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Selective cerebral perfusion

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https://www.readbyqxmd.com/read/29155938/cerebral-autoregulation-in-cardiopulmonary-bypass-surgery-a-systematic-review
#1
Juliana R Caldas, Victoria J Haunton, Ronney B Panerai, Ludhmila A Hajjar, Thompson G Robinson
Cardiopulmonary bypass surgery is associated with a high incidence of neurological complications, including stroke, delirium and cognitive impairment. The development of strategies to reduce the incidence of such neurological events has been hampered by the lack of a clear understanding of their pathophysiology. Cerebral autoregulation (CA), which describes the ability of the brain to maintain a stable cerebral blood flow over a wide range of cerebral perfusion pressures despite changes in blood pressure, is known to be impaired in various neurological disorders...
November 16, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29136088/abcd1-dysfunction-alters-white-matter-microvascular-perfusion
#2
Arne Lauer, Xiao Da, Mikkel Bo Hansen, Gregoire Boulouis, Yangming Ou, Xuezhu Cai, Afonso Liberato Celso Pedrotti, Jayashree Kalpathy-Cramer, Paul Caruso, Douglas L Hayden, Natalia Rost, Kim Mouridsen, Florian S Eichler, Bruce Rosen, Patricia L Musolino
Cerebral X-linked adrenoleukodystrophy is a devastating neurodegenerative disorder caused by mutations in the ABCD1 gene, which lead to a rapidly progressive cerebral inflammatory demyelination in up to 60% of affected males. Selective brain endothelial dysfunction and increased permeability of the blood-brain barrier suggest that white matter microvascular dysfunction contributes to the conversion to cerebral disease. Applying a vascular model to conventional dynamic susceptibility contrast magnetic resonance perfusion imaging, we demonstrate that lack of ABCD1 function causes increased capillary flow heterogeneity in asymptomatic hemizygotes predominantly in the white matter regions and developmental stages with the highest probability for conversion to cerebral disease...
November 9, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29111297/mid-term-outcomes-of-repair-of-coarctation-of-aorta-with-hypoplastic-arch-extended-end-to-side-anastomosis-technique
#3
Eung Re Kim, Woong-Han Kim, Jinhae Nam, Kwangho Choi, Woo Sung Jang, Jae Gun Kwak
OBJECTIVE: The optimal surgical repair technique for coarctation associated with aortic arch hypoplasia (CoA/AAH) in neonates and infants is controversial. This study evaluates our current strategy utilizing extended end-to-side anastomosis (EESA) under selective cerebral and myocardial perfusion (SCMP) in treating this group of patients. METHODS: Through a retrospective review, we analyzed the outcome of 87 infants who underwent surgical repair of CoA/AAH from January 2004 to December 2015...
October 27, 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29109882/successful-mechanical-thrombectomy-of-a-middle-cerebral-artery-occlusion-14-hours-after-stroke-onset
#4
Anelia Dietmann, Kety Wha-Vei Hsieh, Andrea M Humm, Claudio L Bassetti, Urs Fischer, Jan Gralla
A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29049830/acute-debakey-type-i-aortic-dissection-without-intimal-tear-in-the-arch-is-total-arch-replacement-the-right-choice
#5
Andrea Colli, Massimiliano Carrozzini, Annalisa Francescato, Marco Galuppo, Marina Comisso, Francesca Toto, Dario Gregori, Gino Gerosa
OBJECTIVES: Surgical management of acute DeBakey Type I aortic dissection without intimal tear in the aortic arch is controversial. This study compared short- and long-term outcomes of total arch replacement (TAR) versus limited ascending aorta/hemiarch replacement (no-TAR) in a consecutive series of patients. METHODS: Between January 1998 and December 2015, 220 consecutive patients were operated for DeBakey Type I acute aortic dissection; 135 cases did not exhibit an intimal entry tear in the aortic arch and were subsequently selected to comprise the primary study cohort...
July 31, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29038409/-total-arch-replacement-for-distal-arch-aneurysm-with-isolated-left-vertebral-artery-report-of-a-case
#6
Motonori Uchino, Masaru Yoshikai, Hisashi Sato, Jun Osaki
We herein present a case of distal aortic arch aneurysm with an isolated left vertebral artery(LVA). In surgery, after establishing cardiopulmonary bypass, the LVA was anastomosed to the left common carotid artery (LCCA) while under moderate hypothermia. Selective cerebral perfusion (SCP) was then initiated by inserting catheters into the brachiocephalic artery( BCA), the LCCA and the left subclavian artery (LSA). The aorta was transected between the BCA and the LCCA, and an open stent graft was deployed into the descending aorta during circulatory arrest...
October 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29033392/mechanical-recanalization-in-ischemic-anterior-circulation-stroke-within-an-8-hour-time-window-a-real-world-experience
#7
Dagmar Krajíčková, Antonín Krajina, Roman Herzig, Miroslav Lojík, Vendelín Chovanec, Jan Raupach, Eva Vítková, Jan Waishaupt, Oldřich Vyšata, Martin Vališ
PURPOSE: We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6-8 h/unknown onset time, as only limited data are available for a time window beyond 6 h. METHODS: Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time...
November 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/29032219/emergency-extracranial-intracranial-bypass-to-revascularize-salvageable-brain-tissue-in-acute-ischemic-stroke-patients
#8
Jan-Karl Burkhardt, Sebastian Winklhofer, Jorn Fierstra, Susanne Wegener, Giuseppe Esposito, Andreas Luft, Oliver Bozinov, Luca Regli
INTRODUCTION: To present an algorithm based on clinical and radiological factors including MR perfusion/diffusion mismatch (MR-PDM) for the indication of urgent cerebral bypass in patients with acute ischemic stroke METHODS: Analysis of clinical and radiological data on eight consecutive patients undergoing urgent cerebral revascularization for acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery between 2012 and 2015. All patients were either not eligible or failed first line treatment with emergent endovascular revascularization...
October 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29030748/neuroimaging-of-cavernous-malformations
#9
REVIEW
Maxim Mokin, Siviero Agazzi, Lowell Dawson, Christopher T Primiani
PURPOSE OF REVIEW: Cerebral cavernous malformations (CCMs) are common vascular abnormalities often discovered on imaging as an incidental finding. The most common clinical presentations of CCMs include seizure, headache, focal neurological deficits, and intracranial hemorrhage. This article discusses the most recent guidelines including imaging diagnostic criteria and radiographic standards of CCMs and reviews the utility of currently available imaging techniques. RECENT FINDINGS: Gradient echo T2*-weighted imaging and susceptibility-weighted imaging are the recommended imaging protocols for evaluation of suspected CCMs...
October 13, 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28994833/the-efficacy-and-safety-of-endovascular-recanalization-of-occluded-large-cerebral-arteries-during-the-subacute-phase-of-cerebral-infarction-a-case-series-report
#10
Kangning Chen, Xianhua Hou, Zhenhua Zhou, Guangjian Li, Qu Liu, Li Gui, Jun Hu, Shugui Shi
BACKGROUND: Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke. Due to the short treatment time window (<6 hours) and often treatment failure, these patients would still have an intracranial arterial occlusion (IAO). It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase. In this retrospective study, we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) for IAO in the subacute phase of their stroke...
September 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28984668/brain-heart-interactions-in-traumatic-brain-injury
#11
Ayman El-Menyar, Abhishek Goyal, Rifat Latifi, Hassan Al-Thani, William Frishman
The cardiovascular manifestations associated with nontraumatic head disorders are commonly known. Similar manifestations have been reported in patients with traumatic brain injury (TBI); however, the underlying mechanisms and impact on the patient's clinical outcomes are not well explored. The neurocardiac axis theory and neurogenic stunned myocardium phenomenon could partly explain the brain-heart link and interactions and can thus pave the way to a better understanding and management of TBI. Several observational retrospective studies have shown a promising role for beta-adrenergic blockers in patients with TBI in reducing the overall TBI-related mortality...
November 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28977379/single-centre-experience-with-the-frozen-elephant-trunk-technique-in-251-patients-over-15%C3%A2-years
#12
Malakh Shrestha, Andreas Martens, Tim Kaufeld, Erik Beckmann, Sebastian Bertele, Heike Krueger, Julia Neuser, Felix Fleissner, Fabio Ius, Firas Abd Alhadi, Jasmin Hanke, Jan D Schmitto, Serghei Cebotari, Matthias Karck, Axel Haverich, Ajay Chavan
OBJECTIVES: Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. METHODS: A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis...
November 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28966828/sequential-changes-of-arterial-spin-labeling-perfusion-mr-images-with-dual-postlabeling-delay-following-reconstructive-surgery-for-giant-internal-carotid-artery-aneurysm
#13
Takafumi Shimogawa, Takato Morioka, Tomoaki Akiyama, Sei Haga, Shuji Arakawa, Tetsuro Sayama
BACKGROUND: Arterial spin-labeling magnetic resonance perfusion imaging (ASL-MRI) allows noninvasive measurement of cerebral blood flow (CBF) but depends on arterial transit time (ATT). To overcome this problem, we developed a simple ASL technique with dual postlabeling delay (PLD) settings. In addition to the routinely used PLD of 1.5 seconds, we selected another PLD of 2.5 seconds to assess slowly streaming blood flow and detect arterial transit artifacts (ATAs) resulting from stagnant intravascular magnetically labeled spins...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28965105/incorporation-of-relative-cerebral-blood-flow-into-ct-perfusion-maps-reduces-false-at-risk-penumbra
#14
Shlomi Peretz, David Orion, David Last, Yael Mardor, Yotam Kimmel, Shelly Yehezkely, Eyal Lotan, Ze'ev Itsekson-Hayosh, Sylvia Koton, David Guez, David Tanne
PURPOSE: The region defined as 'at risk' penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true 'at risk' tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false 'at risk' tissue, that is, benign oligaemia. METHODS: Among acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT...
September 30, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28964614/potential-of-contrast-enhanced-ultrasound-as-a-bedside-monitoring-technique-in-cerebral-perfusion-a-systematic-review
#15
REVIEW
Elisabeth J Vinke, Anna J Kortenbout, Jens Eyding, Cornelis H Slump, Johannes G van der Hoeven, Chris L de Korte, Cornelia W E Hoedemaekers
Contrast-enhanced ultrasound (CEUS) has been suggested as a new method to measure cerebral perfusion in patients with acute brain injury. In this systematic review, the tolerability, repeatability, reproducibility and accuracy of different CEUS techniques for the quantification of cerebral perfusion were assessed. We selected studies published between January 1994 and March 2017 using CEUS to measure cerebral perfusion. We included 43 studies (bolus kinetics n = 31, refill kinetics n = 6, depletion kinetics n = 6) with a total of 861 patients...
September 27, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28959477/staged-carotid-artery-angioplasty-and-stenting-for-patients-with-high-grade-carotid-stenosis-with-high-risk-of-developing-hyperperfusion-injury-a-retrospective-analysis-of-44-cases
#16
Dapeng Mo, Gang Luo, Bo Wang, Ning Ma, Feng Gao, Xuan Sun, Xiaotong Xu, Zhongrong Miao
BACKGROUND: Hyperperfusion syndrome (HPS) is a rare but potentially a life-threatening complication after carotid artery angioplasty and stenting (CAS). Staged CAS has been an alternative to prevent HPS. MATERIALS AND METHODS: 44 of 908 patients with high-grade internal carotid artery stenosis or near occlusion were at risk of HPS because of poor collateral flow and impaired cerebral blood flow (CBF). They were treated with first (stage 1), followed by a full CAS (stage 2) 1 month later...
December 2016: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28954997/paralytic-ileus-as-the-first-presentation-in-type-a-acute-aortic-dissection
#17
Naoto Fukunaga, Yasunobu Konishi, Takehiko Matsuo, Yoshiaki Saji, Tadaaki Koyama
A 78-year-old female was referred to our hospital with a diagnosis of type A acute aortic dissection. There was a history of thrombosed aortic dissection six months prior and conservative management has been performed. Enhanced computed tomography showed type A acute aortic dissection with patent false lumen limited to the ascending aorta and ileus of the small intestine. Emergency hemiarch replacement was performed under mild hypothermic circulatory arrest and selective antegrade cerebral perfusion. Due to preoperative paralytic ileus, oral intake was initiated postoperative day four...
2017: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/28949999/automatic-flow-analysis-of-digital-subtraction-angiography-using-independent-component-analysis-in-patients-with-carotid-stenosis
#18
Han-Jui Lee, Jia-Sheng Hong, Chung-Jung Lin, Yi-Hsuan Kao, Feng-Chi Chang, Chao-Bao Luo, Wei-Fa Chu
PURPOSE: Current time-density curve analysis of digital subtraction angiography (DSA) provides intravascular flow information but requires manual vasculature selection. We developed an angiographic marker that represents cerebral perfusion by using automatic independent component analysis. MATERIALS AND METHODS: We retrospectively analyzed the data of 44 patients with unilateral carotid stenosis higher than 70% according to North American Symptomatic Carotid Endarterectomy Trial criteria...
2017: PloS One
https://www.readbyqxmd.com/read/28948072/correlation-of-tmax-volumes-with-clinical-outcome-in-anterior-circulation-stroke
#19
Fatih Seker, Johannes Pfaff, Arne Potreck, Sibu Mundiyanapurath, Peter A Ringleb, Martin Bendszus, Markus A Möhlenbruch
BACKGROUND AND PURPOSE: The recent thrombectomy trials have shown that perfusion imaging is helpful in proper patient selection in thromboembolic stroke. In this study, we analyzed the correlation of pretreatment Tmax volumes in MR and CT perfusion with clinical outcome after thrombectomy. METHODS: Forty-one consecutive patients with middle cerebral artery occlusion (MCA) or carotid T occlusion treated with thrombectomy were included. Tmax volumes at delays of >4, 6, 8, and 10 s as well as infarct core and mismatch ratio were automatically estimated in preinterventional MRI or CT perfusion using RAPID software...
September 2017: Brain and Behavior
https://www.readbyqxmd.com/read/28936173/combining-spect-and-quantitative-eeg-analysis-for-the-automated-differential-diagnosis-of-disorders-with-amnestic-symptoms
#20
Yvonne Höller, Arne C Bathke, Andreas Uhl, Nicolas Strobl, Adelheid Lang, Jürgen Bergmann, Raffaele Nardone, Fabio Rossini, Harald Zauner, Margarita Kirschner, Amirhossein Jahanbekam, Eugen Trinka, Wolfgang Staffen
Single photon emission computed tomography (SPECT) and Electroencephalography (EEG) have become established tools in routine diagnostics of dementia. We aimed to increase the diagnostic power by combining quantitative markers from SPECT and EEG for differential diagnosis of disorders with amnestic symptoms. We hypothesize that the combination of SPECT with measures of interaction (connectivity) in the EEG yields higher diagnostic accuracy than the single modalities. We examined 39 patients with Alzheimer's dementia (AD), 69 patients with depressive cognitive impairment (DCI), 71 patients with amnestic mild cognitive impairment (aMCI), and 41 patients with amnestic subjective cognitive complaints (aSCC)...
2017: Frontiers in Aging Neuroscience
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