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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 38-45, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33908231

RESUMO

OBJECTIVE: To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT). MATERIAL AND METHODS: The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis. RESULTS: During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure. CONCLUSION: Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.


Assuntos
Isquemia Encefálica , Stents Farmacológicos , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Isquemia Encefálica/etiologia , Seguimentos , Humanos , Estudos Retrospectivos , Stents , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia
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.
J Stroke Cerebrovasc Dis ; 30(3): 105590, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33583512

RESUMO

AIM: Optimal blood pressure (BP) management in vertebrobasilar circulation stroke patients undergoing thrombectomy remains undetermined. We aimed to evaluate the impact of perioperative BP on clinical outcome after MT in acute basilar artery occlusion (BAO) patients. METHODS: We retrospectively analyzed all consecutive patients hospitalized with acute basilar artery occlusion administered endovascular treatment within 24 h from January 2012 to July 2018 in Beijing Tiantan Hospital. BP was measured at regular intervals during the first 24 h after stroke onset, during and after thrombectomy. The clinical outcomes assessed at 3-month follow up were functional independence (mRS score of 0-2) and mortality (mRS score of 6). RESULTS: Of the 187 treated patients, 157 were male; patient ages were 60±10 years. The median NIHSS on admission was 22. Totally in 179 patients had complete BP level assessment. In these individuals, univariate analysis revealed significant associations of postoperative Max SBP and Max MAP with mortality (all P < 0.05). Multivariate regression analysis also demonstrated that postoperative Max SBP (OR=0.964, 95% CI 0.941 to 0.987, P < 0.003) and Max MAP (OR=0.942, 95% CI 0.907 to 0.979, P < 0.002) were independent predictors of mortality. CONCLUSIONS: In acute BAO patients administered thrombectomy, Max SBP between 120 and 160 mmHg may be associated with better outcome, with a trend of reduced risk of mortality.


Assuntos
Pressão Sanguínea , Procedimentos Endovasculares , Trombectomia , Insuficiência Vertebrobasilar/terapia , Idoso , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologia
4.
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
5.
J Stroke Cerebrovasc Dis ; 30(4): 105562, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33476963

RESUMO

Beauty parlor stroke syndrome is characterized by the development of various neurological symptoms during cervical hyperextension, followed by inadequate blood flow through the posterior circulation of the brain. However, there are few reports of beauty parlor stroke syndrome wherein the cause of the posterior circulatory inadequacy has been directly identified. Here we report a case where we could directly detect the origin of the posterior circulatory inadequacy. A 76-year-old Japanese man with hypertension presented with presyncope following cervical retroflexion. Head magnetic resonance angiography revealed that the vertebrobasilar circulation was exclusively supplied by the right vertebral artery. Cervical spine computed tomography showed compression of the osteophytes on the right superior articular process of C6 into the right transverse foramen of C5. Moreover, computed tomography angiography and carotid duplex ultrasonography showed decreased blood flow in the right vertebral artery on gradual retroflexion of the neck. Based on the above findings, we speculate that the right vertebral artery was compressed by the osteophytes, with the decreased blood flow being the cause of presyncope following cervical retroflexion.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Movimentos da Cabeça , Osteófito/complicações , Síncope/etiologia , Insuficiência Vertebrobasilar/etiologia , Idoso , Circulação Cerebrovascular , Humanos , Osteófito/diagnóstico por imagem , Recidiva , Síncope/diagnóstico , Síncope/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
7.
J Stroke Cerebrovasc Dis ; 30(3): 105558, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33348247

RESUMO

BACKGROUND AND PURPOSE: Perforator stroke is one of the most common complications of vertebrobasilar arterial stenting. We investigated whether perforator stroke after vertebrobasilar arterial stenting is associated with plaque enhancement in patients with severe vertebrobasilar artery stenosis. METHODS: We studied patients with symptomatic vertebrobasilar arterial stenosis who underwent stenting from January 2017 to July 2020. Patients who underwent high resolution magnetic resonance imaging were recruited among them. Demographic data, risk factors of atherosclerosis, procedure details, and characteristics of imaging were extracted from electronic health records and imaging data. Plaque features were investigated by high resolution magnetic resonance imaging. RESULTS: 136 patients were enrolled in this study, 39 of whom fulfilled the inclusion criteria. 18 patients (46.2%) had obvious plaque enhancement among the 39 patients, and 21 (53.8%) had plaque non-enhancement. 21 patients (53.8%) had diffuse distribution, and 22 patients (56.4%) had irregular plaques surface. Patients were divided into plaque enhanced and plaque non-enhanced groups according to the degree of plaque enhancement. Clinical characteristics and other plaque features were similar between two groups. Procedure-related perforator stroke was identified in 4 patients (10.3%). Patients with plaque enhancement were more likely to have perforator stroke after stenting compared with those with plaque non-enhancement (22.2% versus 0%, P = 0.037). CONCLUSIONS: Plaque enhancement in high resolution magnetic resonance imaging may be associated with perforator stroke after vertebrobasilar artery stenting.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Imagem por Ressonância Magnética , Placa Aterosclerótica , Stents , Acidente Vascular Cerebral/etiologia , Insuficiência Vertebrobasilar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem
8.
Vasc Endovascular Surg ; 55(1): 77-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869715

RESUMO

We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.


Assuntos
Angioplastia com Balão , Acidente Vascular Cerebral/terapia , Trombectomia , Tempo para o Tratamento , Insuficiência Vertebrobasilar/cirurgia , Idoso , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
9.
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
10.
Artigo em Russo | MEDLINE | ID: mdl-33095533

RESUMO

OBJECTIVE: To analyze our own results with literature data and substantiate microvascular decompression in patients with trigeminal neuralgia (TN) following vertebrobasilar dolichoectasia (VBD). MATERIAL AND METHODS: A total of 504 patients with TN underwent surgery in 1998-2018. Patients with TN following VBD were included into a retrospective study. There were 4 men and 10 women aged 66 years (range 51-80). Outcomes were evaluated using BNI (Barrow Neurological Institute) scale. PubMed database was used for literature review. RESULTS: TN caused by VBD was diagnosed in 2.8% of patients. Left-sided trigeminal pain was observed in 10 patients, right-sided - in 4 cases. One patient had concomitant hemifacial spasm. MVD followed by shielding of trigeminal nerve root with shredded Teflon was performed in all patients. We did not perform fixation of vertebrobasilar vessels. In one case, open partial trigeminal nerve root rhizotomy was done in addition to MVD. All patients had pain-free early postoperative period. There were no deaths or major complications. There was transient cranial nerve dysfunction lasting no more than three months (facial numbness - 1, IV nerve dysfunction - 1, VI nerve dysfunction - 1, transient partial facial palsy (House-Brackmann II) - 2, hipoacusia - 2 patients). There was no facial pain recurrence in our group. Mean follow-up period was 5.5 years (range 6 months - 16 years). CONCLUSION: MVD is an effective option in the treatment of TN following VBD. In these cases, operation is technically more difficult compared to MVD with intact vessels. However, surgery is much more effective than all the available alternatives. The possibilities of vessel transposition in VBD with or without fixation are limited and ineffective. Teflon wool interposition at the points of conflict is an effective and sufficient technique.


Assuntos
Espasmo Hemifacial , Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Insuficiência Vertebrobasilar , Idoso , Idoso de 80 Anos ou mais , Feminino , Espasmo Hemifacial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia
12.
J Stroke Cerebrovasc Dis ; 29(9): 105081, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807478

RESUMO

BACKGROUND: Cerebrovascular reactivity (CVR) to acetazolamide (ACZ) on single-photon emission computed tomography (SPECT) can be used to assess the severity of chronic cerebral ischemia; however, this is an invasive method. We examined whether whole-brain magnetic resonance angiography (MRA) at 7T could non-invasively detect impaired CVR in patients with chronic cerebral ischemia by demonstrating the leptomeningeal collaterals (LMCs). METHODS: Fifty-seven patients with symptomatic unilateral cervical stenosis underwent whole-brain time-of-flight MRA at 7T and cerebral perfusion SPECT before/after the ACZ challenge. MRA images were visually assessed based on 6-point grading systems to evaluate the development of LMCs toward the middle cerebral artery (MCA) and antegrade flow of MCA. CVR of the affected side was calculated from the SPECT data. Subsequently, we compared the LMC grades on MRA with CVR on SPECT. RESULTS: CVR was significantly lower in grades ≥ 2 of LMCs than in grades 0-1 (P < 0.05) when applying LMCs from the anterior cerebral artery (ACA) and/or posterior cerebral artery (PCA). These differences were more evident than those in the grading of the antegrade MCA flow. The LMC grades from ACA/PCA readily detected reduced CVR (< 18.4%) with a sensitivity/specificity of 0.79/0.82. CONCLUSION: The development of LMCs on whole-brain MRA at 7T can non-invasively detect reduced CVR with a high sensitivity/specificity in patients with unilateral cervical stenosis.


Assuntos
Angiografia Cerebral/métodos , Circulação Cerebrovascular , Circulação Colateral , Angiografia por Ressonância Magnética , Meninges/irrigação sanguínea , Artéria Cerebral Média/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Imagem de Perfusão , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Tomografia Computadorizada de Emissão de Fóton Único , Insuficiência Vertebrobasilar/fisiopatologia
13.
BMC Neurol ; 20(1): 289, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736532

RESUMO

BACKGROUND: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging. METHOD: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70-99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were recorded. RESULTS: ①The mean age of 67 patients (67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of medication treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of micro-guide wire being trapped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36-66 months. CONCLUSIONS: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.


Assuntos
Aterosclerose/complicações , Artéria Basilar/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Circulação Colateral , Constrição Patológica/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Complicações Pós-Operatórias/epidemiologia , Stents , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
14.
World Neurosurg ; 138: 714-722, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32545021

RESUMO

OBJECTIVE: This article analyzes computed tomography (CT) angiography and CT perfusion imaging parameters of patients with cerebral hemorrhage and cerebral infarction, and explores its diagnostic value and clinical significance in the diagnosis of cerebral hemorrhage and cerebral infarction. METHODS: This article selected 52 patients with ischemic cerebrovascular disease who were treated in our neurology department from January 2015 to December 2018. Twenty of these patients had transient ischemic attacks, and 32 had neurologic damage. According to the onset time, patients with cerebral infarction were divided into 12 cases in group A (onset time <6 hours) and 20 cases in group B (onset time >6 hours). CT perfusion imaging was performed within 24 hours after the onset of cerebral hemorrhage. Patients immediately underwent CT perfusion imaging in the cerebral infarction group, and recorded the CT perfusion imaging parameters to analyze the nerve damage. RESULTS: The results showed that among the 20 patients with cerebral hemorrhage, 14 cases had anterior circulation cerebral hemorrhage, and 6 cases had posterior circulation cerebral hemorrhage. No lesions were found on CT and magnetic resonance imaging. CT angiography of 20 patients with cerebral hemorrhage showed that 18 patients had vascular lesions. In the cerebral infarction group, 30 cases developed vascular disease. CONCLUSIONS: Studies have confirmed that changes in brain CT perfusion imaging parameters can reflect changes in brain blood perfusion to diagnose nerve damage, and mean transit time and time to peak are the most sensitive during the diagnosis. CT angiography can detect the degree of stenosis and has important clinical value for the etiology of cerebral hemorrhage and cerebral infarction.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Humanos , Imagem por Ressonância Magnética , Imagem de Perfusão , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/diagnóstico por imagem
16.
J Stroke Cerebrovasc Dis ; 29(7): 104868, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417240

RESUMO

BACKGROUND AND PURPOSE: Safety and efficacy of endovascular thrombectomy (EVT) in patients with mild stroke syndromes is unclear, especially in distal vessel occlusions. METHODS: We analysed in our stroke database (HeiReKa) between 2002 and April 2019 safety and efficacy of EVT compared to intravenous thrombolysis (IVT) in patients with occlusions distal to the M1 segment of the middle cerebral artery and the top of the basilar artery who presented with a National Institute of Health Stroke Scale (NIHSS) below 6. Excellent (good) outcome was defined as modified rankin scale (mRS) 0-1 (0-2) or return to baseline mRS (good) after 3 months. Safety endpoints were mortality after 3 months and intracranial hemorrhage according to the Heidelberg Bleeding Classification (HBC). RESULTS: Of 4167 patients 94 met the inclusion criteria. Sixty-four patients were allocated to the IVT group and 30 to the EVT group of which 15 also received IVT; three patients (4.6%) in the IVT group received rescue EVT. Baseline characteristics did not differ but more M2 occlusions were found in the EVT group (93.3% vs. 64.1%, p = 0.02). Intracranial bleeding occurred more often in EVT patients (HBC class 2: 13.3% vs. 1.6%, p = 0.01). Excellent and good outcome were not significantly different (75% vs. 70%, p = 0.65 and 87.5% vs. 73.3%, p = 0.14). Mortality was significantly lower in IVT patients (1.6% vs. 13.3%, p = 0.04). CONCLUSION: Rates of excellent and good outcome after IVT or EVT were almost similar, but safety parameters were increased after EVT. EVT may be considered in selected patients after careful risk/benefit analysis.


Assuntos
Procedimentos Endovasculares , Fibrinolíticos/administração & dosagem , Infarto da Artéria Cerebral Média/terapia , Terapia Trombolítica , Insuficiência Vertebrobasilar/terapia , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Fibrinolíticos/efeitos adversos , Alemanha , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/mortalidade , Infarto da Artéria Cerebral Média/fisiopatologia , Hemorragias Intracranianas/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologia
17.
Ann Vasc Surg ; 68: 141-150, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32439529

RESUMO

BACKGROUND: Vertebral artery (VA) stenosis as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results, the results of VA stenosis operations and the follow-up studies are analyzed. MATERIAL AND METHODS: This retrospective, single-center study includes 43 symptomatic proximal VA stenosis patients between September 2012 and March 2019. The demographics and clinical data were obtained from the hospital records. Doppler ultrasonography and computed tomography angiography were used to establish the diagnosis and for follow-up. The surgical procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%), and decompression of kinking in 1 (2.3%) patient. Eleven patients (25.5%) had concomitant carotid surgery. The Kaplan-Meier method was used to calculate the survival and patency rates. RESULTS: Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Twenty-five patients were males (58.1%), and the average age was 64.6 ± 9.8 (50-90) years. The 30-day death, 30-day stroke, and 30-day death/stroke rates were 2.3%, 4.7%, and 7%, respectively. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome was found in 5 (11.6%) patients, and facial nerve injury was found in one (2.3%) patient. Three (7.1%) patients died during the follow-up period, and overall survival of the patients at 3 years was 91.4% ± 5.8%. Two (4.7%) patients had cerebrovascular events (CVEs) occurred during the follow-up. One- and three-year CVE-free survivals were 97.1% ± 2.9% and 90.1% ± 7.2%, respectively. Two patients (5.4%) had restenosis. One- and three-year patency of VA after procedure was 89.1% ± 7.4%. Thirty-seven (86%) patients had complete recovery of symptoms after surgery; 5 patients (11.6%) kept their preoperative symptoms in different levels. CONCLUSIONS: Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Restenosis-free, CVE-free, and overall survival rates are satisfactory.


Assuntos
Descompressão Cirúrgica , Veia Safena/transplante , Enxerto Vascular , Insuficiência Vertebrobasilar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/mortalidade , Grau de Desobstrução Vascular , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologia
18.
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
19.
Cerebrovasc Dis ; 49(2): 206-215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289802

RESUMO

PURPOSE: To study the clinical usefulness of serial color-coded duplex ultrasound (DUS) examinations in cervical artery dissection (CeAD) patients. METHODS: Single-center, CeAD registry-based re-review of serial, routine DUS exams in consecutive CeAD patients treated at the Stroke Center Basel, Switzerland (2009-2015). Two experienced raters reassessed all DUS for the occurrence of new arterial findings during follow-up, that is. (i) recanalization of the dissected artery (if occluded at baseline), (ii) delayed occlusion of a patent dissected artery, and (iii) recurrent CeAD. We studied whether these new arterial findings were associated with clinical symptoms. RESULTS: In 94 CeAD patients (n = 40 female [42.6%], median age 46 years [interquartile range (IQR) 36.2-53]), 506 DUS examinations were reviewed covering a median length of follow-up of 54.1 weeks (IQR 30.5-100.5). In total, 105 dissected arteries were detected, of which 27 (25.7%) were occluded. In 28/94 patients (29.8%), 31 new arterial findings were recorded, which were associated with clinical symptoms in 9/31 (30%) patients. Recanalization of occluded CeAD was observed in 22/27 (81.5%) arteries and occurred in 20/22 arteries within 3 months. In 4/22 patients (18.2%), recanalization was associated with clinical symptoms (ischemic events [n = 2], pure local symptoms [n = 2]). Delayed occlusions were observed in 4/78 (5.1%) dissected arteries patent at baseline. All were clinically asymptomatic and occurred within 14 days from baseline. Recurrent CeAD (all symptomatic) occurred in 5 previously non-dissected arteries. CONCLUSION: In CeAD patients, follow-up DUS identified new arterial findings, of which several were associated with clinical symptoms: we found that about 1 of 5 recanalizations were associated with clinical symptoms, of whom half were ischemic symptoms. Further, delayed occlusions occurred in patients with no or mild stenosis at baseline and were asymptomatic. This study emphasizes the potential importance of repeated DUS in CeAD particularly in the early phase of up to 4 weeks.


Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Dissecação da Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Adulto , Dissecação da Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Sistema de Registros , Estudos Retrospectivos , Suíça , Fatores de Tempo , Grau de Desobstrução Vascular , Dissecação da Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/fisiopatologia
20.
Stroke ; 51(4): 1301-1304, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078499

RESUMO

Background and Purpose- Intracranial carotid artery calcification is associated with worse outcome in anterior circulation stroke patients who undergo endovascular thrombectomy. We investigated the association between vertebrobasilar artery calcification (VBAC) and outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Methods- Consecutive patients treated for posterior circulation large vessel occlusion from a prospective single-center registry were studied. VBAC was manually segmented on computed tomography brain scans. The associations between VBAC and VBAC volume, functional independence (90-day modified Rankin Scale score of 0-2), and 90-day mortality were assessed using propensity score-adjusted logistic regression. Results- Sixty-four posterior circulation large vessel occlusion patients were included. Twenty-five (39.1%) patients had VBAC, and of these, the median (interquartile range) VBAC volume was 19.8 (6.65-23.4) mm3. VBAC was associated with reduced functional independence (OR, 0.19 [95% CI, 0.04-0.78]; P=0.03) and increased mortality (OR, 9.44 [95% CI, 2.43-36.62]; P=0.005). Larger VBAC volumes were a significant predictor of reduced functional independence and increased mortality. Conclusions- VBAC is an independent predictor of outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Considering the presence of VBAC might improve prognostication and shared treatment decision-making between patients, families, and physicians.


Assuntos
Procedimentos Endovasculares/métodos , Trombectomia/métodos , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
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