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https://www.readbyqxmd.com/read/28442330/symptomatic-carotid-artery-disease-revascularization
#1
REVIEW
Piero Montorsi, Stefano Galli, Paolo M Ravagnani, Marco Roffi
Patients with symptomatic carotid artery disease should be managed by a multidisciplinary team including neurologists, vascular surgeons and interventionalists. Duplex ultrasound is the most widely used diagnostic modality to assess carotid disease, followed by additional imaging tests (CT- or MR-angiography) to confirm the severity of the stenosis, detect brain lesions, and assess intracranial circulation as well as the supra-aortic anatomy. Although overall randomized trial results favored (CEA) over carotid artery stenting (CAS) in symptomatic patients, this was likely related to the insufficient expertise of the endovascular specialists in several of the trials...
April 22, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28436268/collateral-circulation-alters-downstream-hemodynamic-stress-caused-by-intracranial-atherosclerotic-stenosis
#2
Xin Liu, David Dornbos, Yuehua Pu, Xinyi Leng, Ligang Song, Baixue Jia, Yuesong Pan, David Wang, Zhongrong Miao, Yilong Wang, Liping Liu, Yongjun Wang
OBJECTIVES: Fractional flow reserve (FFR) accurately predicts the degree of stenosis and is now widely used to identify clinically significant severe coronary artery lesions. In the current study, we utilized a similar indicator, fractional flow (FF), to determine the hemodynamic impact of symptomatic intracranial atherosclerotic stenosis (ICAS) and to assess the correlation of FF with the severity of stenosis and collateral circulation. METHODS: Patients with symptomatic ICAS (70-99% stenosis) confirmed on digital subtraction angiography (DSA) were consecutively recruited...
April 23, 2017: Neurological Research
https://www.readbyqxmd.com/read/28434956/superficial-temporal-artery-middle-cerebral-artery-bypass-surgery-for-refractory-symptomatic-intracranial-atherosclerotic-stenosis
#3
Yan Ma, Fan Yang, Liqun Jiao, Meng Li, Yabing Wang, Yanfei Chen, Feng Ling
OBJECTIVE: To evaluate blood flow changes following bypass surgery for refractory symptomatic intracranial atherosclerotic stenosis. METHODS: We examined a cohort of consecutive patients with symptomatic ICAS. STA-MCA bypass was performed in refractory patients with poor perfusion. Angiograms were graded systematically for antegrade, collateral, and bypass flow, and clinical variables were collected preoperatively, and at 7 days, and 3, 6, and 12 months postoperatively...
April 18, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28431144/effect-of-body-mass-index-on-venous-sinus-pressures-in-idiopathic-intracranial-hypertension-patients-before-and-after-endovascular-stenting
#4
Daniel M S Raper, Dale Ding, Thomas J Buell, R Webster Crowley, Robert M Starke, Kenneth C Liu
BACKGROUND: Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes...
April 20, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28424443/case-report-of-a-rarely-seen-long-segment-middle-aortic-syndrome
#5
Kahraman Yakut, İlkay Erdoğan
Middle aortic syndrome (MAS) follows a course with distal thoracic and abdominal aorta stenosis. It is a rare disease that is usually diagnosed after the first decade of life. Clinical reflection of MAS is often in the form of hypertension and claudication in the lower extremities. Its etiology is unclear, but is known to be associated with congenital or acquired diseases. This pathology, which is accompanied by malignant hypertension, often does not respond to medical treatment. In patients with MAS, surgical treatment is first line recommendation to prevent complications such as hypertension, heart failure, intracranial bleeding, or aortic rupture...
March 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28416412/successful-treatment-of-symptomatic-intracranial-carotid-artery-stenosis-using-a-24-mm-long-bare-metal-coronary-stent
#6
Azeem A Rehman, Ryan C Turner, Brandon P Lucke-Wold, SoHyun Boo
BACKGROUND: Intracranial arterial atherosclerosis represents a common cause of stroke. Despite aggressive and optimal medical management, many patients will unfortunately suffer additional cerebrovascular events. The role of endovascular intervention for intracranial atherosclerotic disease continues to be uncertain, particularly in regard to extensive, symptomatic stenosis. CASE DESCRIPTION: We present a case of a 42-year-old male with a complex medical history who presented with recurrent ischemic stroke in the ipsilateral hemisphere despite optimal medical management...
April 14, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28412909/prolonged-perfusion-predicts-recurrent-ischemic-stroke-but-not-transient-ischemic-attack-in-patients-with-symptomatic-intracranial-stenosis
#7
Linfang Lan, Xinyi Leng, Vincent Ip, Thomas Leung, Yannie Soo, Jill Abrigo, Ka Sing Wong
BACKGROUND: Intracranial arterial stenosis (ICAS) is the dominant cause for ischemic stroke worldwide, with hemodynamic compromise as a crucial contributor. Prolonged perfusion is commonly observed in ICAS patients on CT perfusion (CTP) maps, while the clinical significance of this perfusion pattern has not been elucidated. METHODS: Patients having symptomatic ICAS of 50-99% stenosis with sustained downstream cerebral blood flow (CBF) were enrolled into this study...
April 13, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28411747/the-impact-of-carotid-or-intracranial-atherosclerosis-on-perioperative-stroke-in-patients-undergoing-open-aortic-arch-surgery
#8
Ken-Ichi Imasaka, Eiki Tayama, Yukihiro Tomita
OBJECTIVES: This study aimed to clarify the impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. METHODS: Between 2008 and 2015, 200 consecutive patients underwent elective aortic arch surgery with selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Nonselective screening for carotid or intracranial atherosclerosis was performed using carotid ultrasonography or magnetic resonance angiography...
May 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28400985/spanning-from-the-west-to-east-an-updated-review-on-endovascular-treatment-of-intracranial-atherosclerotic-disease
#9
REVIEW
Mohammed Hussain, Neil Datta, Zhe Cheng, David Dornbos, Asif Bashir, Ibrahim Sultan, Tapan Mehta, Faris Shweikeh, Paul Mazaris, Nora Lee, Amre Nouh, Xiaokun Geng, Yuchuan Ding
Ischemic stroke is a major cause of morbidity and mortality, incurring significant cost. Intracranial atherosclerotic disease (ICAD) accounts for 10-15% of ischemic stroke in Western societies, but is an underlying pathology in up to 54% of ischemic strokes in Asian populations. ICAD has largely been treated with medical management, although a few studies have examined outcomes following endovascular treatment. Our objective was to summarize the major trials that have been performed thus far in regard to the endovascular treatment of ICAD and to provide direction for future management of this disease process...
April 2017: Aging and Disease
https://www.readbyqxmd.com/read/28400903/neurosarcoidosis-presenting-with-recurrent-strokes-a-case-report-and-literature-review
#10
Naheed Raza, Karisa C Schreck
Neurosarcoidosis is a rare but important cause of stroke as it is treatable. Cases reported thus far have primarily been in young people who are relatively healthy. Here we report the case of a 73-year-old woman presenting with recurrent strokes and high-grade intracranial stenosis caused by probable neurosarcoidosis. This is unique as neurosarcoidosis is not usually considered as an etiology for recurrent strokes in our patient's age-group. We review and categorize published cases of neurosarcoidosis causing stroke and describe a classification scheme for certainty of diagnosis...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28388675/impact-of-mca-stenosis-on-the-early-outcome-in-acute-ischemic-stroke-patients
#11
Jiann-Shing Jeng, Fang-I Hsieh, Hsu-Ling Yeh, Wei-Hung Chen, Hou-Chang Chiu, Sung-Chun Tang, Chung-Hsiang Liu, Huey-Juan Lin, Shih-Pin Hsu, Yuk-Keung Lo, Lung Chan, Chih-Hung Chen, Ruey-Tay Lin, Yu-Wei Chen, Jiunn-Tay Lee, Chung-Hsin Yeh, Ming-Hui Sun, Ta-Chang Lai, Yu Sun, Mu-Chien Sun, Po-Lin Chen, Tsuey-Ru Chiang, Shinn-Kuang Lin, Bak-Sau Yip, Chin-I Chen, Chi-Huey Bai, Sien-Tsong Chen, Hung-Yi Chiou, Li-Ming Lien, Chung Y Hsu
BACKGROUND: Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). METHODS: Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively...
2017: PloS One
https://www.readbyqxmd.com/read/28385886/preliminary-experience-with-stent-assisted-coiling-of-aneurysms-arising-from-small-2-5-mm-cerebral-vessels-using-the-low-profile-visualized-intraluminal-support-device
#12
C-C Wang, W Li, Z-Z Feng, B Hong, Y Xu, J-M Liu, Q-H Huang
BACKGROUND AND PURPOSE: The Low-Profile Visualized Intraluminal Support (LVIS) stent is a new device recently introduced for the treatment of wide-neck intracranial aneurysms. This single-center study presents the authors' preliminary experience using the LVIS stent to treat saccular aneurysms with parent arteries smaller than 2.5 mm. MATERIALS AND METHODS: Aneurysms with a LVIS stent used in a small parent vessel (<2.5 mm in diameter) between October 2014 and April 2016 were included...
April 6, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28383307/the-thrombolytic-effect-of-diagnostic-ultrasound-induced-microbubble-cavitation-in-acute-carotid-thromboembolism
#13
Thomas R Porter, Feng Xie, John Lof, Jeffry Powers, Francois Vignon, William Shi, Matthew White
BACKGROUND: Acute ischemic stroke is often due to thromboembolism forming over ruptured atherosclerotic plaque in the carotid artery (CA). The presence of intraluminal CA thrombus is associated with a high risk of thromboembolic cerebral ischemic events. The cavitation induced by diagnostic ultrasound high mechanical index (MI) impulses applied locally during a commercially available intravenous microbubble infusion has dissolved intravascular thrombi, especially when using longer pulse durations...
April 5, 2017: Investigative Radiology
https://www.readbyqxmd.com/read/28377257/special-endovascular-treatment-for-acute-large-artery-occlusion-resulting-from-atherosclerotic-disease
#14
Ting-Yu Yi, Wen-Huo Chen, Yan-Min Wu, Mei-Fang Zhang, Yue-Hong Chen, Zong-Zhong Wu, Yan-Chuan Shi, Bai-Ling Chen
BACKGROUND: and Purpose: Acute intracranial atherosclerotic disease (IAD)-related large artery occlusion (LAO) is typically refractory to mechanical thrombectomy. We evaluated the feasibility and safety of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration for acute IAD-related LAO. METHODS: We identified, from among 55 consecutive patients who underwent endovascular treatment for LAO, 12 patients with acute IAD-related LAO who underwent balloon-assisted or stent-assisted angioplasty with (n = 3) or without passage of a stent retriever...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28373708/association-between-high-density-lipoprotein-cholesterol-levels-and-the-prevalence-of-asymptomatic-intracranial-arterial-stenosis
#15
Xin Li, Anxin Wang, Jing Wang, Jianwei Wu, Dandan Wang, Xiang Gao, Shouling Wu, Xingquan Zhao
Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke, and a low level of high-density lipoprotein cholesterol (HDL-C) is also considered to be a predictor for stroke. However, the association between the HDL-C level and asymptomatic ICAS is uncertain. From 2010 to 2011, a random sample of 5,351 participants were enrolled in the Asymptomatic Polyvascular Abnormalities Community (APAC) study. The recruited participants were then separated into 5 roughly uniform-sized factions with varying HDL-C levels...
April 3, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28368084/neurovascular-ultrasound-in-emergency-settings-diagnostic-and-therapeutic-aspects
#16
REVIEW
T Santos, M Veloso, P Barros
INTRODUCTION: Neurovascular ultrasound is a non-invasive, portable and fast imaging method that, when performed by an experienced neurosonologist, offers reliable and reproducible information on the morphological and hemodynamic status of cervical and intracranial vessels. AIM: To review the available evidence regarding the use of this tool in the approach to acute stroke. DEVELOPMENT: Neurovascular ultrasound can be used in one of two ways: diagnostic and therapeutic...
April 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28367905/4d-flow-mr-imaging-of-ophthalmic-artery-flow-in-patients-with-internal-carotid-artery-stenosis
#17
Tetsuro Sekine, Ryo Takagi, Yasuo Amano, Yasuo Murai, Erika Orita, Yoshimitsu Fukushima, Yoshio Matsumura, Shin-Ichiro Kumita
BACKGROUND AND PURPOSE: To assess the clinical feasibility of time-resolved three-dimensional phase contrast (4D Flow) magnetic resonance imaging (MRI) assessment of the ophthalmic artery (OphA) flow in patients with internal carotid artery stenosis (ICS). MATERIALS AND METHODS: Twenty-one consecutive patients with unilateral ICS were recruited. 4D Flow MRI and acetazolamide-stress brain perfusion single photon emission computed tomography (SPECT) were performed...
March 27, 2017: Magnetic Resonance in Medical Sciences: MRMS
https://www.readbyqxmd.com/read/28362885/long-term-clinical-and-angiographic-outcomes-following-pipeline-embolization-device-treatment-of-complex-internal-carotid-artery-aneurysms-five-year-results-of-the-pipeline-for-uncoilable-or-failed-aneurysms-trial
#18
Tibor Becske, Waleed Brinjikji, Matthew B Potts, David F Kallmes, Maksim Shapiro, Christopher J Moran, Elad I Levy, Cameron G McDougall, István Szikora, Giuseppe Lanzino, Henry H Woo, Demetrius K Lopes, Adnan H Siddiqui, Felipe C Albuquerque, David J Fiorella, Isil Saatci, Saruhan H Cekirge, Aaron L Berez, Daniel J Cher, Zsolt Berentei, Miklós Marosfoi, Peter K Nelson
BACKGROUND: Early and mid-term safety and efficacy of aneurysm treatment with the Pipeline Embolization Device (PED) has been well demonstrated in prior studies. OBJECTIVE: To present 5-yr follow-up for patients treated in the Pipeline for Uncoilable or Failed Aneurysms clinical trial. METHODS: In our prospective, multicenter trial, 109 complex internal carotid artery (ICA) aneurysms in 107 subjects were treated with the PED. Patients were followed per a standardized protocol at 180 d and 1, 3, and 5 yr...
January 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28360352/intracranial-venous-pressures-under-conscious-sedation-and-general-anesthesia
#19
Daniel M S Raper, Thomas J Buell, Ching-Jen Chen, Dale Ding, Robert M Starke, Kenneth C Liu
INTRODUCTION: Venous outflow obstruction has been implicated in the pathophysiology of a subset of patients with idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as an effective treatment. However, the effect of anesthesia on venous sinus pressure measurements is unpredictable. A more thorough understanding of the effect of the level of anesthesia on intracranial venous pressures might help to better define patients who might benefit most from stent placement...
March 30, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28357169/low-profile-visualized-intraluminal-support-junior-device-for-the-treatment-of-intracranial-aneurysms
#20
Mihir Gupta, Vincent J Cheung, Peter Abraham, Arvin R Wali, David R Santiago-Dieppa, Brandon C Gabel, Abdulrahman Almansouri, J Scott Pannell, Alexander A Khalessi
OBJECTIVE: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. METHODS: We retrospectively reviewed records of patients treated with the LVIS Jr...
February 17, 2017: Curēus
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