1/87. Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature.OBJECTIVE AND IMPORTANCE: The goal of this report was to describe the successful percutaneous endovascular use of a Gianturco-Roubin-2 coronary stent in the treatment of an acute atherothrombotic occlusion of the basilar artery. To our knowledge, the percutaneous endovascular deployment of an intra-arterial stent for the treatment of an acute atherothrombotic occlusion of the basilar artery and the percutaneous endovascular placement of a Gianturco-Roubin-2 stent in the basilar artery have not been previously reported. CLINICAL PRESENTATION: An 83-year-old man presented with a recurrent, transient, locked-in syndrome resulting from a lower basilar artery occlusion caused by vertebrobasilar thrombosis superimposed on severe proximal basilar artery atheromatous stenosis. INTERVENTION: After successful superselective intra-arterial thrombolysis of the vertebrobasilar clot, balloon angioplasty of the underlying basilar artery stenosis was performed, without significant angiographic improvement. Percutaneous endovascular deployment of a Gianturco-Roubin-2 coronary stent of 4-mm diameter was subsequently performed, with excellent angiographic results. CONCLUSION: The patient made a very good neurological recovery but unfortunately died as a result of cardiogenic shock and sepsis. Detailed neuropathological follow-up results are presented; stent patency was revealed in the postmortem examination. The anatomic and pathophysiological considerations of basilar artery stent placement for the treatment of acute basilar artery occlusion related to atherosclerotic stenosis are discussed.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/87. thromboembolism originated from the pulmonary artery stump after Fontan operation.Cerebral thromboembolism is a rare but serious complication after Fontan operation. This is the report of a patient who underwent a successful intracardiac thrombectomy for cerebral thromboembolism after Fontan operation. A 2-year-old girl was referred to us with the diagnosis of tricuspid atresia without pulmonary stenosis, normally related great arteries, and a ventricular septal defect. Although she underwent a successful Fontan operation and division of the main pulmonary artery, she developed a cerebrovascular event at 3 weeks after the operation. echocardiography demonstrated a large thrombus within the residue of the main pulmonary artery, and suggested that the thrombus had migrated into the systemic circulation by way of the ventricular septal defect. At 2 weeks after the cerebrovascular event, she underwent thrombectomy and excision of the pulmonary valve. Although she has developed slight left-sided hemiparesis, she is leading a normal life at 1 year after the operation.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
3/87. Fatal cerebral embolism following aorto-coronary bypass graft surgery.In a case of fatal cerebral embolic infarction following aorto-coronary bypass graft (ACBG) surgery, postmortem examination revealed thrombosis of the vein grafts to the left circumflex and left anterior descending coronary arteries. Continguous with the thrombus in the graft to the circumflex artery was thrombotic material adherent to the aortic sutures and extending several millimeters into the lumen of the aorta. A nonadherent thrombus of similar histologic character was found in the right middle cerebral artery, associated with localized brain infarction. In addition to the risks of cerebral complication associated with other types of open-heart surgery, the location of the vein grafts in patients undergoing ACBG operations seems to offer a unique mechansim for the occurrence of systemic and cerebral embolism, which may be operational in other cases.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
4/87. Hindbrain stroke in children caused by extracranial vertebral artery trauma.Hindbrain transient ischemic attacks (TIAs) culminating in posterior circulation stroke are described in five children. Atlanto-axial subluxation and angiographical documentation of C1 to C2 level arterial pathology are documented in one patient. Four additional patients with nearly identical clinical presentations, posterior fossa TIAs, stroke and basilar angiographical pathology are reviewed. A mechanical traumatic etiology is suggested. Unexplained transient repeated brain stem and/or cerebellar sympotomatology may be due to extracranial vetebral artery stenosis or occlusion by atlanto-axial instability. After appropriate documentation, stabilization may prevent further TIAs or strokes.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
5/87. Fatal paradoxical embolism to the left carotid artery during partial resection of Wilms' tumor.An 8-year-old boy with an uncorrected ventricular septal defect, pulmonary stenosis, mental retardation, and gigantism died 24 hours after partial resection of a large right-sided Wilms' tumor. The presence of other abnormalities, including a small umbilical hernia and overgrowth of the external genitalia, raises the possibility that this case represents a variant of the beckwith-wiedemann syndrome. The typical facial features of Sotos' syndrome were not present. Gross examination of the surgical specimen revealed that tumor was present in the resected margin of left renal vein. Necropsy showed that death resulted from extensive cerebral infarction due to occlusion of the left internal carotid artery and its branches by tumor emboli. Paradoxical embolism had occurred during or soon after partial resection of the tumor mass due to passage of tumor fragments into the systemic circulation through the ventricular septal defect.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
6/87. Cerebral emboli from the 'stump' of a totally occluded carotid artery: surgical management.The obstructing thrombus in a totally occluded internal carotid artery may act as a source of cerebral emboli. These emboli traverse the external carotid and ophthalmic arteries and enter the intracranial circulation via retrograde collateral pathways. Surgical treatment can result in complete abatement of symptoms in selected patients. The authors describe internal carotid "stump" syndrome in a 47-year-old man and discuss the options for surgical management.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
7/87. Retrograde filling of the anterior choroidal artery: vertebral angiographic sign of obstruction in the carotid system.Retrograde filling of seven anterior choroidal arteries from the posterior circulation was observed on a vertebral angiogram in six patients with occlusion of the proximal anterior choroidal artery or of the internal carotid artery. In one patient with thrombotic occlusion of the internal carotid artery, the enlarged anterior choroidal artery functioned as a major collateral pathway from the posterior circulation to the territory of the middle cerebral artery. Retrograde filling of the anterior choroidal artery is a sign of obstruction changes in the ipsilateral carotid artery at or proximal to the origin of the anterior choroidal artery.- - - - - - - - - - ranking = 19.822834085999keywords = circulation (Clic here for more details about this article) |
8/87. Metallic fragment embolization to the middle cerebral artery.A 25-year-old male was wounded accidentally in the neck by a metallic fragment, which penetrated his right carotid artery and migrated within the ipsilateral middle cerebral artery. Clinical and laboratory findings over a 16-month-period are reported. Problems arising from the presence of metallic emboli to the cerebral circulation are discussed on the basis of the pertinent literature.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
9/87. Intracerebral thrombosis. Case report and brief clinical review.A 29-yr-old writer presented with seizures and left hemiparesis 8 days post-partum. Studies revealed right parietal hemorrhagic infarction secondary to superior sagittal sinus thrombosis. An anticoagulant was given for clot extension associated with increasing cerebral edema and coma. Inpatient rehabilitation was undertaken for residual left hemiparesis, most severe in the leg. Left arm strength rapidly returned to normal. Significant improvement in left leg strength occurred but was delayed for many months. Intracerebral thrombosis is an uncommon but significant cause of stroke in young adults. It frequently occurs in the puerperium and may be associated with unilateral or bilateral neurologic deficits. Treatment with anticoagulants is controversial because of the risk of hemorrhagic cerebral infarction, but may be beneficial in some cases. Recovery may be delayed for several months pending recanalization of the sinus or the development of collateral circulation. The overall prognosis for neurologic and functional recovery in survivors of intracerebral thrombosis is good.- - - - - - - - - - ranking = 9.9114170429994keywords = circulation (Clic here for more details about this article) |
10/87. Successful stenting seven days after atherothrombotic occlusion of the intracranial internal carotid artery.PURPOSE: To report a case of successful stenting after a subacute stroke. CASE REPORT: A 75-year-old man presented with sudden onset of right-sided weakness and difficulty speaking. Imaging revealed an occlusion of the left petrous to lacerum internal carotid artery (ICA) segment and slightly decreased cerebral blood flow in the left hemisphere; there were stenoses of the ostial and cavernous ICA segments on the right. On the seventh day after the stroke, he underwent protected carotid angioplasty of the left intracranial ICA occlusion to reduce the high risk of ischemic stroke owing to bilateral disease. An external arteriovenous shunt was established with an occluding balloon in the proximal ICA and a filter in the femoral vein. After protected balloon dilation of the ICA occlusion, a 3.5 x 18-mm balloon-expandable coronary stent was deployed across the residual stenotic segment. An intraluminal filling defect of the petrous ICA segment suggested an arterial dissection or intraluminal thrombus, so another 2 coronary stents were deployed. Macroscopically visible materials were captured in the filter. The patient had a good clinical course and was discharged without neurological deficits on the twelfth day after the stroke. angiography at 3 months confirmed no restenosis of the stented vessel. CONCLUSION: This experience suggests that short atherothrombotic intracranial ICA occlusions can be opened in the subacute stroke stage without distal migration of thrombi under proximal protection and flow reversal.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
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