Anterior/patologia , Artéria Carótida Interna/patologia , Infarto da Artéria Cerebral Média/terapia , Trombólise Mecânica/métodos , Artéria Cerebral Média/patologia , Idoso , Artéria Cerebral Anterior/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/patologia , Estenose das Carótidas/terapia , Feminino , Humanos , Infarto da Artéria Cerebral Média/patologia , Masculino , Artéria Cerebral Média/fisiopatologia , Modelos Biológicos , Trombose , Resultado do Tratamento
5.
World Neurosurg ; 128: e688-e693, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075493

RESUMO

BACKGROUND: The Pipeline embolization device (PED) is commonly used for the treatment of distal internal carotid artery (ICA) aneurysms, which often require placing the stent across the origin of the precommunicating segment of the anterior cerebral artery (ACA-A1). We sought to characterize the clinical and angiographic consequences of this maneuver. METHODS: We performed a retrospective review of a prospectively collected database of patients treated with the PED at a single academic center from 2011 to 2017 to find patients for whom the PED was extended across the origin of the ACA-A1. The patient demographic data, pretreatment angiographic imaging findings, sizing of the bilateral A1 and ipsilateral M1 segment of the middle cerebral artery (MCA-M1), and follow-up angiographic and clinical imaging findings were recorded. RESULTS: A total of 27 patients were included in the present study (8 men and 19 women; age, 52 ± 14.9 years). Follow-up angiography was conducted at a median of 9.2 months (interquartile range, 6; range, 5-84). The covered A1 segment was patent in 17 patients (63%). The covered ACA-A1/ipsilateral MCA-M1 ratio was 1.43 times greater for the patent ACA-A1 segments than those that were occluded (P = 0.0006). Similarly, the covered ACA-A1/contralateral ACA-A1 ratio was significantly larger statistically (1.64; P < 0.0001) for the patent ACA-A1 segments than that for those that were occluded. None of the patients developed clinical or radiographic signs of ACA stroke. The modified Rankin scale worsened for 1 patient during follow-up owing to a further decline of presenting vision loss. CONCLUSIONS: The PED can be used to treat aneurysms with deployment from the MCA-M1 to the ICA without resulting in ACA stroke. Ipsilateral A1 segment dominance might be predictive of continued blood flow into the ACA after deployment at this location.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Artéria Cerebral Anterior/cirurgia , Prótese Vascular , Artéria Carótida Interna/cirurgia , Circulação Cerebrovascular , Embolização Terapêutica , Adulto , Idoso , Implante de Prótese Vascular , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Eur Radiol ; 29(2): 689-698, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30019140

RESUMO

OBJECTIVES: The study aimed to determine which hemodynamic parameters independently characterize anterior communicating artery (AcomA) aneurysm formation and explore the threshold of wall shear stress (WSS) of the parent artery to better illustrate the correlation between the magnitude of WSS and AcomA aneurysm formation. METHODS: Eighty-one patients with AcomA aneurysms and 118 patients without intracranial aneurysms (control population), as confirmed by digital subtraction angiography (DSA) from January 2014 to May 2017, were included in this cross-sectional study. Three-dimensional-DSA was performed to evaluate the morphologic characteristics of AcomA aneurysms. Local hemodynamic parameters were obtained using transcranial color-coded duplex (TCCD). Multivariate logistic regression and a two-piecewise linear regression model were used to determine which hemodynamic parameters are independent predictors of AcomA aneurysm formation and identify the threshold effect of WSS of the parent artery with respect to AcomA aneurysm formation. RESULTS: Univariate analyses showed that the WSS (p < 0.0001), angle between the A1 and A2 segments of the anterior cerebral artery (ACA) (p < 0.001), hypertension (grade II) (p = 0.007), fasting blood glucose (FBG; > 6.0 mmol/L) (p = 0.005), and dominant A1 (p < 0.001) were the significant parameters. Multivariate analyses showed a significant association between WSS of the parent artery and AcomA aneurysm formation (p = 0.0001). WSS of the parent artery (7.8-12.3 dyne/cm2) had a significant association between WSS and aneurysm formation (HR 2.0, 95% CI 1.3-2.8, p < 0.001). CONCLUSIONS: WSS ranging between 7.8 and 12.3 dyne/cm2 independently characterizes AcomA aneurysm formation. With each additional unit of WSS, there was a one-fold increase in the risk of AcomA aneurysm formation. KEY POINTS: • Multivariate analyses and a two-piecewise linear regression model were used to evaluate the risk factors for AcomA aneurysm formation and the threshold effect of WSS on AcomA aneurysm formation. • WSS ranging between 7.8 and 12.3 dyne/cm 2 was shown to be a reliable hemodynamic parameter in the formation of AcomA aneurysms. The probability of AcomA aneurysm formation increased one-fold for each additional unit of WSS. • An ultrasound-based TCCD technique is a simple and accessible noninvasive method for detecting WSS in vivo; thus, it can be applied as a screening tool for evaluating the probability of aneurysm formation in primary care facilities and community hospitals because of the relatively low resource intensity.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Adulto , Idoso , Angiografia Digital , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Estudos de Casos e Controles , Angiografia Cerebral/métodos , Circulação Cerebrovascular/fisiologia , Estudos Transversais , Feminino , Hemodinâmica/fisiologia , Humanos , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estresse Mecânico , Ultrassonografia Doppler Transcraniana/métodos
7.
J Stroke Cerebrovasc Dis ; 28(2): 392-398, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30409746

RESUMO

BACKGROUND: There are a variety of collateral routes to compensate persistent cerebral ischemia in moyamoya disease. However, there is no report presenting the persistent primitive olfactory artery (POA) as a spontaneous collateral route to the anterior cerebral artery (ACA) in moyamoya disease. METHODS: We precisely examined cerebral angiography in 84 patients with moyamoya disease to identify the collateral channel through the persistent POA. Its anatomy was evaluated on pre- and postoperative angiography. RESULTS: Of 84 patients, four (4.8%) had spontaneous collateral channel through the persistent POA. All of these four hemispheres were categorized into Stage 5. In all four patients, the collateral blood flow arose from the ophthalmic artery and run to the persistent POA through the ethmoidal moyamoya. The persistent POA provided collateral blood flow from the ophthalmic artery to the ACA in all four patients. Superficial temporal artery to middle cerebral artery anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis was performed in three of four patients. After surgery, the collateral channel through the persistent POA completely disappeared or markedly regressed, suggesting a significant improvement of cerebral hemodynamics in the territory of not only the MCA but also the ACA. CONCLUSION: The persistent POA can potentially provide collateral blood flow to the ACA in about 5% of patients with moyamoya disease, and should be recognized as a novel collateral channel in moyamoya disease. The persistent POA may be useful to evaluate therapeutic effects of surgical revascularization on the ACA territory.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Doença de Moyamoya/fisiopatologia , Adolescente , Adulto , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia Cerebral , Artérias Cerebrais/anormalidades , Artérias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Masculino , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia , Imagem de Perfusão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
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
9.
World Neurosurg ; 120: e783-e791, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30176397

RESUMO

OBJECTIVE: To investigate the relationship of anterior cerebral artery (ACA) bifurcation angles with hemodynamic stresses for aneurysm initiation. METHODS: Forty patients with or without anterior communicating artery aneurysms were enrolled, and 3 patients with ACA bifurcation angles of 169.0°, 136.9°, and 73.2°, respectively, were entered into computational fluid dynamics analysis for hemodynamic stresses. RESULTS: Larger bifurcation angles had a larger direct flow impinging zone and larger peak pressure area. In the direct flow impinging center, the total pressure was the highest, whereas the other stresses were the lowest. As blood flowed distally, the total pressure decreased rapidly, whereas all other parameters increased quickly to their peaks. The hemodynamic peak distance was decreased as the bifurcation angle became narrower. The total pressure summit and the peak hemodynamic stresses all decreased with the decrease of bifurcation angles. The distance between the hemodynamic peaks was the smallest at 73.2° compared with larger angles. A significant (P < 0.01) positive linear correlation existed in the ACA bifurcation angle with the distance between hemodynamic stress peaks or in the ACA branch diameter with the distance from the direct impinging center to the ipsilateral hemodynamic stress peak. The hemodynamic stresses on the aneurysm dome were significantly (P < 0.001) smaller than at the aneurysm initiation site. CONCLUSIONS: Larger bifurcation angles may lead to abnormally enhanced hemodynamic stresses, enlarged zones of direct flow impingement, and increased distance between hemodynamic stress peaks to damage the vascular wall for aneurysm initiation on the bifurcation apex wall.


Assuntos
Artéria Cerebral Anterior/patologia , Artéria Cerebral Anterior/fisiopatologia , Hemodinâmica , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/fisiopatologia , Estresse Fisiológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral , Simulação por Computador , Suscetibilidade a Doenças , Feminino , Humanos , Hidrodinâmica , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Modelos Neurológicos
10.
Artigo em Russo | MEDLINE | ID: mdl-30137043

RESUMO

Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.


Assuntos
Aneurisma/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Aneurisma/fisiopatologia , Aneurisma/cirurgia , Artéria Cerebral Anterior/fisiopatologia , Artéria Cerebral Anterior/cirurgia , Angiografia Cerebral , Feminino , Humanos , Consciência no Peroperatório , Imagem por Ressonância Magnética , Monitorização Intraoperatória , Resultado do Tratamento , Adulto Jovem
11.
J Neurosurg ; 130(3): 917-922, 2018 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-29726778

RESUMO

OBJECTIVE: The pathogenesis of cerebral aneurysms in patients with internal carotid artery (ICA) occlusion is hypothesized to be hemodynamic. For the first time, the authors quantify the hemodynamic characteristics associated with aneurysm formation in patients with ICA occlusion. METHODS: Records of patients with unilateral ICA stenosis or occlusion ≥ 90% who underwent hemodynamic assessment before treatment using quantitative MR angiography were retrospectively reviewed. The patients were classified into 2 groups based on the presence or absence of aneurysms. The hemodynamic parameters of flow volume rate, flow velocity, and wall shear stress (WSS) were measured in each vessel supplying collateral flow-bilateral A1 segments and bilateral posterior communicating arteries-and then compared between the groups. RESULTS: A total of 36 patients were included (8 with and 28 without aneurysms). The mean flow (72.3 vs 48.9 ml/min, p = 0.10), flow velocity (21.1 vs 12.7 cm/sec, p = 0.006), and WSS (22.0 vs 12.3 dynes/cm2, p = 0.003) were higher in the A1 segment contralateral to the side of the patent ICA in patients with versus without aneurysms. All de novo or growing aneurysms in our cohort were located on the anterior communicating artery (ACoA) or P1 segment. CONCLUSIONS: Flow velocity and WSS are significantly higher across the ACoA in patients who harbor an aneurysm, and de novo or growing aneurysms are often located on collateral vessels. Thus, robust primary collaterals after ICA occlusion may be a contributing factor in cerebral aneurysm formation.


Assuntos
Estenose das Carótidas/complicações , Hemodinâmica , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/fisiopatologia , Adulto , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estenose das Carótidas/diagnóstico por imagem , Circulação Colateral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estresse Fisiológico , Ultrassonografia Doppler Transcraniana
13.
Sci Rep ; 8(1): 4544, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-29540791

RESUMO

To observe Doppler changes in the three main cerebral arteries in fetuses with congenital heart defects (CHDs). The pulsatility index (PI) values of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were prospectively compared in 78 CHD fetuses and 78 normal control fetuses. Correlations between the cerebral artery PIs and the neurodevelopment scores (psychomotor development index [PDI] and mental development index [MDI]) were assessed. The MCA-PI was decreased significantly in fetuses with hypoplastic left heart syndrome (HLHS). The ACA-PI was reduced significantly in fetuses with HLHS, fetuses with left-sided obstructive lesions (LSOLs) and fetuses with transposition of the great arteries. The PCA-PI was significantly smaller in fetuses with HLHS and fetuses with LSOLs. More fetuses presented signs of cerebral vasodilatation of the ACA than the MCA for certain types of CHD (P < 0.05). The ACA-PI was positively correlated with the PDI and MDI scores in fetuses with CHDs (r2 = 0.26, 0.20, P < 0.01). The MCA-PI was only positively correlated with the PDI scores (r2 = 0.15, P < 0.01). The ACA exhibited signs of vasodilatation more frequently and severely than the MCA. The ACA-PI appears to be more sensitive for predicting abnormal neurodevelopmental outcomes than the MCA-PI.


Assuntos
Artérias Cerebrais/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Artérias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Idade Materna , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/fisiopatologia , Gravidez , Estudos Prospectivos , Fluxo Pulsátil , Vasodilatação , Adulto Jovem
14.
Int J Med Sci ; 15(4): 368-375, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29511372

RESUMO

The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Malformações Arteriovenosas/fisiopatologia , Infarto Cerebral/fisiopatologia , Doença de Moyamoya/fisiopatologia , Malformações Arteriovenosas/complicações , Encéfalo/irrigação sanguínea , Encéfalo/fisiopatologia , Humanos , Doença de Moyamoya/complicações , PubMed
15.
Stroke ; 48(12): 3274-3281, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29089458

RESUMO

BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8). METHODS: Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. RESULTS: Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. CONCLUSIONS: Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Arteriopatias Oclusivas/complicações , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/fisiopatologia , Isquemia Encefálica/cirurgia , Estudos de Coortes , Determinação de Ponto Final , Feminino , Fibrinolíticos/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 26(11): 2638-2644, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28797616

RESUMO

BACKGROUND: Intracranial atherosclerosis of the anterior circulation (anterior ICAS) and intracranial atherosclerosis of the posterior circulation (posterior ICAS) are thought to involve different pathogeneses and risk factors. Recently, we identified a genetic variant that has a significant association with ICAS. The variant was ring finger protein 213 (RNF213) c.14576G>A (rs112735431), which was originally identified as a susceptibility genetic variant for moyamoya disease (MMD). The present study investigated the association of RNF213 c.14576G>A with anterior and posterior ICAS. MATERIALS AND METHODS: A total of 221 study participants (43 with anterior ICAS, 61 with posterior ICAS, 12 with extracranial carotid atherosclerosis [ECAS], 5 with MMD, and 100 control subjects) were recruited from April 2015 to October 2015. A genetic analysis of RNF213 c.14576G>A and an association study with these cerebrovascular diseases were performed. RESULTS: RNF213 c.14576G>A was present in 10 of 43 patients in the anterior ICAS group and 4 of 5 patients in the MMD group, but was not present in the patients in the posterior ICAS and ECAS groups. c.14576G>A was found in 2 of 100 patients in the control group. RNF213 c.14576G>A showed a significant association with anterior ICAS (allele count: P = 3.9 × 10-5, odds ratio [OR] = 13.0, 95% confidence interval [CI] = 2.8-60.8; prevalence of carriers of c.14576G>A: P = 2.6 × 10-5, OR = 14.8, 95% CI = 3.1-71.3). However, RNF213 c.14576G>A showed no association with posterior ICAS. RNF213 c.14576G>A also had a significant association with MMD and had no association with ECAS. CONCLUSIONS: The genetic variant RNF213 c.14576G>A is significantly associated with anterior ICAS but not with posterior ICAS. The present findings may indicate factors involved in the pathogenesis of ICAS-related stroke.


Assuntos
Adenosina Trifosfatases/genética , Predisposição Genética para Doença/genética , Arteriosclerose Intracraniana/genética , Arteriosclerose Intracraniana/fisiopatologia , Polimorfismo de Nucleotídeo Único/genética , Ubiquitina-Proteína Ligases/genética , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/fisiopatologia , Estudos de Casos e Controles , Feminino , Frequência do Gene , Testes Genéticos , Genótipo , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/fisiopatologia
18.
J Clin Neurosci ; 45: 205-208, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28736114

RESUMO

Anterior cerebral artery (ACA) flow diversion (FD), defined as ipsilateral mean velocity (MV) of at least 30% greater than the contralateral artery, could be seen an indirect sign of leptomeningeal collateralization in the setting of middle cerebral artery occlusion. The purpose of the study was to evaluate the association between dynamic FD and functional outcome in acute anterior stroke patients with large artery occlusion. Acute middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive stroke patients within 12h were recruited. Transcranial Doppler ultrasound was done at baseline, 24h and 7d after onset and velocities of MCA and ACA were recorded. FD ratio was calculated by dividing the ipsilateral ACA MV by the contralateral ACA MV. FD was determined positive when FD ratio ≥1.3. Outcome was assessed by 90-day modified Rankin's Scale (mRS). The association between FD at different time points and functional outcome were analyzed. 16 patients (median age of 67 and 75% were male) were recruited. FD ratio showed a trend of decline but did not reach statistical significance (p=0.056). The proportion of FD at baseline (p=0.026), 24h (p=0.001) and 7d (p=0.044) was significantly higher in patients with favorable outcome. Higher FD ratio at baseline (p=0.02) and 24h (p=0.003) were significantly associated with favorable outcome. These results suggested that FD ratio showed a trend of decline after stroke onset. Presence of FD within 7days was associated with favorable functional outcome in acute MCA/ICA occlusive stroke patients.


Assuntos
Artéria Cerebral Anterior/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Cerebrovascular/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Artéria Carótida Interna/fisiopatologia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Fatores de Tempo , Ultrassonografia Doppler Transcraniana
19.
J Neurol Sci ; 376: 143-150, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28431602

RESUMO

PURPOSE: To evaluate the relationship between anterior cerebral artery (ACA) velocities (and ancillary parameters) and ACA infarction following aneurysmal subarachnoid hemorrhage (aSAH), and to examine the factors that influence velocities. METHODS: Retrospective investigation of 500 consecutive aSAH patients. ACA mean velocities (Vm) were evaluated by daily transcranial ultrasound during the early (days 1-4) and late (days 5-20) periods posthemorrhage. Presence and timing of acute ACA infarctions were identified by serial retrospective review of cerebral computerized tomography (CT) scans. Predictors of ACA velocities were identified and compared to predictors of vasospasm and infarction from the literature. RESULTS: Decreased velocities on the day of infarction were observed in infarct-positive vessels when compared to infarct-negative vessels. ACA velocity increases, ipsilateral/contralateral ACA velocity ratios, and ACA velocity ranges, were inaccurate in anticipating infarction. Decreased ACA index velocities were moderately accurate in anticipating ACA infarction during the early [Vm<60cms/s], late [Vm<70cms/s] and overall [Vm<70cms/s] time periods. Decreased index velocities also independently predicted infarction during all time periods. ACA velocities were most consistently predicted by age, race, hemorrhage quantity on CT, and ACA/ACom (anterior communicating artery) aneurysm location. CONCLUSIONS: ACA velocity increases and ancillary parameters do not relate to the development of infarction, whereas velocity decreases are moderately accurate in anticipating infarction. Predictors of velocity increases generally coincide with those of vasospasm, whereas predictors of velocity decreases coincide more with those of infarction following aSAH.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Área Sob a Curva , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Cerebrovascular/fisiologia , Progressão da Doença , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Anterior/fisiopatologia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana
20.
J Int Med Res ; 45(2): 723-732, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28173711

RESUMO

Objective To examine patency of the cerebral anterior and posterior communicating arteries in patients with ischaemic stroke with or without diabetes mellitus. Methods This retrospective study included patients with acute ischaemic stroke treated between July 2011 and May 2016. Cerebral infarction was evaluated by magnetic resonance imaging. Anterior and posterior communicating-artery patency was determined using magnetic resonance angiography. Vessels were defined as patent or occluded. Results Out of 1 406 patients, incidence of vertebral basilar artery brain infarction and posterior cerebral artery brain infarction were significantly higher in patients with diabetes versus those without diabetes (35.5% versus 22.3% and 11.7% versus 6.8%, respectively). Among patients with posterior cerebral artery brain infarction, anterior and posterior communicating-artery patency rates were higher in patients with diabetes versus those without diabetes (66.7 versus 23.5% and 33.3% versus 5.9% [bilateral], respectively). Among patients with vertebral basilar artery infarction and posterior cerebral artery P1 segment infarction, patency rate of the anterior communicating artery was higher in patients with diabetes versus those without diabetes (55.7% versus 45.9%). Conclusion Among patients with ischaemic stroke, patency rate of the circle of Willis may be higher in patients with diabetes than those without diabetes.


Assuntos
Infarto Cerebral/fisiopatologia , Círculo Arterial do Cérebro/fisiopatologia , Diabetes Mellitus/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Artéria Cerebral Anterior/fisiopatologia , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/patologia , Circulação Cerebrovascular , Círculo Arterial do Cérebro/diagnóstico por imagem , Círculo Arterial do Cérebro/patologia , Complicações do Diabetes , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/patologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/patologia , Artéria Cerebral Posterior/fisiopatologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia
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