Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.311
Filtrar
1.
Medicine (Baltimore) ; 100(9): e25043, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655982

RESUMO

RATIONALE: Anatomical variations in aortic arch (AA) branching are not unusual. Generally, these variations are asymptomatic and are diagnosed incidentally. Here, we report a rare case of a middle-aged female patient with an aberrant right subclavian artery (ARSA) associated with anomalous origins of the bilateral vertebral arteries (VAs). PATIENT CONCERNS: The patient treated for urolithiasis complained of repeated dizziness for several years. DIAGNOSES: Echocardiography and computed tomography angiography (CTA) confirmed arterial variations. Moreover, mild stenosis was found in the left common carotid artery (LCCA), which was considered to be the cause of dizziness. INTERVENTIONS: Congenital anomalous arteries were not necessary to intervene urgently, but aspirin and atorvastatin were administered to prevent potential thrombosis attributed to vascular stenosis after completing the operation for urolithiasis. OUTCOMES: Whether the symptoms will be alleviated or not should be continuously followed up, and the patient may accept interventional therapy in the future if necessary. LESSONS: Here, we report the rare variation of AA branches and highlight the importance of preoperative vascular assessment in surgical or interventional procedures for the affected body regions.


Assuntos
Anormalidades Múltiplas , Anormalidades Cardiovasculares/diagnóstico , Artéria Subclávia/anormalidades , Malformações Vasculares/diagnóstico , Artéria Vertebral/anormalidades , Adulto , Angiografia por Tomografia Computadorizada , Ecocardiografia , Feminino , Humanos , Artéria Vertebral/diagnóstico por imagem
2.
J Med Case Rep ; 15(1): 111, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653404

RESUMO

BACKGROUND: Most sudden-onset hearing loss is due to otolaryngologic- and very rarely to cerebrovascular disease. We report a woman with sudden bilateral sensorineural hearing loss. This case suggests that even in the absence of brainstem or cerebellar signs, magnetic resonance imaging (MRI) and MR angiography (MRA) should be performed since such studies may reveal signs of life-threatening vertebrobasilar artery occlusion. CASE PRESENTATION: A 73-year-old Japanese woman with a history of hypertension, hyperlipidemia, and atrial fibrillation who suffered bilateral deafness with vertigo and vomiting was transferred from a local hospital to our department. On admission her consciousness was clear and vertigo was absent. Neurological examination revealed only bilateral sensorineural hearing loss. Head computed tomography (CT) returned no significant findings. The next morning she gradually developed severe drowsiness. Diffusion-weighted MRI demonstrated acute cerebral infarction in the brainstem and bilateral cerebellum; MRA showed basilar artery occlusion due to a cardioembolic thrombus. Revascularization was obtained by endovascular treatment. However, her condition worsened progressively during the following hours. CT revealed new brainstem lesions, massive cerebellar swelling, and obstructive hydrocephalus. She died on the second day after her admission. CONCLUSIONS: When hearing loss is due to vertebrobasilar occlusive disease, the prognosis is very poor. We suggest that vertebrobasilar stroke be suspected in patients with bilateral sensorineural hearing loss who present with risk factors for stroke such as atrial fibrillation and other neurologic signs.


Assuntos
Infartos do Tronco Encefálico/complicações , Doenças Cerebelares/complicações , Perda Auditiva Bilateral/etiologia , Perda Auditiva Súbita/etiologia , Diagnóstico Ausente , Insuficiência Vertebrobasilar/complicações , Idoso , Fibrilação Atrial/complicações , Artéria Basilar/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem
3.
BMJ Case Rep ; 14(2)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622754

RESUMO

COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.


Assuntos
/complicações , Delírio/virologia , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Angiografia por Tomografia Computadorizada , Delírio/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Prognóstico , Acidente Vascular Cerebral/virologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia
5.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500306

RESUMO

An 83-year-old man experienced left upper limb uncontrolled movements preceded by intense gasping during night rest, which progressed to unconsciousness and respiratory arrest requiring intubation. He was diagnosed with acute stroke due to distal occlusion of the basilar artery and received indication for endovascular thrombectomy. Standard endovascular approach includes percutaneous puncture of the femoral or radial arteries; however, the presence of unfavourable vascular anatomies (stenotic origin and tortuosity) did not allow catheterisation of the intracranial vessels through conventional access, and based on the consistent time lapse from onset of symptoms and deterioration of the clinical condition, a direct right vertebral artery ultrasound-guided puncture was performed. After one attempt of a triaxial technique, a complete recanalisation of the basilar artery and of its distal branches was achieved. Direct percutaneous puncture of the vertebral artery represents a rescue access strategy for treatment of posterior circulation stroke when other routes are not feasible.


Assuntos
Procedimentos Endovasculares/métodos , Punções/métodos , Trombectomia/métodos , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/cirurgia , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Artéria Femoral , Humanos , Masculino , Cirurgia Assistida por Computador , Ultrassonografia , Dispositivos de Oclusão Vascular , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
6.
No Shinkei Geka ; 48(12): 1177-1182, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353881

RESUMO

Positional vertebral artery occlusion(PVAO)is a mechanical occlusion of the extracranial vertebral artery(VA)due to physiological movement of the head and neck. However, only a few cases of mechanical VA compression due to routine flexion-extension of the neck have been reported. We present a unique case of PVAO due to neck extension with an occipital condylar spur. A 78-year-old man was admitted to our hospital for sudden onset of right hemiparesis and dysarthria. Magnetic resonance imaging(MRI)revealed bilateral occipital and cerebellar infarctions and vessel occlusion extending from the VA to the basilar artery. Mechanic thrombectomy resulted in partial recanalization. Computed tomography angiography(CTA)performed the next day showed spontaneously recanalized left VA with some wall irregularity. CTA in the neck-extended position revealed a severely compressed left VA in its V3 segment, which was attributed to the left occipital condylar spur with degenerative changes of the condyle-C1 facet. Cervical MRI also showed a pseudotumor from the lower clivus to the odontoid process that indicated mechanical stress on the occipitocervical ligaments. An occiput to C2 fusion was performed to stabilize and avoid dynamic vascular compression. Postoperative CTA revealed no evidence of restricted flow with flexion or extension movements of the neck. It should be noted that physiological head and neck movements accompanied by condylar degenerative changes could be a cause of vertebrobasilar insufficiency.


Assuntos
Artéria Vertebral , Insuficiência Vertebrobasilar , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia
7.
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
8.
Stroke Vasc Neurol ; 5(3): 291-301, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792460

RESUMO

BACKGROUND: The management of bilateral intracranial vertebral artery dissecting aneurysms (IVADAs) is controversial, and requires the development of endovascular treatment modalities and principles. We aim to investigate the endovascular treatment strategy and outcomes of bilateral IVADAs. METHODS: We identified all bilateral IVADAs at a high-volume neurointerventional centre over a 10-year period (from January 2009 to December 2018). Radiographic and clinical data were recorded, and a treatment algorithm was derived. RESULTS: Twenty-seven patients with bilateral IVADAs (54 IVADAs in total, 51 unruptured, 3 ruptured) were diagnosed. Four patients (14.8%) received single-stage endovascular treatment, 12 patients (44.4%) with staged endovascular treatment and 11 patients (40.8%) with unilateral endovascular treatment of bilateral IVADAs. Thirty-six IVADAs (85.7%) have complete obliteration at the follow-up angiography. Two of three ruptured IVADAs with stent-assisted coiling recanalised, and had further recoiling. Three patients (11.1%) have intraprocedural or postprocedural complications (two in single-stage and one in staged). Twenty-five patients (92.6%) had a favourable clinical outcome, and two patients (7.4%, all in single-stage) showed an unfavourable clinical outcome at follow-up. For the patients with unilateral reconstructive endovascular treatment, the contralateral untreated IVADAs were stable and had no growth or ruptured during follow-up period. None of all IVADAs had rebleeding during the clinical follow-up. CONCLUSIONS: Endovascular treatment can be performed in bilateral IVADAs with high technical success, high complete obliteration rates and acceptable morbidity/mortality. Contralateral IVADAs had low rates of aneurysm growth and haemorrhage when treated in a staged/delayed fashion.


Assuntos
Algoritmos , Aneurisma Roto/terapia , Técnicas de Apoio para a Decisão , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Dissecação da Artéria Vertebral/terapia , Artéria Vertebral , Aneurisma Roto/diagnóstico por imagem , Tomada de Decisão Clínica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem
10.
Nat Commun ; 11(1): 3851, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737314

RESUMO

Intravascular imaging has emerged as a valuable tool for the treatment of coronary and peripheral artery disease; however, no solution is available for safe and reliable use in the tortuous vascular anatomy of the brain. Endovascular treatment of stroke is delivered under image guidance with insufficient resolution to adequately assess underlying arterial pathology and therapeutic devices. High-resolution imaging, enabling surgeons to visualize cerebral arteries' microstructure and micron-level features of neurovascular devices, would have a profound impact in the research, diagnosis, and treatment of cerebrovascular diseases. Here, we present a neurovascular high-frequency optical coherence tomography (HF-OCT) system, including an imaging console and an endoscopic probe designed to rapidly acquire volumetric microscopy data at a resolution approaching 10 microns in tortuous cerebrovascular anatomies. Using a combination of in vitro, ex vivo, and in vivo models, the feasibility of HF-OCT for cerebrovascular imaging was demonstrated.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Microscopia/métodos , Tomografia de Coerência Óptica/métodos , Artéria Vertebral/diagnóstico por imagem , Angiografia/instrumentação , Angiografia/métodos , Animais , Cadáver , Circulação Cerebrovascular/fisiologia , Humanos , Microscopia/instrumentação , Suínos , Tomografia de Coerência Óptica/instrumentação
11.
J Card Surg ; 35(8): 2035-2036, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652780

RESUMO

We present a case of a 4-year-old child operated previously for cyanotic congenital heart disease where the follow-up computed tomography (CT) angiography revealed anomalous origin of the left vertebral artery from the descending thoracic aorta. This case also highlights the potential implications of this variant and the value of CT angiography in diagnosing this anomaly.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagem , Pré-Escolar , Humanos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem
12.
Am Surg ; 86(5): 531-533, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684028

RESUMO

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.


Assuntos
Traumatismo Múltiplo , Traumatismos da Medula Espinal , Artéria Vertebral/lesões , Vértebras Cervicais , Feminino , Humanos , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
13.
Clin Imaging ; 68: 108-110, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32585416

RESUMO

Diagnosis of intracranial arterial dissections can be challenging due to the wide spectrum of imaging presentations. High-resolution vessel wall MR imaging can be a useful adjunct to conventional lumen-based imaging techniques for diagnosing arterial dissections. We present a case of a 37-year-old male with a history of a Wolff-Parkinson-White syndrome presenting with acute onset of nausea, vertigo, and left body hemisensory loss of pain and temperature. A conventional brain MRI identified an acute infarct in the right lateral medulla, concordant with clinical symptoms of Wallenberg syndrome. CT angiogram of the head and neck showed lack of opacification of the right intradural vertebral artery. Intracranial vessel wall MR imaging showed findings suggestive of an intimal dissection flap with both intramural and intraluminal thrombus. Intracranial vessel wall MR imaging can provide complementary information to conventional lumen-based imaging to diagnose a vertebral dissection.


Assuntos
Dissecação da Artéria Vertebral , Adulto , Cabeça , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem
14.
J Stroke Cerebrovasc Dis ; 29(7): 104889, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417243

RESUMO

Accurate knowledge of the variant origin of the vertebral arteries (VAs) is important in vascular surgery and angiographic procedures in the neck. A triple origin of the VA is extremely rare. We report the first adult case of triple origin of the right VA from the right subclavian artery (SA). This report demonstrates magnetic resonance (MR) angiography findings of this unusual anatomic variation .


Assuntos
Artéria Subclávia/anormalidades , Malformações Vasculares , Artéria Vertebral/anormalidades , Adulto , Feminino , Humanos , Angiografia por Ressonância Magnética , Artéria Subclávia/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem
15.
Rinsho Shinkeigaku ; 60(6): 434-440, 2020 Jun 06.
Artigo em Japonês | MEDLINE | ID: mdl-32435047

RESUMO

We herein reported a patient with acute ischemic stroke in the bilateral medial medullary and the left tegmentum of the pons who presented with various neurological symptoms. Fusing digital subtraction angiography (DSA) and MRI (DSA-MR fusion imaging) could reveal the infarct-relevant arteries. A 41-year-old male presented with headache, bilateral arm's dysesthesia, quadriplegia, left Horner's syndrome, upbeat nystagmus, internuclear ophthalmoplegia and left peripheral facial paralysis. Diffusion weighted MRI (DWI) revealed the high intensity lesion in the bilateral medial medullary and the left tegmentum of the pons. MRA showed right vertebral artery (VA) occlusion. A high intensity on T1 weighted imaging was shown on the right VA vessel wall. DSA-MR fusion imaging revealed the anterior spinal artery (ASA) occlusion proximal to the infarction. The stenosis was located at the origin of the right VA perforating branch distributing into the infarct lesion. The steno-occlusive lesion of ASA and VA perforating branch due to VA dissection resulted in infarction in the pontomedullary junction and caused various neurological symptoms. DSA-MR fusion imaging would prove the radiological anatomy of infarct-relevant arteries and clarify the etiology of ischemic stroke.


Assuntos
Angiografia Digital/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia Cerebral/métodos , Imagem por Ressonância Magnética/métodos , Bulbo/irrigação sanguínea , Tegmento Pontino/irrigação sanguínea , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Artéria Vertebral/diagnóstico por imagem , Adulto , Arteriopatias Oclusivas/complicações , Humanos , Masculino , Transtornos da Motilidade Ocular/etiologia
16.
J Stroke Cerebrovasc Dis ; 29(7): 104852, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404286

RESUMO

BACKGROUND: Branch atheromatous disease is an ischemic stroke, involving occlusion or severe stenosis of the perforating artery, causing neurologic symptoms and serious sequelae. We aimed to investigate initial morphometric and hemodynamic characteristics of the vertebral artery immediately post-onset to predict lesion expanding. METHODS: This case-control study collected demographic, historical, and physical examination data from 44 patients with branch atheromatous disease in the pons at admission. The maximum ischemic pons area and stenosis rate in the basilar artery were calculated using magnetic resonance images. Diameter, velocity, and flow volume of the vertebral arteries were measured using carotid artery ultrasonography. Correlations between ischemic lesion extent and these parameters were investigated. RESULTS: Patients were assigned to groups of less (Group 1) or more (Group 2) than the median maximum ischemic area in the pons, calculated from magnetic resonance images (121.6 mm2). Modified Rankin scale scores were significantly worse in Group 2. Blood pressure and blood findings were similar between groups. Group 2 showed significantly higher basilar artery stenosis rates. Flow volume, velocity, peak systolic velocity, and end-diastolic velocity in the vertebral artery on both sides were significantly decreased in Group 2. CONCLUSIONS: Deteriorated vertebral artery hemodynamics caused a more extensive ischemic lesion in branch atheromatous disease in the pons. Evaluation of the vertebral using carotid artery ultrasonography in the acute phase may be useful for predicting disease progression.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Hemodinâmica , Arteriosclerose Intracraniana/diagnóstico por imagem , Placa Aterosclerótica , Ponte/irrigação sanguínea , Ultrassonografia Doppler de Pulso , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/fisiopatologia
18.
Ann Vasc Surg ; 67: 566.e11-566.e15, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32335248

RESUMO

The endovascular repair of subclavian aneurysms or pseudoaneurysms is now widely adopted. However, controversies still prevail in the management of dominant vertebral arteries originating close to aneurysms, as coverage of the vertebral artery might be complicated by either endoleaks or ischemic events. Here, we present a rare case of multiple aneurysmal lesions involving the right subclavian artery and bilateral internal carotid arteries treated by way of a total endovascular method using parallel stent grafts for the simultaneous exclusion of a subclavian artery pseudoaneurysm and flow preservation of the adjacent vertebral artery. To the best of our knowledge, this is the first study to report the use of this technique for the endovascular repair of juxta-vertebral subclavian artery pseudoaneurysms.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia/cirurgia , Artéria Vertebral/cirurgia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Fluxo Sanguíneo Regional , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia
19.
World Neurosurg ; 139: 163-168, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305612

RESUMO

BACKGROUND: Aneurysmal bone cysts (ABCs) comprise 1%-2% of all bone tumors. ABCs involving the upper cervical spine in pediatric patients complicate intervention because of an immature skeleton and nearby neurovascular elements. Treatment often consists of surgical intervention with preoperative embolization to mitigate blood loss. During selective arterial embolization, it is important to be aware of extracranial-intracranial anastomoses from tumor feeding vessels. We describe a C2 vertebrae ABC that had multiple tumor arteries anastomosing with bilateral vertebral arteries. CASE DESCRIPTION: A 3-year-old healthy girl presented with 1 month of progressive neck pain and palpable posterior neck mass. Imaging was most consistent with an ABC of the C2 vertebra. Preoperative embolization was planned. Angiography demonstrated tumor arterial supply anastomosing with the left and right vertebral artery stemming from the ascending and deep cervical artery branches. Tumor embolization was therefore carried out using coils and larger embolization particles to decrease ischemic stroke risk. Follow-up angiography showed successful tumor embolization with no vertebrobasilar complications. Surgical excision was uncomplicated and the patient's cervical spine has remained stable without fusion. CONCLUSIONS: Preoperative embolization for ABC resection is common, but thorough angiography must be done to rule out dangerous extracranial-intracranial anastomoses. This case demonstrated 2 key anastomoses with the vertebral artery that if not recognized, could lead to disastrous consequences. Comprehensive angiographic evaluation is necessary because previous reports have described ischemic complications from embolization because of unrecognized vertebrobasilar anastomoses. If any angiographic evidence is seen, then larger particle size, coil embolization, or abandoning the case should be considered.


Assuntos
Vértebra Cervical Áxis , Cistos Ósseos Aneurismáticos/irrigação sanguínea , Embolização Terapêutica/métodos , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/terapia , Artéria Vertebral/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/terapia , Angiografia Cerebral , Vértebras Cervicais , Pré-Escolar , Feminino , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Doenças da Coluna Vertebral/diagnóstico por imagem
20.
World Neurosurg ; 139: 101-105, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305617

RESUMO

BACKGROUND: Transradial access (TRA) has recently gained traction as the preferred approach in a variety of neurointerventions after studies have demonstrated equivalent outcomes with fewer complications than transfemoral access (TFA). However, multiple access sites are occasionally necessary when simultaneous selective catheterization of 2 vessels is required. We present the first cases detailing bilateral TRA for complex posterior circulation interventions. CASE DESCRIPTIONS: All neuroendovascular cases in which bilateral TRA was obtained at the University of Miami/Jackson Health System were reviewed. Two patients, each with complex left vertebral artery aneurysms, were identified. In each case, bilateral TRA was chosen because 1) left vertebral artery catheterization via right TRA can be technically challenging; 2) simultaneous catheterization of both vertebral arteries was felt to be necessary; 3) prior angiograms had demonstrated that the subclavian arteries would provide the most direct, anatomically feasible access route; and 4) the primary surgeon preferred to avoid TFA. Right TRA and left distal transradial access via the anatomic snuffbox were obtained in both cases to allow both arms to sit on the operator side of the table. Neither patient experienced any perioperative complications. CONCLUSIONS: Bilateral TRA can be an effective method for catheterizing both vertebral arteries during complex posterior circulation interventions and obviates the need for TFA when multiple arterial access sites are required. Furthermore, distal transradial access allows the left hand to remain more anatomically neutral while being positioned on the right side of the table so that both access sites remain ergonomically favorable for the interventionalist.


Assuntos
Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Artéria Radial , Artéria Vertebral/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Vertebral/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...