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Mid-cerebral artery occlusion

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
Prasham Dave, Cheemun Lum, Rebecca Thornhill, Santanu Chakraborty, Dar Dowlatshahi
PURPOSE: Parenchymal hypoattenuation distal to occlusions on CTA source images (CTASI) is perceived because of the differences in tissue contrast compared to normally perfused tissue. This difference in conspicuity can be measured objectively. We evaluated the effect of contrast timing on the conspicuity of ischemic areas. METHODS: We collected consecutive patients, retrospectively, between 2012 and 2014 with large vessel occlusions that had dynamic multiphase CT angiography (CTA) and CT perfusion (CTP)...
May 2017: Neuroradiology
Taichiro Imahori, Kazuhiro Tanaka, Junji Koyama, Atsushi Arai, Ryoji Shiomi, Hirofumi Iwahashi, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1-M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups...
March 15, 2017: Neurologia Medico-chirurgica
Alexandra S Gersing, Benedikt J Schwaiger, Justus F Kleine, Johannes Kaesmacher, Silke Wunderlich, Benjamin Friedrich, Sascha Prothmann, Claus Zimmer, Tobias Boeckh-Behrens
BACKGROUND: This study aimed to analyze the effects of technical outcome of mechanical thrombectomy (MTE) on the associations between collateral status, assessed with pretreatment computed tomography angiography (CTA), and neurological and functional outcome, as well as associations between collaterals and metabolic risk factors (arterial hypertension, diabetes, hyperlipidemia, overweight). METHODS: Prospectively collected data of 115 patients with CTA-proven isolated middle cerebral artery occlusion treated successfully with MTE (Thrombosis in Cerebral Infarction [TICI] scale 2b or 3) were assessed retrospectively...
November 14, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Felix Ulbrich, Ulrich Goebel
The noble gas argon has attracted increasing attention in recent years, especially because of its neuroprotective properties. In a variety of models, ranging from oxygen-glucose deprivation in cell culture to complex models of mid-cerebral artery occlusion, subarachnoid hemorrhage or retinal ischemia-reperfusion injury in animals, argon administration after individual injury demonstrated favorable effects, particularly increased cell survival and even improved neuronal function. As an inert molecule, argon did not show signs of adverse effects in the in vitro and in vivo model used, while being comparably cheap and easy to apply...
October 31, 2016: International Journal of Molecular Sciences
Fadhel Alomar, Jaipaul Singh, Hee-Seong Jang, George J Rozanzki, Chun Hong Shao, Babu J Padanilam, William G Mayhan, Keshore R Bidasee
BACKGROUND AND PURPOSE: Endothelial cell-mediated vasodilatation of cerebral arterioles is impaired in individuals with Type 1 diabetes (T1D). This defect compromises haemodynamics and can lead to hypoxia, microbleeds, inflammation and exaggerated ischaemia-reperfusion injuries. The molecular causes for dysregulation of cerebral microvascular endothelial cells (cECs) in T1D remains poorly defined. This study tests the hypothesis that cECs dysregulation in T1D is triggered by increased generation of the mitochondrial toxin, methylglyoxal, by smooth muscle cells in cerebral arterioles (cSMCs)...
September 9, 2016: British Journal of Pharmacology
Francesco Briganti, Giuseppe Leone, Lorenzo Ugga, Mariano Marseglia, Antonio Macera, Andrea Manto, Luigi Delehaye, Maurizio Resta, Mariachiara Resta, Nicola Burdi, Nunzio Paolo Nuzzi, Ignazio Divenuto, Ferdinando Caranci, Mario Muto, Domenico Solari, Paolo Cappabianca, Francesco Maiuri
BACKGROUND: Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device. METHODS: 40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed. RESULTS: Complete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%)...
January 2017: Journal of Neurointerventional Surgery
Sophie Merckelbach, Tesse Leunissen, Joyce Vrijenhoek, Frans Moll, Gerard Pasterkamp, Gert Jan de Borst
BACKGROUND: Following carotid endarterectomy (CEA), cerebrovascular hemodynamic may be hampered by ipsilateral restenosis or development of contralateral stenosis. It remains to be clarified if these patients need follow-up for identifying development of contralateral stenosis. Identification of risk factors contributing to development of contralateral stenosis could allow more specific follow-up. In this current study, we assessed clinical risk factors and plaque characteristics of patients undergoing CEA with development of new contralateral stenosis during mid-term follow-up...
2016: Cerebrovascular Diseases
Kara A Sands, Reza Bavarsad Shahripour, Gyanendra Kumar, Kristian Barlinn, Michael J Lyerly, Michal Haršány, Joel Cure, Yuri L Yakov, Anne W Alexandrov, Andrei V Alexandrov
BACKGROUND: Isolated central facial palsy (I-CFP) is attributed to a lacunar syndrome affecting the corona radiata region or pons. We examined our acute stroke registry for patients presenting with I-CFP and localized their symptoms to a vascular lesion. SUBJECT & METHODS: Our database of consecutive patients with symptoms of acute cerebral ischemia admitted from January 2008 to December 2012 was reviewed for NIH Stroke Scale (NIHSS) scores and subcomponents. All patients with I-CFP ± dysarthria (total NIHSS ≤ 3) had contrast-enhanced MR-angiography and transcranial Doppler as standard of care...
September 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Matthew Boyko, Ahmad Nassar, Jacob Kaplanski, Alexander Zlotnik, Yael Sharon-Granit, Abed N Azab
Stroke is a leading cause of mortality and morbidity worldwide. Few therapeutic options with proven efficacy are available for the treatment of this disabling disease. Lithium is the gold standard treatment for bipolar disorder. Moreover, lithium has been shown to exhibit neuroprotective effects and therapeutic efficacy as a treatment of other neurological disorders. This study was undertaken to examine the effects of lithium on brain inflammatory mediators levels, fever, and mortality in postischemic stroke rats...
2015: BioMed Research International
Büşra Yurtsever, Murat Çabalar, Hakan Kaya, Betül Tuğcu, Zahide Mine Yazıcı, Vildan Yayla
Susac's syndrome is a rare autoimmune disease, which is characterized by microangiopathic changes that affects the brain, retina, and cochlea. It is mainly characterized by asymptomatic cerebral infarctions, low-and mid-frequency sensorineural hearing loss, and bilateral distal retinal artery occlusions. Otolaryngologists should be familiar with Susac's syndrome because hearing loss may be the initial presenting symptom. The recommended treatment options vary from antithrombotic to immunomodulatory drugs. Although in its early stage, remission from the disease or self-limiting clinical course may be observed...
August 2015: Journal of International Advanced Otology
Wonhyoung Park, Do Hoon Kwon, Jae Sung Ahn, Sung Ho Lee, Jung Cheol Park, Byung Duk Kwun
BACKGROUND: Dissecting aneurysms of the posterior cerebral artery (PCA) are rare and difficult to treat because of their deep and unfamiliar locations and unusual shapes. Although several treatment modalities have been proposed, none have generated satisfying results. Our experiences with PCA-dissecting aneurysms are reviewed and the treatment strategies discussed. METHODS: All consecutive patients with PCA-dissecting aneurysm who were treated in a tertiary referral hospital between January 1998 and March 2014 were identified by retrospective review...
October 2015: Acta Neurochirurgica
Sanjith Aaron, Sunithi Mani, A T Prabhakar, K Karthik, Anil Kumar B Patil, P Suresh Babu, Mathew Alexander
BACKGROUND: Strokes caused by normal variants of the cerebral circulation can be difficult to diagnose, hence a high index of suspicion is needed. This case series discusses the clinical and radiological aspects of one such stroke caused by occlusion of the artery of Percheron (AOP). MATERIALS AND METHODS: Computerized discharge summaries, outpatient records and imaging from picture archiving and communication system (PACS, GE), of patients with AOP infarction over a period of 12-years (2002-2014) were identified and their clinical and radiological features analyzed...
July 2015: Neurology India
Justus F Kleine, Tobias Boeckh-Behrens, Sascha Prothmann, Claus Zimmer, Thomas Liebig
BACKGROUND: Stroke in aged patients has a relatively poor prognosis, even after recanalizing therapy. Potential reasons include mechanisms that relate directly to the extent of brain tissue damage, but also age-dependent factors which are not, or only indirectly, stroke-related, such as pre-existing functional deficits, comorbidities, and post-stroke complications (eg, infections). OBJECTIVE: To compare early neurological course with subsequent functional outcome in older (≥80 years) and younger stroke patients in order to estimate the relative impact of these factors...
July 2016: Journal of Neurointerventional Surgery
Anna Luisa Kühn, Samuel Y Hou, Ajit S Puri, Christine F Silva, Matthew J Gounis, Ajay K Wakhloo
BACKGROUND: Stent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm). OBJECTIVE: To present our experience with stents approved for SACE in aneurysms with small parent arteries. METHODS: All patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified...
June 2016: Journal of Neurointerventional Surgery
Friedhelm Brassel, Katharina Melber, Martin Schlunz-Hendann, Dan Meila
INTRODUCTION: Y-configured stent assisted coiling is a promising therapeutic option to ensure safe coil embolization and preserve the affected arteries in complex wide necked aneurysms. We present our experience with self-expanding Acandis Acclino stents for the treatment of complex aneurysms using the kissing-Y technique. METHODS: We retrospectively reviewed seven patients with seven complex aneurysms (three anterior communicating artery (AcomA), two middle cerebral artery, one basilar artery/superior cerebellar artery, and one vertebral artery/posterior inferior cerebellar artery) who were treated with the kissing-Y technique by stent assisted coiling from June 2013 to July 2014, with follow-up until January 2015...
April 2016: Journal of Neurointerventional Surgery
Sudhir Datar, Giuseppe Lanzino, Alejandro A Rabinstein
BACKGROUND: Acute basilar artery occlusion is associated with poor outcome. In a few cases, occlusion occurs over a period allowing adequate collateral circulation to the posterior fossa. We describe a rare presentation with transient loss of consciousness (LOC) in a patient with extensive occlusion of the posterior circulation. METHODS: Case report. RESULTS: We describe a 70-year-old right-handed man with a history significant for atrial fibrillation and dolichoectasia of the basilar artery...
July 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Diogo C Haussen, Sushrut S Dharmadhikari, Brian Snelling, Vasileios-Arsenios Lioutas, Ajith Thomas, Eric C Peterson, Mohamed Samy Elhammady, Mohammad Ali Aziz-Sultan, Dileep R Yavagal
BACKGROUND: We aimed to evaluate if vertebrobasilar anatomic variations impact reperfusion and outcome in intra-arterial therapy (IAT) for basilar artery occlusion (BAO). METHODS: Consecutive BAO patients with symptom onset <24 h treated with IAT were included. Vertebral artery (VA) V3 and posterior communicating artery (PCoA) diameters were measured (CT angiography or MR angiography). The presence of PCoA atresia, VA hypoplasia, VAs that end in the posterior inferior cerebellar artery (PICA), and extracranial VA occlusion was recorded...
December 2015: Journal of Neurointerventional Surgery
Jian-Lie Yuan, Xiang Bao, Wei Zhang, Qiu-Qin Shi, Xiao-Bo Liu
PURPOSE: The aim of this study was to evaluate the feasibility of endovascular treatment (EVT) for unruptured small wide-necked ophthalmic segment aneurysms (OSAs) of the internal carotid artery (ICA). MATERIALS AND METHODS: Between January 2010 and May 2013, 17 patients with 19 unruptured small wide-necked OSAs received EVT. Occlusion rates were classified as total/near-total (95-100%), subtotal (80-95%) and partial (<80%) occlusions. This was determined by immediate and follow-up angiography...
November 2013: Neurology India
Fotis A Markatis, George S Sfyroeras, Konstantinos G Moulakakis, John Kakisis, Elias N Brountzos, Christos D Liapis
BACKGROUND: High-grade stenoses of both common (CCA) and the internal (ICA) carotid arteries are rare and represent a therapeutic dilemma for the treating physician. The aim of this article is to present our experience with fully endovascular repair of those lesions. METHODS: Between January 2011 and December 2012, 5 patients (all male, age 73.6 years) with concomitant CCA and ICA stenoses were treated endovascularly. All patients were asymptomatic. The lesions involved the left carotid in 3 and the right carotid in 2 cases...
July 2014: Annals of Vascular Surgery
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