1/177. Endovascular treatment of carotid dissecting aneurysms.BACKGROUND AND PURPOSE: Cervical arterial dissection is a well-recognised cause for acute ischaemic stroke. Dissecting aneurysms commonly occur in the affected vessels contributing to the clinical presentation. Persistence of these aneurysms may provide a source of future embolic events as well as causing local symptoms or even be at risk of spontaneous rupture. methods: We describe 4 patients with traumatic internal carotid artery (ICA) dissections with aneurysm formation at the skull base. Three of the 4 patients still had carotid aneurysms on follow-up investigations and so underwent endovascular procedures using stenting and coil techniques. The carotid aneurysm resolved spontaneously in the fourth patient. RESULTS: The endovascular procedures resulted in significant reduction or obliteration of the flow within the carotid aneurysms with restoration of the true lumen diameter in the adjacent ICA in all 3 patients. No perioperative complications were experienced except for transient headache in 2 patients. CONCLUSIONS: In patients with persistent aneurysms the exact risk of subsequent ischaemic events remains unknown and prospective long-term studies are needed to ascertain this risk. If recurrent stroke rates are found to be high, then carotid stenting (with or without coil insertion) is a feasible invasive approach which could be considered in these patients.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
2/177. Embolization of meningohypophyseal and inferolateral branches of the cavernous internal carotid artery.BACKGROUND AND PURPOSE: Despite the continued improvements in endovascular techniques this decade, few dedicated studies addressing the feasibility of such procedures or their efficacy relative to risk have been conducted. The purpose of this study was to use current endovascular techniques to assess the feasibility, effectiveness, and safety of direct selective catheterization and embolization of the small branches of the cavernous segment of the internal carotid artery. methods: We retrospectively reviewed the findings in 10 patients with lesions (five meningiomas and five arteriovenous malformations) primarily or partly supplied by branches of the meningohypophyseal trunk or inferolateral trunk who had undergone endovascular embolization of the feeding arteries during the period from 1991 to 1997. In each case, the artery was selectively catheterized with a microcatheter/microguidewire system and embolized with polyvinyl alcohol particles (n = 5), n-butyl cyanoacrylate tissue adhesive (n = 4), or both (n = 1). RESULTS: In all 10 patients, the feeding artery from the meningohypophyseal trunk (eight patients) or inferolateral trunk (three patients; one patient with both) was successfully catheterized and embolized. In nine patients, embolization resulted in complete obliteration of the vascular territory; in the remaining patient, blood supply was decreased by an estimated 80%. No immediate or delayed complications occurred. CONCLUSION: Advances in microcatheter and microguidewire technology allow more efficient and safer selective catheterization and embolization of branches of the cavernous segment of the internal carotid artery than in the recent past. Meticulous technique and detailed knowledge of the vascular anatomy of the cavernous sinus region are necessary to maximize lesion devascularization and to minimize the risk of stroke, cranial nerve palsies, and blindness.- - - - - - - - - - ranking = 0.70389255960931keywords = blindness (Clic here for more details about this article) |
3/177. Transverse cervical artery bypass pedicle for treatment of common carotid artery occlusion: new adjunct for revascularization of the internal carotid artery domain.OBJECTIVE: We present two cases of common carotid artery occlusion that were treated by vascular reconstruction using the transverse cervical artery. methods: Two patients with common carotid artery occlusion presented with transient ischemic attacks resulting from decreased cerebral blood flow on the affected side. Both patients underwent vascular reconstruction using the transverse cervical artery. The transverse cervical artery was anastomosed to the ipsilateral external carotid artery at its origin, as a pedicle graft. A superficial temporal artery-middle cerebral artery anastomosis was then performed. RESULTS: The postoperative courses were uneventful. The transverse cervical artery bypass grafts were patent, and cerebral blood flow increased to normal levels. CONCLUSION: Transverse cervical artery grafting provides a less tedious alternative to saphenous vein interposition grafting for revascularization of the internal carotid artery domain.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
4/177. Congenital Horner's syndrome resulting from agenesis of the internal carotid artery.OBJECTIVE: To report a patient with agenesis of the right internal carotid artery associated with ipsilateral, congenital Homer's syndrome. DESIGN: Case report. methods: A 30-year-old woman, with a past history of migraine headaches, underwent neuro-ophthalmologic and neuroradiologic evaluation for transient visual obscurations and congenital Horner's syndrome. RESULTS: A right, third-order neuron Horner's syndrome was confirmed with 1% hydroxyamphetamine topical drops. Cranial magnetic resonance imaging revealed an absent right internal carotid artery flow void, computed tomography demonstrated absence of the right carotid canal, and cerebral angiography confirmed absence of the right internal carotid artery. No atheromatous lesions were found and the results of coagulation studies were normal. CONCLUSIONS: Agenesis of the internal carotid artery is a rare cause of congenital Horner's syndrome. The cause of transient visual blurring in the current patient remains unproven.- - - - - - - - - - ranking = 2keywords = transient (Clic here for more details about this article) |
5/177. necrosis of the tongue after transient ischemic attack.We report an unusual case of necrosis of the tongue after transient ischemic attack in a 67-year-old man. Angiography revealed occlusion of the right external carotid artery at the bifurcation of the common carotid artery. debridement of the wound and removal of the necrotic tissue resulted in good healing.- - - - - - - - - - ranking = 5keywords = transient (Clic here for more details about this article) |
6/177. Transient cardiac standstill induced by adenosine in the management of intraoperative aneurysmal rupture: technical case report.OBJECTIVE AND IMPORTANCE: Intraoperative aneurysmal rupture represents a potentially catastrophic event. We describe the use of an intravenous adenosine bolus to induce transient cardiac asystole to control a severe intraoperative aneurysmal rupture. This treatment resulted in a brief period of severe hypotension, which enabled successful clipping of the aneurysm. CLINICAL PRESENTATION: A 55-year-old man was referred to our institution 7 days after experiencing a mild subarachnoid hemorrhage from a fusiform, multilobulated aneurysm of the anterior communicating artery. The patient was found to have multiple additional fusiform aneurysms as well as a large parietal arteriovenous malformation. INTERVENTION: A craniotomy was performed to clip the aneurysm, but surgical dissection was complicated by premature rebleeding that could not be controlled satisfactorily with tamponade or temporary arterial occlusion. Infusion of adenosine resulted in the rapid onset of profound hypotension, allowing for safe completion of the dissection and clipping of the aneurysm with a good outcome. There were no complications identified in relation to the use of adenosine. CONCLUSION: In the setting of severe intraoperative aneurysmal rupture, intravenous adenosine represents a potential means of achieving a near-immediate profound decrease in the blood pressure that may allow for safe completion of the dissection and aneurysm clipping.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
7/177. Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection. A case report.A mandibular block injection produced temporary uniocular blindness, total ophthalmoplegia, mydriasis, and ptosis of the eyelid, with diplopia developing as the sight returned. These effects lasted 25-30 minutes. The explanation offered as to the cause of the anaesthetic phenomenon is an intra-arterial injection into the maxillary artery with backflow of anaesthetic solution into the middle meningeal artery. The instantaneous blindness results from the anaesthetic agent being carried into the central artery of the retina through an anastomosis of the ophthalmic and middle meningeal arteries via the recurrent meningeal branch of the lacrimal artery. Although of short duration, the symptoms mimic a more serious carotid artery embolus occluding the ophthalmic artery. Complications of mandibular blocks have been reported in the literature, however total blindness and ophthalmoplegia are extremely rare. This case report highlights an event where individual anatomical variation of the maxillary and middle meningeal arteries has allowed anaesthetic solution to be delivered to an ectopic site.- - - - - - - - - - ranking = 4.9272479172652keywords = blindness (Clic here for more details about this article) |
8/177. Superficial temporal artery to middle cerebral artery bypass and external carotid reconstruction for carotid restenosis after angioplasty and stent placement.The recent proliferation of endovascular treatment of carotid atherosclerotic disease will increase the number of patients who require treatment for recurrent carotid stenosis after angioplasty and stent placement. The optimal management of these patients has not yet been defined. We describe a 66-year-old woman who required 2 surgical procedures for recurrent in-stent carotid stenosis. She experienced numerous transient ischemic attacks 5 months after left extracranial internal carotid artery angioplasty and stenting for asymptomatic stenosis. Angiography showed high-grade in-stent restenosis, left intracranial carotid artery stenosis, and poor collateral flow to the left middle cerebral artery circulation. The patient underwent a superficial temporal artery to middle cerebral artery bypass, and the transient ischemic attacks resolved. Five months later, angiography showed progressive stenosis of the external carotid artery at the site of the stent. The patient underwent successful external carotid reconstruction with an on-lay patch. Extracranial-intracranial bypass grafting may be used successfully in the treatment of recurrent extracranial carotid artery stenosis after angioplasty and stent placement. Also, external carotid artery reconstruction at the site of an internal carotid artery stent can be performed safely.- - - - - - - - - - ranking = 2keywords = transient (Clic here for more details about this article) |
9/177. Extracranial arterial aneurysms: a cause of crescendo transient ischaemic attacks.Crescendo transient ischaemic attacks (TIAs) should be regarded as a medical emergency. patients require hospitalisation with urgent assessment and symptom control with anticoagulant therapy. We report on three patients, all of whom had atherosclerotic aneurysmal disease of the extracranial arterial circulation who presented with crescendo TIAs. The possibility of extracranial aneurysmal disease should always be considered and excluded.- - - - - - - - - - ranking = 5keywords = transient (Clic here for more details about this article) |
10/177. Visual disturbance due to carotid artery thrombosis in a patient with familial hypercholesterolemia; response to surgical thrombotectomy.A 48 years-old Japanese man suffered from marked xanthomas on ankles, knees, hand fingers, and foot joints due to insufficient control of serum hypercholesterolemia despite low density lipoprotein (LDL-C) absorptive therapy followed by treatment with potent anti-hypercholesterolemic agents. He had undergone surgical resection of xanthoma on the knee, foot and hand finger joints. Treatment with simvastatin returned the serum total cholesterol levels to nearly normal levels, followed by marked fluctuations. He subsequently experienced transient right-visual disturbance, and roentogenographic examination was performed. The patient was diagnosed as right-common carotid artery thrombosis. After the thrombotectomy of the right-common carotid artery, his visual power was markedly improved.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
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