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posterior circulation stroke

Caterina Kulyk, Chiara Voltan, Marialaura Simonetto, Anna Palmieri, Filippo Farina, Francesca Vodret, Federica Viaro, Claudio Baracchini
BACKGROUND: The role of vertebral artery hypoplasia (VAH) in stroke pathophysiology is still debated. In this study, we correlated extra- and intra-cranial vertebral artery ultrasound findings with brain CT/MRI and clinical outcome. MATERIALS AND METHODS: We recruited all consecutive first-ever stroke patients with a documented acute ischemic brain lesion and a complete extra-intracranial ultrasound evaluation. Those with previous stroke, or with anterior and posterior strokes were excluded...
August 16, 2018: Journal of Neurology
Antti Lindgren, Mervyn DI Vergouwen, Irene van der Schaaf, Ale Algra, Marieke Wermer, Mike J Clarke, Gabriel Je Rinkel
BACKGROUND: Around 30% of people who are admitted to hospital with aneurysmal subarachnoid haemorrhage (SAH) will rebleed in the initial month after the haemorrhage if the aneurysm is not treated. The two most commonly used methods to occlude the aneurysm for prevention of rebleeding are microsurgical clipping of the neck of the aneurysm and occlusion of the lumen of the aneurysm by means of endovascular coiling. This is an update of a systematic review that was previously published in 2005...
August 15, 2018: Cochrane Database of Systematic Reviews
Yue Hu, Jialin Du, Zhenlei Liu, Hao Wu, Jianping Ding, Fengzeng Jian
BACKGROUND: Atlantoaxial dislocation (AAD) is the most common craniovertebral junction malformation (CVJm) which are anomalies of the bones and soft tissues surrounding the foramen magnum. It usually leads to neurologic abnormalities because of instability of this mobile area. But vertebral artery dissection (VAD) caused by AAD is uncommon. CASE REPORT: We report a 15-year-old boy who presented with acute onset of bilateral VAD leading to posterior circulation ischemic stroke (PCIS)...
August 14, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Neville Jadeja, Krishna Nalleballe
No abstract text is available yet for this article.
August 14, 2018: Neurology
Tengfei Zhou
OBJECTIVE: This study aimed to evaluate the efficacy and safety of intracranial stenting as a rescue therapy for acute ischemic stroke (AIS) after stentriever thrombectomy failure. METHODS: Patients who received intracranial stenting as a rescue therapy for AIS after failure of stent retrieval, with or without concomitant treatment between January 2014 and December 2016, were retrospectively analyzed. Recanalization results and outcome at three months were assessed, and perioperative complications related to the procedure were recorded...
August 9, 2018: World Neurosurgery
Zhi-Xin Huang, Qi-Zhang Wang, Ying-Yi Dai, Hai-Ke Lu, Xiao-Yu Liang, Huan Hu, Xin-Tong Liu
BACKGROUND: To investigate whether endovascular therapy (EVT) was one of the factors influencing the incidence of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) as compared with intravenous thrombolysis alone. METHODS: This study was based on our single-center's database that included information on stroke patients hospitalised between January 2012 and September 2015. A total of 220 patients who underwent EVT after IV rt-PA, EVT or IV rt-PA alone...
August 7, 2018: Journal of the Chinese Medical Association: JCMA
Abhay Venkat, Cecilia Cappelen-Smith, Shabeel Askar, Peter R Thomas, Sonu Bhaskar, Amanda Tam, Alan J McDougall, Suzanne J Hodgkinson, Dennis J Cordato
BACKGROUND: Failure to recognise acute stroke may result in worse outcomes due to missed opportunity for acute stroke therapies. Our study examines factors associated with stroke misdiagnosis in patients admitted to a large comprehensive stroke centre. METHODS: Retrospective review comparing 156 consecutive stroke patients misdiagnosed in emergency department (ED) with 156 randomly selected stroke controls matched for age, gender, language spoken and stroke subtype for the period 2014-2016...
August 9, 2018: Neuroepidemiology
Sucharita Anand, Anmol Singh Rai, Rohit Chhirolya, Vimal Kumar Paliwal
Patients suffering from acute intractable vomiting are usually treated in the Gastroenterology department. The causes of acute intractable vomiting range from acute pancreatitis and acute intestinal obstruction to cardiac causes like acute myocardial infarction and neurological causes like posterior circulation stroke. However, most of the underlying causes of acute intractable vomiting also produce other telltale signs/symptoms. Rarely, isolated acute intractable vomiting may be the initial symptom of a recurrent neurological syndrome of neuromyelitis optica spectrum disorder (NMOSD)...
August 8, 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Hiroki Yamada, Ryogo Kikuchi, Akiyoshi Nakamura, Hiromichi Miyazaki
Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and multifocal cerebral vasoconstriction. Cerebral vasoconstriction is reversible, and most cases have good prognosis. However, clinical outcome is possibly severe when it is complicated by stroke, yet detailed reports on such a case are few. We experienced a case of severe reversible cerebral vasoconstriction syndrome in a 32-year-old woman with medical history of preeclampsia 3 years prior. She presented with sudden sharp headache followed by altered mental status and vasoconstriction of the bilateral posterior cerebral arteries...
August 4, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Nilüfer Yeşilot, Esme Ekizoğlu, Oğuzhan Çoban
Introduction: Cerebrovascular disease is the second most common cause of central nervous system involvement in cancer patients after metastases. Procoagulant substances secreted by tumour cells, cancer therapy, and embolus from tumour have been implicated in ischemic stroke (IS) in cancer patients. Methods: Four thousand twenty patients with IS were prospectively recorded to the Istanbul Medical School Stroke Registry from August 1997 to May 2016. Ninety-two patients with IS and cancer and 3928 IS patients without cancer constituted the two groups...
2018: Noro Psikiyatri Arsivi
Monika Müller-Eschner, Se-Jong You, Kolja Jahnke, Sara Kammerer, Christian Foerch, Waltraud Pfeilschifter, Arne Lauer, Joachim Berkefeld, Marlies Wagner
BACKGROUND AND PURPOSE: To describe our first experience using a small stent retriever specifically designed for thrombectomy in cerebral arteries with a small caliber (Acandis APERIO® 3.5/28) in patients with acute ischemic stroke. MATERIALS AND METHODS: All patients with an acute ischemic stroke, who underwent endovascular recanalization using the APERIO® thrombectomy device with a diameter of 3.5 mm, were identified in retrospect and included in the present analysis...
July 23, 2018: Cardiovascular and Interventional Radiology
Man Kwun Andrew Li, Anderson Chun On Tsang, Frederick Chun Pong Tsang, Wai Shing Ho, Raymand Lee, Gilberto Ka Kit Leung, Wai Man Lui
PURPOSE: Stenting and angioplasty of the vertebral artery (VA) is used to treat symptomatic stenosis but the long-term outcomes and complications are unclear. This study evaluated the long-term clinical outcomes and procedure-related complications in patients who underwent extracranial VA stenting and angioplasty, in particular the risks of in-stent restenosis (ISR) and stent fracture. METHODS: This was a retrospective review of consecutive patients suffering from symptomatic extracranial VA stenosis who were treated with balloon-expandable bare metal stents...
July 23, 2018: Clinical Neuroradiology
Hannes Nordmeyer, René Chapot, Ayhan Aycil, Christian P Stracke, Marta Wallocha, M Jeffrie Hadisurya, Markus Heddier, Patrick Haage, Ralph Weber
Background and Purpose: Subgroup analysis of the SAMMPRIS trial showed a higher rate of periprocedural perforator strokes with the Wingspan stent in the basilar artery in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). It remains unclear whether angioplasty (PTA) alone or in combination with other stent types (PTAS) will yield similar results in perforator-bearing segments of the anterior and posterior circulation. Methods: We retrospectively analyzed the periprocedural complication rate, long term outcome and stroke etiology in 59 consecutive patients with ICAS of the middle cerebral artery (79 treatments) and 67 patients with ICAS of the intracranial vertebral and basilar artery (76 treatments) treated with PTA or PTAS from 2007 to 2015 in a high-volume neuro-interventional center...
2018: Frontiers in Neurology
Aravind Ganesh, Mayank Goyal
PURPOSE OF REVIEW: Mechanical thrombectomy has become the standard of care for acute ischemic stroke with proximal large vessel occlusions (LVO). This article reviews recent research relating to thrombectomy. RECENT FINDINGS: Thrombectomy for anterior circulation stroke with proximal LVO was first shown to be highly efficacious within 6 h of stroke onset, but "late-window" trials have further demonstrated efficacy until 24-h postonset in select patients with salvageable tissue...
July 23, 2018: Current Neurology and Neuroscience Reports
Marialaura Simonetto, Keith DeSousa, Nelly Campo, Vikas Pandey, Sebastian Koch
BACKGROUND: Atherosclerotic plaques located at the vertebral artery ostium (VAo) are a mechanism for posterior circulation stroke, but little is known about VAo plaque topography and formation. In this study, we describe the topography of atherosclerotic plaques involving the origin of the vertebral artery (VA). METHODS: Cross-sectional analyses of extracranial duplex studies were performed, and VAo plaques were classified based on their topography in 3 groups: (1) exclusively at the VA ostium; (2) predominantly subclavian, with extension into the vertebral ostium; and (3) predominantly ostial, with extension into the subclavian artery)...
July 19, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Krishnan Ravindran, Alejandro Enriquez-Marulanda, Peter T M Kan, Leonardo Renieri, Nicola Limbucci, Salvatore Mangiafico, Mohamed M Salem, Abdulrahman Y Alturki, Justin M Moore, Christopher S Ogilvy, Ajith J Thomas
OBJECTIVE: The safety and efficacy of flow diversion for distal circulation aneurysms of the cerebral vasculature has not been well-evaluated. The objective of this study was to assess the use of flow diversion for distal circulation aneurysms - defined as at or beyond the M1, P1 and A1 segments of the MCA, PCA and ACA, respectively -in an international, multi-center cohort. METHODS: Clinical and radiological records from all patients undergoing flow diversion treatment of distal circulation aneurysms at 3 academic centers (2 US, 1 Europe) from 2014 until 2017 were retrospectively reviewed...
July 16, 2018: World Neurosurgery
Jad Farah, Aymeric Rouchaud, Theophraste Henry, Catherine Regen, Cristian Mihalea, Jacques Moret, Laurent Spelle
OBJECTIVES: To establish dose reference levels (RLs) for stroke interventions while carefully analysing the impact of clinical and technical parameters on patient exposure. METHODS: The study retrospectively analysed data from 377 stroke patients prospectively collected between 15 October 2015 and 30 March 2017 at a single, level-3 stroke centre equipped with Philips Allura Clarity systems. Local dose RLs were first derived as the 75th percentile of the dose area product (DAP), cumulative air kerma (Ka,r ), fluoroscopy time (FT) and the number of images (NI)...
July 17, 2018: European Radiology
Toshiya Ishihara, Shoichiro Sato, Toshiyuki Uehara, Tomoyuki Ohara, Mikito Hayakawa, Kazumi Kimura, Yasushi Okada, Yasuhiro Hasegawa, Norio Tanahashi, Akifumi Suzuki, Jyoji Nakagawara, Kazumasa Arii, Shinji Nagahiro, Kuniaki Ogasawara, Shinichiro Uchiyama, Masayasu Matsumoto, Koji Iihara, Kazunori Toyoda, Kazuo Minematsu
BACKGROUND AND PURPOSE: Patients with transient ischemic attack (TIA) occasionally show nonfocal symptoms, such as unconsciousness, amnesia, and unsteadiness. The purpose of this study was to clarify the characteristics and prognosis of patients with TIA with nonfocal symptoms, using data from the PROMISE-TIA (Prospective Multicenter Registry to Identify Subsequent Cardiovascular Events After Transient Ischemic Attack). METHODS: Patients with TIA within 7 days of onset were consecutively enrolled in the Japanese nationwide registry...
July 16, 2018: Stroke; a Journal of Cerebral Circulation
Darian R Esfahani, Dilip Pandey, Xinjian Du, Linda Rose-Finnell, Fady T Charbel, Colin P Derdeyn, Sepideh Amin-Hanjani
BACKGROUND AND PURPOSE: The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated posterior circulation distal flow status, determined by quantitative magnetic resonance angiography, is a robust predictor of vertebrobasilar stroke risk in patients with symptomatic atherosclerotic vertebrobasilar disease. Flow-compromised high-risk patients may benefit from flow-restoring endovascular procedures, such as submaximal angioplasty. In this study, we examine the cost-effectiveness of quantitative magnetic resonance angiography screening to identify patients who may benefit from submaximal angioplasty to restore vertebrobasilar flow...
July 16, 2018: Stroke; a Journal of Cerebral Circulation
Benjamin Friedrich, Felix Kempf, Tobias Boeckh-Behrens, Johanna Fischer, Manuel Lehm, Maria Bernd, Silke Wunderlich, Sebastian Mönch, Claus Zimmer, Christian Maegerlein
PURPOSE: In patients with acute occlusions of the middle cerebral artery, the collaterals play an important role in infarct growth and potentially on clinical outcome. As the primary collateral pathway, the posterior cerebral artery with the posterior communicating artery (PComA) is important. We analyzed the influence of the presence of an ipsilateral PComA on infarct growth and clinical outcome. METHODS: We included 101 patients with M1 occlusions and subsequent endovascular treatment and differentiated patients without an ipsilateral PComA from those with an ipsilateral PComA...
July 10, 2018: Cardiovascular and Interventional Radiology
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