1/89. Cerebral angioplasty and stenting for intracranial vertebral atherosclerotic stenosis.A 72-year-old man underwent cerebral angioplasty and stenting for a high-grade eccentric atherosclerotic stenosis (93%) of the right intracranial vertebral artery. The lesion was sufficiently and smoothly dilated very easily with the use of a highly flexible, balloon-expandable coronary stent. No complications occurred during or after the procedure. This therapeutic option may prove to be a safe and useful means to resolve an intracranial atherosclerotic stenosis.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/89. Atherosclerotic superficial temporal artery aneurysm: report of a case.We herein report a rare case of an atherosclerotic superficial temporal artery (STA) aneurysm. The patient was a 34-year-old Japanese man. He noticed a throbbing swelling just in front of his right ear, which had slowly increased in size. There was no history of trauma. Digital subtraction angiography and ultrasound revealed an aneurysm measuring 2cm in diameter fed by STA. A ligation and resection were performed under local anesthesia. The recovery period was uneventful. A microscopic examination revealed a moderate degree of atherosclerosis. We found 48 cases of STA aneurysm in the Japanese literature from 1969 to 1997, including our case. Thirty-six of these cases (75.0%) were considered to be traumatic in origin. Three cases (6.2%) occurred after a craniotomy. To date, only nine reported cases (18.8%) have been attributed to a spontaneous or congenital etiology.- - - - - - - - - - ranking = 32.571941049326keywords = atherosclerosis, artery (Clic here for more details about this article) |
3/89. Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience.OBJECT: patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty. methods: Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively. CONCLUSIONS: Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.- - - - - - - - - - ranking = 111.2877641973keywords = atherosclerosis, artery (Clic here for more details about this article) |
4/89. Elective stenting of symptomatic middle cerebral artery stenosis.Percutaneous balloon angioplasty has been found to be useful for the treatment of intracranial atherosclerotic arterial stenosis. Nonetheless, an ongoing risk of this procedure is arterial dissection, which increases the hazards of acute closure, stroke, and restenosis. Stenting of the intracranial vasculature recently has been shown to be feasible in a variety of circumstances. To our knowledge, however, stenting of the middle cerebral artery has not been possible until now primarily because of difficulty with tracking stents across the carotid siphon. We describe the successful treatment of a symptomatic middle cerebral artery stenosis achieved using a balloon-expandable flexible coronary stent.- - - - - - - - - - ranking = 15.697329349649keywords = carotid, artery (Clic here for more details about this article) |
5/89. Complicated stent supported cerebrovascular angioplasty: case analyses and review of literature.BACKGROUND: Hemodynamic lesions of the cervicocerebral vasculature are currently being treated with stent supported percutaneous transluminal angioplasty. These procedures have met with increasing success when compared to the risks and morbidity of more invasive surgical approaches. The versatility of stent-supported angioplasty as a primary therapeutic modality is examined in the following complex cases. CASE DESCRIPTION: We present four cases involving cervical angioplasty with emergent or adjunctive stent placement. Two cases involved the subclavian arteries, whereas the others involved the vertebral and internal carotid arteries. In our experience, complications of cervicocerebral artery angioplasty have been successfully managed by stent placement. CONCLUSION: Our cases demonstrate the emerging role of cervical angioplasty and stent implantation as a successful therapeutic modality, highlighted in these complex cases.- - - - - - - - - - ranking = 10.697329349649keywords = carotid, artery (Clic here for more details about this article) |
6/89. pathology of a dissecting intracranial aneurysm.The pathological findings of six autopsy cases of dissecting intracranial aneurysm are studied. Clinically, all cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited rupture of the vertebral artery and subarachnoid hemorrhage. Two types of lesion were present. First, all cases showed the formation of a dilatated pseudoaneurysm with widespread disruption of the entire arterial wall, which was composed of thin adventitia. Second, a medial disruption of the arterial wall and subadventitial dissecting hemorrhage, which formed a false lumen and stenosis of the 'true' lumen of the artery, was also found. However, these lesions were found to be connected to the site of rupture. The autopsy cases within 1 day of onset of intracranial dissecting aneurysm showed the formation of fibrin thrombus, a marked degree of leukocyte infiltration and necrosis of the arterial wall at the site of the lesion. The cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration. No arteriosclerosis was found in any lesion studied. These data suggest that the disruption of the entire arterial wall might initially occur and cause medial disruption and subadventitial hemorrhage. hypertension and arteriosclerosis might function as causal and protective factors in the pathogenesis of dissecting intracranial aneurysms, respectively.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
7/89. radiation induced vascular injury after stereotactic radiosurgery for trigeminal neuralgia: case report.BACKGROUND: Stereotactic radiosurgery is increasingly used for the treatment of medically unresponsive trigeminal neuralgia. CASE DESCRIPTION: We present the case of a 69-year-old man with trigeminal neuralgia who underwent stereotactic radiosurgery after a failed balloon compression procedure. The radiosurgery also failed to provide the patient with any significant pain relief, and microvascular decompression of the trigeminal nerve was performed 10 months later. At operation, two adjacent veins and the superior cerebellar artery were noted to have focal changes consistent with atheromatous disease. CONCLUSION: We postulate that the recent radiation exposure resulted in the observed vascular injury. As a result, patients having trigeminal neuralgia radiosurgery need to be followed carefully for possible delayed ischemic events secondary to radiation-induced vascular injury.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
8/89. Rapidly progressive stroke in a young adult with very low high-density lipoprotein cholesterol.Ischemic strokes can affect young adults (15-45 years old). Most such strokes are caused by cardioembolic events, small vessel disease, or illicit drug use, and less frequently by large vessel atherosclerosis. Large vessel cerebral atherosclerosis is usually associated with high levels of low-density lipoprotein (LDL) cholesterol, but a low level of high-density lipoprotein (HDL) is also a risk factor for ischemic strokes. The magnitude of increased risk is unclear, particularly with extremely low HDL levels found only in various genetic and inherited disorders. Advanced atherosclerosis developed in the patient in this study, with HDL of 3 mg/dL, leading to rapidly progressive stroke with a fatal outcome. The disease primarily affected the posterior circulation. The course of this case illustrates that very low HDL may be associated with advanced cerebrovascular atherosclerosis and fatal stroke, and as such should be considered in young individuals with stroke.- - - - - - - - - - ranking = 110.2877641973keywords = atherosclerosis (Clic here for more details about this article) |
9/89. Progressive intracranial vascular disease with strokes and seizures in a boy with progeria.progeria, a rare genetic disorder, is characterized by severe growth failure, premature aging, and very early atherosclerosis with coronary artery and cerebrovascular disease. There has been no detailed description of progressive cerebrovascular changes in progeria or any attempted neurologic correlation of those changes. A 5-year-old boy developed signs of progeria at 4 months and hypertension at 4 years, treated with atenolol and dipyridamole. Left-sided seizures with a left hemiparesis occurred at 5 years. magnetic resonance imaging (MRI) showed bilateral acute, subacute, and chronic cerebral infarctions. magnetic resonance angiography disclosed severe stenosis of the left internal carotid artery. The child was also found to have an aortic valve vegetation and was anticoagulated. He subsequently developed right-sided seizures, and treatment with gabapentin was started. Later, severe stenosis also of the right internal carotid artery was found. MRI showed new left cerebral infarction. The child's neurologic symptoms almost certainly were caused by cerebral infarctions from progressive atherosclerosis of major intracranial vessels, but clinical-neuroradiologic correlations were imprecise. There were multiple cerebral infarctions of different ages, some asymptomatic, others ipsilateral to the child's neurologic findings. No therapy has halted progression of the child's cerebrovascular disease.- - - - - - - - - - ranking = 94.916298652115keywords = atherosclerosis, carotid, carotid artery, artery (Clic here for more details about this article) |
10/89. Hyperperfusion phenomenon after percutaneous transluminal angioplasty for atherosclerotic stenosis of the intracranial vertebral artery. Case report.The authors report on a patient who underwent percutaneous transluminal angioplasty (PTA) for stenosis of the intracranial vertebral artery (VA). This 67-year-old man's dizziness while walking was caused by infarction of the left cerebellar peduncle. On angiograms, his left VA manifested 90% stenosis at the intracranial portion and his right VA ended at the posterior inferior cerebellar artery. Because single-photon emission computerized tomography (SPECT) showed low perfusion and poor perfusion reserve in the posterior circulation, the authors performed PTA of the left VA, which was only 35% dilated due to stenosis. Although the patient's postoperative course was uneventful, postoperative hemodynamic studies (SPECT and transcranial Doppler [TCD] ultrasonography) revealed the hyperperfusion phenomenon. A 100% increase of regional cerebral blood flow in the posterior circulation was demonstrated on SPECT studies and TCD ultrasonography revealed a doubling of blood flow velocity in the VA compared with preoperative values. Careful control of the patient's blood pressure resulted in resolution of the hyperperfusion phenomenon within I week post-PTA. Although hyperperfusion syndrome following carotid endarterectomy is not rare, it is seldom seen after reconstruction of the posterior circulation, and the possibility of its occurrence must be kept in mind when the posterior circulation is reconstructed.- - - - - - - - - - ranking = 15.697329349649keywords = carotid, artery (Clic here for more details about this article) |
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