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2.
Surg Radiol Anat ; 45(1): 39-42, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36508001

RESUMO

PURPOSE: The purpose of the study was to describe a case of duplicated superior cerebellar arteries (SCAs), whose caudal branch was supplied by a persistent trigeminal artery (PTA) variant, diagnosed by magnetic resonance (MR) angiography. CASE REPORT: A 74-year-old woman with a history of cerebral infarction underwent cranial MR imaging and MR angiography. MR imaging revealed chronic-stage left cerebellar and right basal ganglionic infarctions. MR angiography showed no steno-occlusive lesions in the intracranial arteries; however, duplicated left SCAs were observed and the caudal branch arose from the precavernous segment of the left internal carotid artery, which is indicative of a PTA variant. DISCUSSION: Variations of the SCA (e.g., duplication, early bifurcation, and common trunk of the posterior cerebral artery and SCA) are frequently seen. A cerebellar artery arising from the precavernous segment of the internal carotid artery without connection to the basilar artery is regarded as a PTA variant. According to a meta-analysis, the prevalence is reported to be 0.2%. The majority of PTA variants are classified as the anterior inferior cerebellar artery type. PTA and PTA variants are frequently associated with other cerebral variations. A case of duplicated posterior inferior cerebellar artery, in which one of the branches was supplied by a PTA variant, was reported previously. However, the combination of duplicated SCA and PTA variants has not been reported. CONCLUSION: Using MR angiography, the author diagnosed a case of duplicated SCA, whose caudal branch was supplied by a PTA variant. No similar case has been reported in the relevant English-language literature.


Assuntos
Artéria Basilar , Angiografia por Ressonância Magnética , Feminino , Humanos , Idoso , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Infarto Cerebral , Angiografia Cerebral
6.
BMC Neurol ; 22(1): 415, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352362

RESUMO

BACKGROUND: The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome. RESULTS: We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0-3, RR 1.54, 1.16-2.06, p = 0.003) and functional independence (mRS 0-2, RR 1.69, 1.05-2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16-23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65-0.89, p = 0.0004). CONCLUSIONS: Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Humanos , Artéria Basilar/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
7.
J Coll Physicians Surg Pak ; 32(11): 1392-1397, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36377003

RESUMO

OBJECTIVE: To investigate the prognostic factors of intravascular therapy for acute basilar artery occlusion (aABO), and to evaluate the prognostic value of various imaging scores based on CTA. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, China, from January 2018 to January 2022. METHODOLOGY: Clinical data of 120 patients who underwent intravascular therapy for aABO were analysed retrospectively. The patients were divided into the poor prognosis group (n=54) and the good prognosis group (n=66) according to the score of the modified rankin scale (mRS) 90 days after the intervention. General clinical parameters of patients and the results of three imaging scores based on CTA i.e. basilar artery CT angiography (BATMAN) score, posterior circulation collateral circulation score (pc-CS), and posterior circulation CT angiography (pc-CTA) score, were taken as independent variables. Prognosis was taken as dependent variable. Univariate and unconditional binary logistic regression analyses were carried out respectively. RESULTS: Multivariate logistic regression analysis showed that preoperative National Institutes of Health Stroke Scale (NIHSS) score (OR=1.063, 95%CI: 1.014~1.114, p=0.011), pc-CTA score (OR=17.183, 95%CI: I3.515~84.010, p <0.001), BATMAN score (OR=0.393, 95%CI: 0.229~0.675, p=0.001), and pc-CS score (OR=0.374, 95%CI: 0.206~0.682, p=0.001) were independent factors affecting the short-term prognosis of patients with aABO. ROC curve analysis showed that the area under the curve (AUC) of the Batman score, pc-CS score and pc-CTA score were 0.900, 0.864 and 0.842 respectively, and the cut-off values were 4.5, 4.5 and 1.5 respectively. CONCLUSION: Preoperative high NIHSS score and high pc-CTA score were independent risk factors for poor prognosis of patients with aABO after intravascular therapy, while high BATMAN score and high pc-CS score were protective factors for prognosis. KEY WORDS: Acute basilar artery occlusion, Intravascular therapy, Basilar artery CT angiography score, Posterior circulation collateral circulation score, Posterior circulation CT angiography.


Assuntos
Arteriopatias Oclusivas , Acidente Vascular Cerebral , Humanos , Artéria Basilar/diagnóstico por imagem , Prognóstico , Angiografia Cerebral/métodos , Estudos Retrospectivos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
8.
Neurol India ; 70(5): 2111-2115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352617

RESUMO

Background and Aim: Basilar artery occlusion (BAO) is known for its catastrophic outcomes, whether death or disability, in approximately 70% of patients. Mechanical thrombectomy (MT) has been approved as an intervention in large vessel occlusion of anterior circulation, based on multiple randomized controlled trials (RCTs) and meta-analyses. Even though two RCTs appeared recently, there is still uncertainty about the effect of MT in BAO. Our study aims to report the outcome of MT in BAO and the variables affecting good outcomes and mortality rate. Materials and Methods: We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center by MT between July 2016 and July 2021. A favorable clinical outcome was considered if mRS was ≤2. A favorable radiological result was considered if modified Thrombolysis in Cerebral Infarction (mTICI) was ≥2b at the end of the intervention. Multiple variables were tested for their effects on favorable clinical outcomes and mortality. Results: The mean age of the 30 patients was 61.23 ± 16.81 years; 20/30 (66.7%) were male. A favorable functional outcome was achieved in 40.7%. Successful revascularization was achieved in 26 patients (86.7%). Mortality at 90 days was observed in 11 patients (36.7%). The presenting National Institute of Health and Stroke Scale (NIHSS) was the only predictor of mortality, and the optimal cut-off value for death was 15 with area under the curve (AUC) = 0.758 (sensitivity 91% and specificity 59%) and P value = 0.02. Conclusion: Thrombectomy is an effective procedure in BAO which has naturally a bad outcome. The presenting NIHSS might be the only predictor of mortality in our study.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Trombectomia/efeitos adversos , Trombectomia/métodos , Medicina Baseada em Evidências , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/etiologia , Procedimentos Endovasculares/métodos
9.
J Stroke Cerebrovasc Dis ; 31(12): 106847, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36323166

RESUMO

INTRODUCTION: It is poorly understood if endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) better facilitates clinical outcomes in patients with acute basilar artery occlusion (BAO) ischemic stroke. METHODS: A systematic literature review and meta-analysis was completed to investigate the outcomes of EVT with IVT versus direct EVT alone in acute BAO. Data was collected from the literature and pooled with the authors' institutional experience. The primary outcome measure was 90-day modified Rankin sale (mRS) of 0-2. Secondary measures were successful post-thrombectomy recanalization defined as mTICI ≥2b, 90-day mortality, and rate of symptomatic ICH. RESULTS: Our institutional experience combined with three multicenter studies resulted in a total of 1,127 patients included in the meta-analysis. 756 patients underwent EVT alone, while 371 were treated with EVT+IVT. Patients receiving EVT+IVT had a higher odds of achieving a 90-day mRS of ≤ 2 compared to EVT alone (OR: 1.50, 95% CI 1.15 to 1.95, P =0.002, I2 =0%). EVT+IVT also had a lower odds of 90-day mortality (OR: 0.57, 95% CI 0.37 to 0.89, P=0.01, I2=24%). There was no difference in sICH between the two groups (OR: 1.0, 95% CI: 0.56 to 1.79, P=0.99, I2=0%). There was also no difference in post-thrombectomy recanalization rates defined as mTICI ≥2b (OR: 1.11, 95% CI 0.70 to 1.75, P = 0.65, I2=37%). CONCLUSIONS: On meta-analysis, EVT with bridging IVT results in superior 90-day functional outcomes and lower 90-day mortality without increase in symptomatic ICH. These findings likely deserve further validation in a randomized controlled setting.


Assuntos
AVC Isquêmico , Trombectomia , Terapia Trombolítica , Humanos , Artéria Basilar , Procedimentos Endovasculares , Fibrinolíticos , AVC Isquêmico/terapia , Trombectomia/métodos , Resultado do Tratamento , Estudos Multicêntricos como Assunto
10.
N Engl J Med ; 387(15): 1361-1372, 2022 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-36239644

RESUMO

BACKGROUND: Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS: We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS: Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation. CONCLUSIONS: In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).


Assuntos
Arteriopatias Oclusivas , Artéria Basilar , Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Humanos , Administração Intravenosa , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/cirurgia , Artéria Basilar/efeitos dos fármacos , Artéria Basilar/cirurgia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/etiologia , Estudos Prospectivos , Qualidade de Vida , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Trombectomia/métodos , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Resultado do Tratamento , Recuperação de Função Fisiológica
12.
N Engl J Med ; 387(15): 1373-1384, 2022 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-36239645

RESUMO

BACKGROUND: The effects and risks of endovascular thrombectomy 6 to 24 hours after stroke onset due to basilar-artery occlusion have not been extensively studied. METHODS: In a trial conducted over a 5-year period in China, we randomly assigned, in a 1:1 ratio, patients with basilar-artery stroke who presented between 6 to 24 hours after symptom onset to receive either medical therapy plus thrombectomy or medical therapy only (control). The original primary outcome, a score of 0 to 4 on the modified Rankin scale (range, 0 to 6, with a score of 0 indicating no disability, 4 moderately severe disability, and 6 death) at 90 days, was changed to a good functional status (a modified Rankin scale score of 0 to 3, with a score of 3 indicating moderate disability). Primary safety outcomes were symptomatic intracranial hemorrhage at 24 hours and 90-day mortality. RESULTS: A total of 217 patients (110 in the thrombectomy group and 107 in the control group) were included in the analysis; randomization occurred at a median of 663 minutes after symptom onset. Enrollment was halted at a prespecified interim analysis because of the superiority of thrombectomy. Thrombolysis was used in 14% of the patients in the thrombectomy group and in 21% of those in the control group. A modified Rankin scale score of 0 to 3 (primary outcome) occurred in 51 patients (46%) in the thrombectomy group and in 26 (24%) in the control group (adjusted rate ratio, 1.81; 95% confidence interval [CI], 1.26 to 2.60; P<0.001). The results for the original primary outcome of a modified Rankin scale score of 0 to 4 were 55% and 43%, respectively (adjusted rate ratio, 1.21; 95% CI, 0.95 to 1.54). Symptomatic intracranial hemorrhage occurred in 6 of 102 patients (6%) in the thrombectomy group and in 1 of 88 (1%) in the control group (risk ratio, 5.18; 95% CI, 0.64 to 42.18). Mortality at 90 days was 31% in the thrombectomy group and 42% in the control group (adjusted risk ratio, 0.75; 95% CI, 0.54 to 1.04). Procedural complications occurred in 11% of the patients who underwent thrombectomy. CONCLUSIONS: Among patients with stroke due to basilar-artery occlusion who presented 6 to 24 hours after symptom onset, thrombectomy led to a higher percentage with good functional status at 90 days than medical therapy but was associated with procedural complications and more cerebral hemorrhages. (Funded by the Chinese National Ministry of Science and Technology; BAOCHE ClinicalTrials.gov number, NCT02737189.).


Assuntos
Arteriopatias Oclusivas , Artéria Basilar , Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Humanos , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/cirurgia , Artéria Basilar/efeitos dos fármacos , Artéria Basilar/cirurgia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , Isquemia Encefálica/cirurgia , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/etiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Trombectomia/métodos , Fatores de Tempo , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 31(11): 106804, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36206608

RESUMO

INTRODUCTION: Uncertainty remains on the optimal management of basilar artery occlusion (BAO). Two large randomized controlled trials (RCTs) in 2019 and 2021 demonstrated neutral results with respect to the use of endovascular therapy (EVT) for BAO. This study aimed to understand regional variation in physicians' perceptions towards the treatment of BAO as stratified by physician respondents from China versus outside China, prior to the publication of studies demonstrating a benefit of EVT for BAO. METHODS: An international online survey was conducted of stroke neurologists and neurointerventionalists from January to March 2022. Survey questions evaluated physician opinions toward the use of EVT in BAO, as well as the clinical and imaging features underlying treatment decisions. Respondents were dichotomized as either from China or from other countries and differences between groups were analyzed. RESULTS: There were 1245 physician respondents across 73 countries of which 295 (23.7%) were from China. Compared to respondents from the rest of the world, respondents from China were more likely to be interventionalists (71.5% vs 35.0%; p < 0.0001). Overall, more than 95% of respondents believed that EVT was superior to medical therapy under certain circumstances. Chinese respondents were more likely to believe that further RCTs were necessary than respondents from other countries (93.6% vs 76.2%; p < 0.0001). Chinese respondents were more likely to use advanced imaging in later time windows and use a premorbid mRS threshold of ≤2 for BAO selection to EVT. CONCLUSION: Most stroke physicians believe EVT is beneficial in selected patients with BAO. Clinical and imaging modality differences were observed in the selection criteria used for EVT. There was greater inclination to enroll all trial eligible patients in a BAO RCT by respondents from China as compared to other parts of the world.


Assuntos
Arteriopatias Oclusivas , Artéria Basilar , Procedimentos Endovasculares , Humanos , Arteriopatias Oclusivas/terapia , Artéria Basilar/cirurgia , Procedimentos Endovasculares/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Inquéritos e Questionários , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Surg Radiol Anat ; 44(11): 1475-1480, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36241748

RESUMO

PURPOSE: No study has documented the oculomotor nerve (OMN) segment lying between the posterior cerebral (PCA) and superior cerebellar (SCA) arteries adjacent to the brainstem. The present study aimed to characterize it. METHODS: A total of 71 patients underwent thin-sliced, sagittal T2-weighted magnetic resonance imaging for analysis. RESULTS: The OMN segments lying between the PCA and SCA were identified in all patients. The OMN segment in relation to the PCA and SCA was classified into five types. Of them, the PCA-OMN contact type was the most frequent and found in 35.2% of 71 sides on the right and 39.4% on the left. Also, the PCA-OMN compression type was identified in 12.7% on the right and 15.5% on the left. In these types, the mean distance between the brainstem and contact/compression sites were measured 4.4 ± 2.3 mm on the right and 4.4 ± 1.6 mm on the left. In more than forty percent, the sites were located at the level of the pontomesencephalic junction. CONCLUSIONS: The OMN may be frequently in contact with the PCA near the brainstem. The site located more distal than the central-peripheral myelin junction of the OMN can attribute to a low frequency of neurovascular compression syndrome of the nerve.


Assuntos
Artéria Basilar , Nervo Oculomotor , Humanos , Nervo Oculomotor/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos
16.
Radiologia (Engl Ed) ; 64(5): 407-414, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36243440

RESUMO

BACKGROUND: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.


Assuntos
Ângulo Cerebelopontino , Zumbido , Artéria Basilar , Ângulo Cerebelopontino/irrigação sanguínea , Ângulo Cerebelopontino/diagnóstico por imagem , Feminino , Humanos , Masculino , Estudos Retrospectivos , Zumbido/diagnóstico por imagem , Zumbido/etiologia
17.
Clin Neurol Neurosurg ; 222: 107450, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36191439

RESUMO

OBJECTIVES: To investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. METHODS: Fifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. RESULTS: Changes in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. CONCLUSIONS: Morphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.


Assuntos
Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Estudos Retrospectivos , Inibidores da Agregação Plaquetária/uso terapêutico , Clopidogrel , Dissecação da Artéria Vertebral/diagnóstico por imagem , Hemorragias Intracranianas , Infarto Cerebral , Artéria Vertebral/patologia , Aneurisma Intracraniano/terapia
18.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 38(9): 807-812, 2022 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-36082711

RESUMO

Objective To investigate whether capsaicin (CAP) can improve the proliferation and migration of cerebral basilar artery smooth muscle cells (BASMCs) in spontaneously hypertensive rats (SHR). Methods Primary BASMCs of SHR and Wistar-Kyoto (WKY) rats were cultured in vitro, randomly divided into control group (WKY group), SHR group and capsaicin treatment group (CAP group). The intervention concentration of CAP was determined by CCK-8 assay; TranswellTM chamber assay and scratch test were used to detect the migration ability of BASMCs; the expression and distribution of osteopontin (OPN) and proliferating cell nuclear antigen (PCNA) in BASMCs were detected by immunofluorescence assay, and Western blot analysis was used to detect the protein levels of OPN and PCNA in BASMCs. Results Compared with WKY group, the proliferation and migration ability of BASMC in SHR group were enhanced, while the CAP treatment undermined the proliferation and migration of BASMCs. OPN was expressed in the cytoplasm and nucleus of BASMCs, while PCNA was mainly expressed in the nuclei. Compared with WKY group, the expression and protein level of OPN and PCNA were increased in SHR group, and decreased significantly after CAP treatment. Conclusion Capsaicin can reduce the proliferation and migration of SHR derived BASMCs.


Assuntos
Artéria Basilar , Capsaicina , Animais , Capsaicina/metabolismo , Proliferação de Células , Células Cultivadas , Miócitos de Músculo Liso/metabolismo , Antígeno Nuclear de Célula em Proliferação/metabolismo , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY
20.
Neurosurg Rev ; 45(5): 3427-3436, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36069955

RESUMO

The natural history of ruptured basilar artery dissecting aneurysms (BADAs) remains unclear compared to that of ruptured vertebral artery dissecting aneurysms (VADAs). In this study, we investigated the natural history and optimal management of ruptured BADAs. We identified 17 patients with ruptured BADA among 4586 patients with aneurysmal subarachnoid hemorrhage (SAH) treated in seven participating hospitals. A scoping literature review was undertaken to investigate prognostic factors. Six patients among the profiled patients (35.3%) died, all with poor SAH grades (World Federation of Neurological Societies Grade IV and V). Rebleeding after admission was observed in three patients (17.6%) with poor SAH grades. Aggressive treatment and conservative management were initiated in seven and ten patients, respectively. Patients with good SAH grades had significantly higher favorable treatment outcomes than those with poor grades (83.3% vs. 9.1%, P = 0.005). Moreover, based on a scoping review of 158 cases with ruptured BADA, including the patients from our series, approximately 90% of patients with good SAH grades had favorable outcomes. A good SAH grade and no rebleeding after admission were favorable prognostic factors (P < 0.0001 and P = 0.002, respectively). The rebleeding rates were 20.2%, 13.3%, and 6.3% for dilated, pearl and string, and stenotic lesions, respectively. We concluded that the natural history of isolated ruptured BADAs may be better than that of VADAs. Although definitive treatment, if possible, is undoubtedly important, conservative management with careful radiological follow-up for morphological changes might be a viable option for patients in good clinical condition and with non-dilated lesions.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Dissecação da Artéria Vertebral , Aneurisma Roto/cirurgia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
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