1/90. Cerebral microembolus generation in different extracorporeal circulation systems.Microemboli generated during extracorporeal circulation (ECC) are likely to induce neurological sequelae. This study examines whether the choice of a distinct type of ECC can reduce intracerebral emboli counts. middle cerebral artery blood flow during coronary artery bypass grafting was monitored continuously by transcranial Doppler ultrasound in 45 patients. The ECC systems used were a roller pump (n = 16), a centrifugal pump (n = 18) and a combination of centrifugal pump and heparin-coated ECC system (n = 11). patients' characteristics as well as surgical and anesthesiological procedure did not differ between the groups. Total counts did not differ significantly between the three groups. Intraoperative events in individual patients may lead to massive embolus generation overcoming positive properties of a distinct ECC system.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/90. Monitoring of the extracranial and intracranial course of single emboli of cardiac origin: a preliminary report.Simultaneous monitoring of emboli in extracranial and intracranial arteries recorded with identical probes, in a patient with an artificial cardiac valve, allowed the identification and characterization of pairs of signals, which most likely represent single emboli flowing through the common carotid artery into the middle cerebral artery. This technique offers new insight into emboligenesis with obvious therapeutic implications.- - - - - - - - - - ranking = 14.490205156255keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
3/90. Intracranial clot dissolution is associated with embolic signals on transcranial Doppler.reperfusion of intracranial arteries can be detected by transcranial Doppler (TCD). The authors report microembolic signals (MES) on TCD as a sign of clot dissolution and recanalization. Microembolic signals were detected during routine diagnostic TCD examination performed in the emergency room in patients eligible for thrombolytic therapy. Microembolic signals were found at the site of M1 middle cerebral artery (MCA) high-grade stenosis or near-occlusion. Transcranial Doppler was performed before, during, and after thrombolytic therapy. Of 16 consecutive patients, 3 (19%) had MES on TCD. All three patients had a severe MCA syndrome at 2 hours after stroke onset scored using the National Institutes of health stroke Scale (NIHSS). In patient #1 (NIHSS 12), clusters of MES were detected distal to a high-grade M1 MCA stenosis preceding spontaneous clinical recovery by 2 minutes. Because of subsequent fluctuating clinical deficit, intraarterial thrombolysis was given with complete recovery. In patient #2 (NIHSS 20), TCD detected an M1 MCA near-occlusion. At 1.5 hours after intravenous tissue plasminogen activator, TCD showed minimal MCA flow signals followed by MES, increased velocities, and normal flow signals in just 2 minutes. She gradually recovered up to NIHSS 8 in 5 days. In patient #3 with NIHSS 22 and an M1 MCA near-occlusion, TCD detected MES 15 minutes after TPA bolus followed by MCA flow velocity improvement from 15 cm/sec to 30 cm/sec. The patient recovered completely by the end of tissue plasminogen activator infusion. The authors conclude that embolic signals detected by TCD at the site of arterial obstruction can indicate clot dissolution. Intracranial recanalization on TCD can be associated with MES and changes in flow waveform, pulsatility, and velocity if insonation is performed at the site of arterial obstruction.- - - - - - - - - - ranking = 0.5keywords = artery (Clic here for more details about this article) |
4/90. Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature.OBJECTIVE: To determine the prevalence, clinical characteristics, and long-term outcomes in cases involving transient ischemic attacks (TIAs) or ischemic strokes secondary to embolization from unruptured intracranial aneurysms. methods: We identified all available patients with intracranial aneurysms and ischemic strokes in three university-affiliated hospitals, using either international classification of diseases-9th Revision codes or local registries. patients with clinically or radiologically detected cerebral infarctions distal to intracranial aneurysms, in the absence of other causes for the infarctions, were included. An aneurysmal embolic source was considered highly probable by the primary neurosurgeon/neurologist in all cases. Follow-up data for the patients were acquired through reviews of clinical visits or telephone interviews. A review of the literature was performed to identify characteristics of previously reported patients. RESULTS: Ischemic strokes or TIAs attributable to embolization from the aneurysmal sac were observed for 9 of 269 patients (3.3%) with unruptured aneurysms. Of these nine patients, five were women and four were men (mean age, 62 yr; age range, 45-72 yr). Symptomatic aneurysms were located in the middle cerebral artery (n = 4), internal carotid artery (n = 3), posterior cerebral artery (n = 1), or vertebral artery (n = 1). The mean maximal diameter was 12.5 mm (range, 5-45 mm). Six patients underwent surgical treatment, of whom two experienced postoperative cerebral infarctions referable to the distribution of the artery harboring the aneurysm. Two patients were treated with aspirin, and one patient received no treatment. The mean follow-up period was 38 months (range, 1-60 mo). None of the patients experienced additional ischemic events during the follow-up period. Among the 41 previously reported patients, conservative treatment was used for 20 patients (mean follow-up period, 50.7 /- 44.5 mo). Four of the 20 patients experienced recurrent TIAs, 1 patient experienced worsening of symptoms, and 1 patient died during the follow-up period. A total of 21 patients underwent surgical treatment (mean follow-up period, 33.6 /- 32.3 mo). Of these patients, only one experienced recurrent TIAs. Two patients experienced postoperative seizures, and one patient died during the follow-up period. All recurrent symptoms with either surgical or conservative treatment were transient, and no patient experienced a major or disabling stroke during the follow-up period. CONCLUSION: Ischemic events can occur distal to both small and large unruptured intracranial aneurysms (predominantly in the anterior circulation). The long-term risk of recurrent ischemic events, particularly major or disabling strokes, seems to be low with either surgical or conservative treatment.- - - - - - - - - - ranking = 15.990205156255keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
5/90. basilar artery occlusion due to mucormycotic emboli, preceded by acute hydrocephalus.A rare case of brain stem infarction caused by mucormycotic emboli, preceded by acute hydrocephalus, is reported. The patient, who had suffered from leukemia and had undergone bone marrow transplantation several months before, presented initially with seizure and persistent disturbance of consciousness. A head CT scan revealed marked ventricular dilation and diagnosed as acute hydrocephalus. The patient received emergent ventricular drainage. Despite the aggressive treatment, the patient did not survive. autopsy revealed systemic mucormycosis occluding and invading various arteries including basilar artery and its branches, causing fatal brainstem infarction. Although early diagnosis remains difficult in the cases of systemic mucormycosis, prompt initiation of treatment is mandatory; one must have in mind the possibility of presence of fungal infection when treating patients with acute neurological deterioration who have underlying debilitating diseases, even though fungi themselves are hard to detect in most cases.- - - - - - - - - - ranking = 2.5keywords = artery (Clic here for more details about this article) |
6/90. Prevention of complications resulting from endovascular carotid sacrifice: a retrospective assessment.OBJECTIVE: To determine the protective effects of various periprocedural interventions in the prevention of cerebral ischemia as a complication of endovascular carotid sacrifice (ECS). methods: Thirty-two cases of ECS performed at our institution, between October 1987 and July 1998, were reviewed. Fifteen patients underwent superficial temporal artery-to-middle cerebral artery bypass surgery. In 21 patients, the carotid artery was occluded proximal to the target lesion; and in 11 patients, a lesion trapping procedure was performed. Six patients were prophylactically anticoagulated, 14 received antiplatelet agents prophylactically, and 12 received no pharmacoprophylaxis. RESULTS: Among the six patients who were anticoagulated, there were no embolic events. Embolic events affected 4 of 14 patients receiving prophylactic antiplatelet agents, 2 of 12 patients receiving no pharmacoprophylaxis, 1 of 11 patients who underwent a trapping procedure, and 5 of 21 patients whose carotid artery was occluded proximal to the target lesion. Postocclusion cerebral ischemia developed in 7 of 15 patients who underwent bypass surgery, and in 1 of the remaining 17. CONCLUSION: Superficial temporal artery-to-middle cerebral artery bypass did not protect against postocclusion cerebral ischemia after ECS in this series (P = 0.01). Although the small number of patients studied precludes statistical validity (P = 0.29), the trends suggest that antiplatelet agents provide no protection against postocclusion cerebral emboli after ECS. Prophylactic anticoagulation (P = 0.32) and lesion trapping (P = 0.12) may reduce the frequency of postocclusion embolic events after ECS; however, because of the small number of patients, statistical significance could not be demonstrated.- - - - - - - - - - ranking = 70.305421148018keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
7/90. mumps hemiplegia.Neurological involvement of mumps is commonly restricted to aseptic meningitis. However, rarely mumps is associated with more severe encephalitic illness; other known associations described with mumps are cases of transverse myelitis and Gullain Barre like illness. We report a case of hemiplegia due to mumps parotitis probably caused by involvement of carotid artery.- - - - - - - - - - ranking = 13.990205156255keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
8/90. Normal diffusion-weighted imaging in cerebral air embolism complicating angiography.We report a case of cerebral air embolism resulting from accidental air infection during cerebral angiography. A 60-year-old man was accidentally injected with air via the left subclavian artery. Angiography demonstrated air within the basilar artery. The patient showed signs of posterior circulation ischaemia (confusion, blindness, gaze palsy and hemiparesis). However, MRI, including diffusion-weighted imaging, showed no abnormality 4 h later. The patient was treated with hyperbaric oxygen within 5 h of the embolism. All symptoms and signs resolved completely within a week.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
9/90. Cerebral embolism in a patient with polycythemia rubra vera.polycythemia rubra vera (PRV) is a rare haematological disorder that has a high risk of stroke, although the pathophysiological origin of the cerebral ischaemia in this disease is not well known. We report a case of a stroke patient with PRV in whom bilateral embolic signals were detected by transcranial Doppler (TCD). Cerebral computed tomography showed a cortical middle cerebral artery infarction, echocardiography was normal, duplex-scan showed moderate left carotid stenosis and digital angiography disclosed right siphon stenosis. TCD examinations in the acute phase repeatedly showed a great number of bilateral microembolic signals (MESs). Four months later magnetic resonance angiography showed no flow signal in the right siphon and a severe stenosis of the proximal right MCA. The detection of bilateral MESs in the absence of cardiac sources of embolism observed in this patient suggests that ischaemic cerebral events in PRV may have an embolic origin favoured by a prothrombotic state.- - - - - - - - - - ranking = 8.5650021671015keywords = carotid, artery (Clic here for more details about this article) |
10/90. Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report.OBJECTIVE AND IMPORTANCE: We describe the case of a patient in whom a snare designed for the removal of foreign bodies was successfully used to retrieve a thromboembolism from the middle cerebral artery. This technique can be used to reestablish blood flow when maximal pharmacological therapies have failed. CLINICAL PRESENTATION: A 38-year-old man with scrotal squamous cell carcinoma presented with the abrupt onset of left hemiparesis and numbness. Computed tomography of the head showed no hemorrhage or hypodensity, and right middle cerebral artery thrombosis was suspected. INTERVENTION: cerebral angiography demonstrated a near-total occlusion of the right middle cerebral artery at the M1-M2 junction. The administration of intra-arterial urokinase, systemic heparin, and systemic abciximab, and mechanical maceration failed to lyse the clot. A 4-mm goose-neck snare was guided through a microcatheter, and the clot was snared and withdrawn. Immediate postoperative angiography demonstrated the reconstitution of normal flow. Pathological examination of the snared material was consistent with clot. By postoperative Day 5, the patient had regained full strength, except for the fingers of the left hand, which remained moderately weak. Computed tomography demonstrated a right insular and extreme capsular infarct. CONCLUSION: To our knowledge, this is the first reported use of a snare to remove clot in the setting of thromboembolic stroke. As the use of intra-arterial thrombolysis increases, transcatheter snare removal of pharmacologically resistant clot may be considered as a salvage strategy.- - - - - - - - - - ranking = 3.5keywords = artery (Clic here for more details about this article) |
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