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Sample records for anterior communicating artery

  1. Totally thrombosed giant anterior communicating artery aneurysm

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    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  2. Fenestrated A1 segment of right anterior cerebral artery associated to duplicated anterior communicating artery

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    Sonda, Ildo; Basso, Luciano Silveira

    2015-01-01

    We present a case of fenestrated anterior cerebral artery associated to duplicated anterior communicating artery found duringa routine dissection of the brain in a male human body. Fenestrations of the A1 segment of the anterior cerebral artery are rare,especially if associated to a duplicated anterior communicating artery. To our knowledge, this is the second reported case in theliterature. We also present a brief review of the surgical importance of this anomaly

  3. Anterior communicating artery aneurysm presenting with vision loss

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    Dhaval P Shukla

    2013-01-01

    Full Text Available Anterior communicating artery aneurysm rarely presents with symptoms of compression of anterior visual pathways. We report a case of 65 years old man, who had complete loss of vision in right eye and temporal hemianopsia in left eye due to giant anterior communicating artery aneurysm.

  4. Anterior communicating artery aneurysm presenting with vision loss

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    Shukla, Dhaval P.; Bhat, Dhananjaya I.; Devi, Bhagavatula I.

    2013-01-01

    Anterior communicating artery aneurysm rarely presents with symptoms of compression of anterior visual pathways. We report a case of 65 years old man, who had complete loss of vision in right eye and temporal hemianopsia in left eye due to giant anterior communicating artery aneurysm.

  5. Anterior communicating artery aneurysm presenting with vision loss.

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    Shukla, Dhaval P; Bhat, Dhananjaya I; Devi, Bhagavatula I

    2013-07-01

    Anterior communicating artery aneurysm rarely presents with symptoms of compression of anterior visual pathways. We report a case of 65 years old man, who had complete loss of vision in right eye and temporal hemianopsia in left eye due to giant anterior communicating artery aneurysm.

  6. [Microsurgical anatomy importance of A1-anterior communicating artery complex].

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    Monroy-Sosa, Alejandro; Pérez-Cruz, Julio César; Reyes-Soto, Gervith; Delgado-Hernández, Carlos; Macías-Duvignau, Mario Alberto; Delgado-Reyes, Luis

    2013-01-01

    The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

  7. Anterior communicating artery aneurysm presenting as monocular blindness.

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    Bhat, Dhananjaya I; Sampath, Somanna

    2011-10-01

    Anterior communicating artery (AcomA) aneurysm presenting with rapidly progressing monocular visual loss is rare. We present one such case masquerading as retrobulbar optic neuritis, with no improvement following steroid therapy. Monocular blindness was due to compression of the optic nerve by a large AcomA aneurysm, which was detected after rupture.

  8. Anterior communicating artery aneurysm related to visual symptoms.

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    Park, Jung Hyun; Park, Sang Keun; Kim, Tae Hong; Shin, Jun Jae; Shin, Hyung Shik; Hwang, Yong Soon

    2009-09-01

    Intracranial aneurysms are sometimes presented with visual symptoms by their rupture or direct compression of the optic nerve. It is because their prevalent sites are anatomically located close to the optic pathway. Anterior communicating artery is especially located in close proximity to optic nerve. Aneurysm arising in this area can produce visual symptoms according to their direction while the size is small. Clinical importance of visual symptoms presented by aneurysmal optic nerve compression is stressed in this study. Retrospective analysis of ruptured anterior communicating artery aneurysms compressing optic apparatus were carried out. Total 33 cases were enrolled in this study. Optic nerve compression of the aneurysms was confirmed by the surgical fields. In 33 cases among 351 cases of ruptured anterior communicating artery aneurysms treated surgically, from 1991 to 2000, the dome of aneurysm was compressed in optic pathway. In some cases, aneurysm impacted into the optic nerve that deep hollowness was found when the aneurysm sac was removed during operation. Among 33 cases, 10 cases presented with preoperative visual symptoms, such as visual dimness (5), unilateral visual field defect (2) or unilateral visual loss (3), 20 cases had no visual symptoms. Visual symptoms could not be checked in 3 cases due to the poor mental state. In 6 cases among 20 cases having no visual symptoms, optic nerve was deeply compressed by the dome of aneurysm which was seen in the surgical field. Of 10 patients who had visual symptoms, 8 showed improvement in visual symptoms within 6 months after clipping of aneurysms. In 2 cases, the visual symptoms did not recover. Anterior communicating artery aneurysm can cause visual symptoms by compressing the optic nerve or direct rupture to the optic nerve with focal hematoma formation. We emphasize that cerebral vascular study is highly recommended to detect intracranial aneurysm before its rupture in the case of normal CT findings with

  9. Junctional chiasmatic syndrome due to large anterior communicating artery aneurysm

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    Maruthi Kesani; Pavan Kumar Pelluru; Suchanda Bhattacharjee; Rajesh Alugolu; A K Purohit

    2017-01-01

    Even though aneurysm involving the anterior communicating artery (A Com A) was common in clinical practice, producing compressive symptoms such as visual loss was rare. We report a case, in which patient had gradually progressive visual loss with features of the junctional chiasmatic syndrome, imaging revealed partially thrombosed large A Com A aneurysm. Intraoperatively, aneurysm was found compressing the optic chiasm and right optic nerve, following clipping and decompression of the optic n...

  10. Junctional chiasmatic syndrome due to large anterior communicating artery aneurysm

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    Maruthi Kesani

    2017-01-01

    Full Text Available Even though aneurysm involving the anterior communicating artery (A Com A was common in clinical practice, producing compressive symptoms such as visual loss was rare. We report a case, in which patient had gradually progressive visual loss with features of the junctional chiasmatic syndrome, imaging revealed partially thrombosed large A Com A aneurysm. Intraoperatively, aneurysm was found compressing the optic chiasm and right optic nerve, following clipping and decompression of the optic nerve and chiasm there was gradually improvement in the vision over 2 weeks postoperatively.

  11. A study of the hemodynamics of anterior communicating artery aneurysms

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    Cebral, Juan R.; Castro, Marcelo A.; Putman, Christopher M.

    2006-03-01

    In this study, the effects of unequal physiologic flow conditions in the internal carotid arteries on the intra-aneurysmal hemodynamics of anterior communicating artery aneurysms were investigated. Patient-specific vascular computational fluid dynamics models of five cerebral aneurysms were constructed from bilateral 3D rotational angiography images. The aneurysmal hemodynamics was analyzed under a range of physiologic flow conditions including the effects of unequal mean flows and phase shifts between the flow waveforms of the left and right internal carotid arteries. A total of five simulations were performed for each patient, and unsteady wall shear stress (WSS) maps were created for each flow condition. Time dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed and used to analyze the influence of the inflow conditions. It was found that mean flow imbalances in the feeding vessels tend to shift the regions of elevated WSS (flow impingement region) towards the dominating inflow jet and to change the magnitude of the WSS peaks. However, the overall qualitative appearance of the WSS distribution and velocity simulations is not substantially affected. In contrast, phase differences tend to increase the temporal complexity of the hemodynamic patterns and to destabilize the intra-aneurysmal flow pattern. However, these effects are less important when the A1 confluence is less symmetric, i.e. dominated by one of the A1 segments. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than one avenue of inflow should be incorporated into flow models.

  12. Is anterior communicating artery syndrome related to fornix lesions?

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    Molino, Ivana; Cavaliere, Carlo; Salvatore, Elena; Quarantelli, Mario; Colucci, Luisa; Fasanaro, Angiola Maria

    2014-01-01

    Anterior communicating artery (ACoA) syndrome, which may occur after rupture of ACoA aneurysms, consists of anterograde memory problems, executive dysfunctions, confabulations, and personality changes. Recently, the employment of diffusion tensor tractography (DTT) has related ACoA to microstructural lesions in the cingulum and the fornix, but an accurate characterization of these subjects should be provided. We report the clinical and neuropsychological findings of a patient who developed a severe and persistent amnesia together with significant behavioral changes, as well as her imaging results, where the sole evidence of brain damage was that of the fornix demonstrated by DTT. The four-year neuropsychological follow-up of the subject allows exclusion of other causes. This case demonstrates that microstructural lesions of fornix may lead to persistent amnesia, executive impairments, and behavioral changes and contributes to the knowledge of its role in cognition.

  13. Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature

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    Patil, Akshay; Menon, Girish R.; Nair, Suresh

    2013-01-01

    Aneurysms generally present with bleed and epileptogenic aneurysms are rare. Unruptured epilpetogenic anterior communicating artery aneurysms are extremely rare and anecdotal. We present three patients with unruptured anterior communicating artery aneurysms who presented with seizures and were surgically managed. Seizure might be related to the large size, presence of thrombus, microbleeds and surrounding gliosis. We suggest that large thrombosed anterior communicating artery aneurysms should be considered in the differential diagnosis of patients presenting with late onset of seizure and having a suprasellar lesion on imaging. Surgical clipping offers a fair chance of seizure freedom in selected patients. PMID:24403964

  14. ARTERIA ANASTOMOTICA INFUNDIBULARIS MAGNA- AN ABNORMAL COMMUNICATION BETWEEN ANTERIOR INTERVENTRICULAR ARTERY AND RIGHT CORONARY ARTERY

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    Vengadachalam Kittu

    2017-07-01

    Full Text Available BACKGROUND Knowledge of coronary artery branching pattern and their anomalies that occur during foetal development is essential for clinicians. They are associated with high incidence of morbidity and mortality due to congenital heart diseases. Failure to recognise them can lead to inadequate or prolonged procedures and may also lead to misdiagnosis and complications such as accidental ligation. MATERIALS AND METHODS A properly embalmed and stored 50 human heart specimens were dissected in the age group of 20-65 years to study the course and distribution of coronary arteries. The study was conducted in dissection hall, Department of Anatomy, Rajah Muthiah Medial College and Hospital (RMMC and H, Annamalai University, Chidambaram, Tamil Nadu, India, from August 2010 to July 2013. RESULTS We found a very rare incidence of anomalous branching pattern in the coronary circulation out of 50 heart specimens. The anterior interventricular artery was found giving off one communicating branch to Right Coronary Artery (RCA on the anterior aspect of infundibulum, which after taking sinuous course to join RCA. We coined this anomalous communication as arteria anastomotica infundibularis magna. To our knowledge, this is a very rare incidence and it is not reported elsewhere. CONCLUSION Due to excessive stress and strain of day-to-day modern life, the incidence of death due to myocardial ischaemia also increases. To treat medically and surgically, the basic knowledge of the coronary arteries and its branching pattern with any anomalous is essential for cardiologists, cardiothoracic surgeons, radiologists and especially anatomists for teaching of undergraduate and postgraduate students of anatomy.

  15. Posterior Communicating Artery Giving Rise to Shared-Origin Anterior Choroidal Artery: Case Illustration.

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    Tonetti, Daniel A; Andrews, Edward G; Stabingas, Kristen; Tyler-Kabara, Elizabeth; Gross, Bradley A; Jadhav, Ashutosh

    2018-01-01

    The origin point of the anterior choroidal artery (AChA) is variable, typically arising from the supraclinoid internal carotid artery (ICA) distal to the posterior communicating artery (PComA) on either the posterolateral or posterior aspect of the ICA. Variations of AChA origin have important clinical implications, and rare origins reported previously include the ICA bifurcation and middle cerebral artery. We provide illustrations of a case of a shared-origin PComA and AChA. A young girl presented with intracranial hemorrhage and underwent angiography to evaluate for an underlying cause. Ultimately, 3-dimensional rotational angiography incidentally demonstrated a common origin of the AChA with the PComA. A rare case of a shared-origin AChA and PComA is reported for angiographic illustration. The radiologic findings, embryology behind the development of the AChA, and neurosurgical and neurovascular relevance of this variant are discussed. The importance of recognizing the origin of the AChA is emphasized. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm

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    Lee, Kook; Shin, Sun Young; Park, Shin Hae

    2013-01-01

    Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with S...

  17. Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm.

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    Lee, Kook; Shin, Sun Young; Park, Shin Hae

    2013-01-01

    Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with SAH from ruptured anterior communicating artery aneurysm. Five months after immediate craniotomy with aneurysm neck clipping, his visual acuity was improved to 20/63 with a pale optic disc appearance. Acute retrobulbar optic neuropathy may be the sole manifestation of SAH from ruptured anterior communicating artery aneurysm. Unilateral decrease of visual acuity with periorbital pain, in the absence of other neurological change, may be the initial and isolated sign.

  18. Photophobia as the visual manifestation of chiasmal compression by unruptured anterior communicating artery aneurysm. Case report.

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    Hagihara, Naoshi; Abe, Toshi; Yoshioka, Fumitaka; Watanabe, Mitsuo; Tabuchi, Kazuo

    2009-04-01

    A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved following clipping of the aneurysm. AcomA aneurysm should be considered in patients who experience photophobia without visual loss.

  19. Computed Tomographic Angiogram of an Anterior Communicating Artery Aneurysm Causing Acute Retrobulbar Optic Neuropathy: A Case Report

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    Chang, Jee Ho; Lee, Dong-Kyu; Kim, Bum Tae; Ohn, Young-Hoon

    2011-01-01

    Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identif...

  20. Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

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    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2007-03-01

    The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

  1. Computed tomographic angiogram of an anterior communicating artery aneurysm causing acute retrobulbar optic neuropathy: a case report.

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    Chang, Jee Ho; Lee, Dong-Kyu; Kim, Bum Tae; Ohn, Young-Hoon

    2011-10-01

    Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identified directly during surgery.

  2. Enterprise Deployment Through PulseRider To Treat Anterior Communicating Artery Aneurysm Recurrence.

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    Valente, Iacopo; Limbucci, Nicola; Nappini, Sergio; Rosi, Andrea; Laiso, Antonio; Mangiafico, Salvatore

    2018-02-01

    PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. We report the case of a 55-year-old man who underwent coiling of an 8-mm anterior communicating artery aneurysm with assistance of a PulseRider neck reconstruction device. The 6-month digital subtraction angiography control showed aneurysm recurrence, so we deployed an Enterprise 2 closed-cell stent (Codman, Miami Lakes, Florida, USA) in the A1-A2 segment passing across the previously implanted PulseRider. Enterprise correctly expanded and allowed for adequate coiling of the aneurysm. An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Alien Hand Sign and Other Cognitive Deficits following Ruptured Aneurysm of the Anterior Communicating Artery

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    Alan J. Parkin

    1991-01-01

    Full Text Available We describe a right-handed patient who suffered a ruptured aneurysm of the anterior communicating artery (ACoA which was clipped successfully. Computerized tomography indicated a low density area in the genu of the corpus callosum and the infero-lateral aspect of the left frontal lobe. On recovery the patient's most notable deficit was the “alien hand sign” whereby the left hand would frequently interfere with the actions of the right hand. Problems in response initiation were also evident. There was significant memory loss and performance was impaired on some tests of frontal lobe function. Discussion centres on the functional locus of the alien hand sign but other aspects of the patient's deficits are also considered.

  4. Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms.

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    Kim, So Yeon; Jeon, Hong Jun; Ihm, Eun Hyun; Park, Keun Young; Lee, Jae Whan; Huh, Seung Kon

    2015-10-01

    We investigated the effectiveness of a right hemispheric surgical approach in treating unruptured anterior communicating artery aneurysms. Between January 2005 and June 2012, 305 patients with anterior communicating artery (Acom) aneurysms were treated using the pterional approach. Among them, 113 who underwent microsurgery with an unruptured Acom aneurysm were enrolled in this study. Every patient was evaluated with digital subtraction angiography preoperatively and CT scans were taken several times postoperatively. Surgical outcomes and complications were evaluated at discharge using the Glasgow Outcome Scale and at 6 months after surgery with CT angiography. Enrolled patients included 55 males and 58 females with a mean age of 56.3 years (range: 30-75 years). The mean diameter of the aneurysm was 5.8mm (range: 1.9-24.1). Left A1 dominancy was found in 71 patients (62.8%) whereas right A1 dominancy was found in 20 patients (17.7%), and right pterional craniotomies were performed in 92 patients (81.4%) while left pterional craniotomies were performed in 21 patients (18.6%). Complete clip application was achieved in 94.9% of patients (74 of 78) in right-side approach group but in only 81.3% of patients (13 of 16) in left-side approach group. Despite a left A1 dominancy and approached from the right, more than 90% of the patients had an excellent outcome at discharge (GOS 5) and more than 90% a complete aneurysm clipping at the 6-month follow-up CT angiography although it was not statistically significant. Microsurgical clipping of the unruptured Acom aneurysm through a right-side surgical approach showed favorable postoperative clinical and anatomical outcomes, especially aneurysms smaller than 10mm. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. [Blister-like Aneurysm Originating from the Anterior Communicating Artery:A Case Report].

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    Abiko, Tomohiro; Saito, Katsuya; Murase, Makoto; Tomita, Hideyuki

    2018-03-01

    Blister-like aneurysms(BLA)are morphologically thin-walled fragile structures that are associated with a high risk of intraoperative rupture. BLAs presumably originate from an arterial dissection and often stem from a non-branching site on the supraclinoid segment of the internal carotid artery. We report a rare case of a patient who was successfully treated for a ruptured BLA originating from the anterior communicating artery(Acom). A 60-year-old woman presented with severe headache and loss of consciousness. Computed tomography(CT)showed diffuse subarachnoid hemorrhage(SAH), which was observed to be particularly dense in the interhemispheric fissure around the Acom. CT angiography and three dimensional-digital subtraction angiography(DSA)did not show any aneurysms along the Acom. Follow-up DSA performed on day 13 showed a small aneurysmal dilatation of the Acom, which was surgically treated via interhemispheric approach. Intraoperatively, a BLA observed to be originating from the Acom was wrapped with a piece of temporal fascia using fibrin glue. Postoperatively, this patient showed a good clinical course without re-rupture. Follow-up DSA performed 5 months after the occurrence of the SAH demonstrated disappearance of the BLA originating from the Acom. The findings in this patient strongly suggest that the pathomechanism of BLAs is attributable to an arterial dissection, which can often show morphological changes on short-term angiographic follow-up, and they demonstrate spontaneous repair. Thus, the therapeutic strategy to be utilized for the management of a BLA of the Acom should be carefully considered, because aneurysmal neck clipping or trapping can injure the Acom perforators and cause cognitive deficits. Further studies are needed to establish the optimal treatment strategy for the management of BLAs of the Acom.

  6. Serial position learning effects in patients with aneurysms of the anterior communicating artery.

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    Stefanova, Elka; Kostic, Vladimir S; Ziropadja, Ljubomir; Markovic, Milan; Ocic, Gordana

    2002-08-01

    Ruptured and repaired Anterior Communicating Artery (ACoA) aneurysm can result in devastating impairments involving memory, executive function, confabulation, and personality changes. This study tested serial position learning effects (SPEs) in patients following repaired and ruptured ACoA aneurysm, using results on the Rey Auditory Verbal Learning Test (RAVLT). Thirty patients with ruptured aneurysms of the ACoA and 31 matched controls were included in the study. The primacy-recency effects were maintained during five learning trials in ACoA group, albeit at an overall lower level than in the controls. There was no difference in primacy-recency relation across five learning trials in ACoA group. On the delayed recall trial the patient group demonstrated neither a primacy, nor a recency phenomenon, reflecting a lack of recall of any parts of the word list. This kind of primacy-recency profile across learning trials in ACoA group has no similarity with SPE results in frontal lesion groups, or with SPE distributions in other amnesic disorders, despite the fact that memory and executive deficits were evident in our ACoA group.

  7. Neuropsychological rehabilitation in a patient with ruptured anterior communicating artery aneurysm: 48 month outcomes

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    Silvia A. Prado Bolognani

    Full Text Available Abstract The neurobehavioral impairments associated with aneurysms of the anterior communicating artery (ACoA are severe amnesia, executive problems and personality changes. Although most patients achieve a favorable neurological outcome, those cognitive deficits usually prevent return to previous activities and levels of social integration. Objectives: To report the outcomes of a neuropsychological and behavioral intervention in a 55 year-old man with very severe memory and executive dysfunctions following ACoA aneurysm rupture. Methods: Neuropsychological intervention focused in functional adjustment in everyday life was used, including individual sessions with the patient, discussion sessions with caregivers and also work with patient at home, aiming generalization of the rehabilitation strategies. Neuropsychological and functional assessments were conducted pre and post intervention. Results: Important improvements were seeing in behavior and daily living performance after treatment. Conclusions: A neuropsychological rehabilitation approach focused on goals based on the family and caregivers necessities is an efficient manner in which to carry out cognitive rehabilitation in severe cases. The importance of a supportive family should be stressed.

  8. Endovascular treatment of acutely ruptured, wide-necked anterior communicating artery aneurysms using the Enterprise stent.

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    Huang, Qing-Hai; Wu, Yong-Fa; Shen, Jie; Hong, Bo; Yang, Peng-Fei; Xu, Yi; Zhao, Wen-Yuan; Liu, Jian-Min

    2013-02-01

    The treatment of anterior communicating artery (AcomA) wide-necked aneurysms with the Enterprise stent (Codman, Miami Lakes, FL, USA) has not been commonly described, due to the complexity of the vascular anatomy and the small vessels of the AcomA complex. To evaluate the feasibility, effectiveness and safety of Enterprise stent placement in AcomA aneurysms, we performed this retrospective study. Between November 2008 and December 2010, 27 wide-necked AcomA ruptured aneurysms were treated within 72 hours of ictus with the Enterprise stent. Data collected and analyzed were: demographic data, morphologic features of the aneurysm, treatment results and follow-up results. Twenty-nine Enterprise stents were successfully deployed in all 27 aneurysms, including Y-configuration stent deployment in two patients. The initial embolization degrees were Raymond class I in 20 patients, class II in five and class III in the other two. The angiographic follow-up of 21 patients (mean, 8.4 months) showed that all aneurysms remained stable or improved; there was no in-stent stenosis, recurrence or retreatment. The clinical follow-up of 26 patients (mean, 12.6 months) showed that 23 patients displayed no symptoms and no or mild disability; three patients remained with severe or moderately severe disability. The Enterprise stent is feasible and safe for endovascular embolization of wide-necked AcomA ruptured aneurysms. Further follow up is needed to assess the long-term efficacy of Enterprise stent placement in AcomA. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. [A Case of Ruptured Anterior Communicating Artery Aneurysm with Visual Field Defects and Deteriorating to Severe Vision Loss].

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    Sakakura, Kazuki; Ikeda, Go; Nakai, Yasunobu; Watanabe, Noriyuki; Shiigai, Masanari; Uemura, Kazuya; Yamamoto, Tetsuya; Matsumura, Akira

    2017-10-01

    Although Terson's syndrome is a well-known cause of vision loss due to intracerebral aneurysm rupture, optic nerve neuropathy can also occur because of other causes. Here, we report such a case, i.e., a ruptured anterior communicating artery aneurysm accompanied by vision loss and visual field disturbances due to a cause other than Terson's syndrome. A 47-year-old man presented with right superior altitudinal hemianopia. Computed tomography (CT) showed subarachnoid hemorrhage (SAH), and three-dimensional CT angiography revealed an anterior communicating artery aneurysm. Coil embolization was performed. Right visual acuity degenerated to blindness in the acute stage. MRI performed on day 7 post-admission revealed that the aneurysm had swollen and made contact with the right optic disk. On the basis of the patient's clinical course, we believe that the deterioration in his visual acuity could have been due to ischemic optic neuropathy (ION) resulting from SAH, and the subsequent edema and poor blood perfusion may be attributed to spasm. In cases of visual disturbance associated with SAH, as in our case, it is important to perform MRI to evaluate the damage or risk to the optic nerve as soon as possible. (Received December 26, 2016; Accepted June 9, 2017; Published October 1, 2017).

  10. Injuries of the cingulum and fornix after rupture of an anterior communicating artery aneurysm: a diffusion tensor tractography study.

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    Hong, Ji Heon; Choi, Byung Yeon; Chang, Chul Hoon; Kim, Seong Ho; Jung, Young Jin; Byun, Woo Mok; Jang, Sung Ho

    2012-04-01

    After rupture of an anterior communicating artery (ACoA) aneurysm, the anterior cingulum and the fornix can be vulnerable to injury. However, very little is known about this topic. To investigate injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture with diffusion tensor tractography. Eleven consecutive patients with an ACoA aneurysm rupture and 11 age- and sex-matched normal control subjects were recruited. Diffusion tensor imaging was scanned at an average of 54.1 days (range, 29-97 days) after onset of ACoA aneurysm rupture. We found that 6 (54.5%) and 7 (63.6%) of 11 patients revealed no trajectory of the anterior cingulum and the fornical body on diffusion tensor tractography, respectively. In terms of diffusion tensor imaging parameters, we found that the fractional anisotropy value and tract volume of the cingulum and fornix were decreased (P fornix, which showed no difference (P > .05). We found injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture. It is our belief that sustained memory impairment of patients with an ACoA aneurysm rupture might be related to injury of the cingulum and fornix. Therefore, we recommend evaluation of the cingulum and fornix with diffusion tensor tractography for patients with an ACoA aneurysm rupture.

  11. Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall.

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    Linzey, Joseph R; Chen, Kevin S; Savastano, Luis; Thompson, B Gregory; Pandey, Aditya S

    2017-08-25

    Brain shifts following microsurgical clip ligation of anterior communicating artery (ACoA) aneurysms can lead to mechanical compression of the optic nerve by the clip. Recognition of this condition and early repositioning of clips can lead to reversal of vision loss. The authors identified 3 patients with an afferent pupillary defect following microsurgical clipping of ACoA aneurysms. Different treatment options were used for each patient. All patients underwent reexploration, and the aneurysm clips were repositioned to prevent clip-related compression of the optic nerve. Near-complete restoration of vision was achieved at the last clinic follow-up visit in all 3 patients. Clip ligation of ACoA aneurysms has the potential to cause clip-related compression of the optic nerve. Postoperative visual examination is of utmost importance, and if any changes are discovered, reexploration should be considered as repositioning of the clips may lead to resolution of visual deterioration.

  12. Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.

    Science.gov (United States)

    Tan, Jeffrey; Ndoro, Samuel; Okafo, Uchenna; Garrahy, Aoife; Agha, Amar; Rawluk, Danny

    2016-12-16

    Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications. Shortly after surgery, he developed clear features of ADI with adipsic severe hypernatraemia and hypotonic polyuria, which was associated with cognitive impairment that was confirmed with biochemical investigations and cognitive assessments. He was treated with DDAVP along with a strict intake of oral fluids at scheduled times to maintain eunatremia. Repeat assessment at six months showed recovery of thirst and a normal water deprivation test. Management of ADI with cognitive impairment is complex and requires a multidisciplinary approach. Recovery from ADI is very rare, and this is only the second report of recovery in this particular clinical setting.

  13. Aphasia following anterior cerebral artery occlusion

    International Nuclear Information System (INIS)

    Shimosaka, Shinichi; Waga, Shiro; Kojima, Tadashi; Shimizu, Takeo; Morikawa, Atsunori

    1982-01-01

    We have report two cases of aphasia that had infarcts in the distribution of the left or right anterior cerebral artery, as confirmed by computed tomography. Case 1 is a right-handed, 65-year-old man in whom computerized tomographic scanning revealed an infarction of the territory of the left anterior cerebral artery after the clipping of the anterior communicating artery aneurysm. The standard language test of aphasia (SLTA) revealed non-fluent aphasia with dysarthria, good comprehension, almost normal repetition with good articulation, and a defectiveness in writing. This syndrome was considered an instance of transcortical motor aphasia. Although three years had passed from the onset, his aphasia did not show any improvement. Case 2 is a 37-year-old man who is right-handed but who can use his left hand as well. He was admitted because of subarachnoid hemorrhage from an anterior communicating aneurysm. Because of postoperative spasm, an infarction in the distribution of the right anterior cerebral artery developed. He was totally unable to express himself vocally, but he could use written language quite well to express his ideas and had a good comprehension of spoken language. This clinical picture was considered that of an aphemia. After several weeks, his vocalization returned, but the initial output was still hypophonic. (J.P.N.)

  14. Aphasia following anterior cerebral artery occlusion

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    Shimosaka, Shinichi; Waga, Shiro; Kojima, Tadashi; Shimizu, Takeo; Morikawa, Atsunori (Mie Univ., Tsu (Japan). School of Medicine)

    1982-10-01

    We have report two cases of aphasia that had infarcts in the distribution of the left or right anterior cerebral artery, as confirmed by computed tomography. Case 1 is a right-handed, 65-year-old man in whom computerized tomographic scanning revealed an infarction of the territory of the left anterior cerebral artery after the clipping of the anterior communicating artery aneurysm. The standard language test of aphasia (SLTA) revealed non-fluent aphasia with dysarthria, good comprehension, almost normal repetition with good articulation, and a defectiveness in writing. This syndrome was considered an instance of transcortical motor aphasia. Although three years had passed from the onset, his aphasia did not show any improvement. Case 2 is a 37-year-old man who is right-handed but who can use his left hand as well. He was admitted because of subarachnoid hemorrhage from an anterior communicating aneurysm. Because of postoperative spasm, an infarction in the distribution of the right anterior cerebral artery developed. He was totally unable to express himself vocally, but he could use written language quite well to express his ideas and had a good comprehension of spoken language. This clinical picture was considered that of an aphemia. After several weeks, his vocalization returned, but the initial output was still hypophonic.

  15. Unruptured anterior communicating artery aneurysm with co-existing blister aneurysms: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Karthikeyan Y. R.

    2017-06-01

    Full Text Available Blister aneurysms are a separate class of vascular malformations with a unique etiopathogenesis and clinical profile, elusive to radiological imaging and complex to manage. Unless identified and managed appropriately they often lead increased morbidity intra and post operatively. They are commonly reported in internal carotid artery. We are reporting a rare case of intraoperatively diagnosed blister aneurysm of the anterior cerebral artery, the management options and the importance of constant vigilance in cases where the aneurysm appears unruptured intraoperatively.

  16. Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex-a cadaveric study.

    Science.gov (United States)

    Spiessberger, Alexander; Baumann, F; Nevzati, E; Kothbauer, K F; Fandino, J; Muroi, C

    2017-06-01

    In selected cases, microsurgical clipping remains a valuable treatment alternative to endovascular occlusion of anterior communicating artery (AComA) aneurysms. Their clipping is challenging and carries a risk of postsurgical cognitive impairment. We evaluate the microsurgical anatomy of a new, minimally invasive combined interhemispheric-subfrontal approach to the AComA complex via a medial supraorbital craniotomy. In this descriptive anatomic study, four alcohol-embedded, silicon-injected human cadaver heads were used. In each of the two cadavers, the AComA complex was approached from either the right or left side. An operating microscope and standard microsurgical instruments were used. After a medial eyebrow incision, a medial supraorbital minicraniotomy was performed. The frontal sinus was opened and cranialized. Following the dural opening, a subfrontal arachnoid dissection was performed to identify the optico-carotid complex. By following the A1 segment, a low-lying AComA complex could be visualized. Shifting the corridor towards the midline enabled an interhemispheric dissection. This dissection resulted in a wide superior-inferior corridor. Higher-lying AComA complexes could also be visualized. The achieved exposure of the AComA complex would allow safe dissection and clipping of low- and high-lying AComA aneurysms, with minimal retraction and preservation of the surrounding anatomical structures, in particular the perforators. We demonstrate the anatomy of a novel approach for surgical clipping of AComA aneurysms. Our study suggests that this approach provides good exposure without concomitant structural and vascular injury and thus might reduce the risk of procedure-related morbidity.

  17. Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network.

    Science.gov (United States)

    Liu, Jinjin; Chen, Yongchun; Lan, Li; Lin, Boli; Chen, Weijian; Wang, Meihao; Li, Rui; Yang, Yunjun; Zhao, Bing; Hu, Zilong; Duan, Yuxia

    2018-02-23

    Anterior communicating artery (ACOM) aneurysms are the most common intracranial aneurysms, and predicting their rupture risk is challenging. We aimed to predict this risk using a two-layer feed-forward artificial neural network (ANN). 594 ACOM aneurysms, 54 unruptured and 540 ruptured, were reviewed. A two-layer feed-forward ANN was designed for ACOM aneurysm rupture-risk analysis. To improve ANN efficiency, an adaptive synthetic (ADASYN) sampling approach was applied to generate more synthetic data for unruptured aneurysms. Seventeen parameters (13 morphological parameters of ACOM aneurysm measured from these patients' CT angiography (CTA) images, two demographic factors, and hypertension and smoking histories) were adopted as ANN input. Age, vessel size, aneurysm height, perpendicular height, aneurysm neck size, aspect ratio, size ratio, aneurysm angle, vessel angle, aneurysm projection, A1 segment configuration, aneurysm lobulations and hypertension were significantly different between the ruptured and unruptured groups. Areas under the ROC curve for training, validating, testing and overall data sets were 0.953, 0.937, 0.928 and 0.950, respectively. Overall prediction accuracy for raw 594 samples was 94.8 %. This ANN presents good performance and offers a valuable tool for prediction of rupture risk in ACOM aneurysms, which may facilitate management of unruptured ACOM aneurysms. • A feed-forward ANN was designed for the prediction of rupture risk in ACOM aneurysms. • Two demographic parameters, 13 morphological aneurysm parameters, and hypertension/smoking history were acquired. • An ADASYN sampling approach was used to improve ANN quality. • Overall prediction accuracy of 94.8 % for the raw samples was achieved.

  18. Aneurismas del complejo arteria cerebral anterior / arteria comunicante anterior: Resultados del tratamiento quirúrgico Aneurysms of the anterior cerebral artery-anterior communicating artery complex: Results of the surgical treatment

    Directory of Open Access Journals (Sweden)

    Justo L González González

    2006-03-01

    Full Text Available Los aneurismas del complejo arteria cerebral anterior-arteria comunicante anterior figuran entre los más frecuentes de localización intracraneal y, debido a su variabilidad anatómica y características hemodinámicas, constituyen un reto especial para cualquier esfuerzo terapéutico. Con el objetivo de caracterizarlos y evaluar los resultados del tratamiento quirúrgico de estas lesiones, se estudian los pacientes operados en el Servicio de Neurocirugía del Hospital Clinicoquirúrgico «Hermanos Ameijeiras», entre enero de 1983 y agosto de 1998. Se observó que el 71,1 % de la muestra egresó en excelente estado; el 13,44 %, con secuelas mínimas; el 3,48 %, con secuelas graves y que la mortalidad fue del 11,53 %. Se concluye que estos aneurismas son más frecuentes en el sexo masculino, en la cuarta y quinta décadas de la vida (media de 39,9 años y que el tamaño crítico de ruptura se ubica mayoritariamente entre 6 mm y 11 mm. De igual forma se observó que la edad, el tamaño sacular, el vasoespasmo y la ruptura transoperatoria influyen sobre los resultados y que la influencia de estas dos últimas complicaciones es muy fuerte. El infarto cerebral isquémico fue la causa de muerte más frecuente

  19. Infraoptic course of the anterior cerebral artery: case report

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Myong Hee; Lee, Ghi Jai; Shim, Jae Chan; Kwon, O Ki; Koh, Young Cho; Kim, Ho Kyun [Inje University College of Medicine, Seoul (Korea, Republic of)

    2002-12-01

    An infraoptic anterior cerebral artery (ACA) arising at a low bifurcation of the internal carotid artery is a rare anomaly, of which about 33 cases have been reported to date, often in association with cerebral aneurysms. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. Angiography revealed the presence of an abnormal solitary ACA, arising from the intracranial proximal internal carotid artery near the origin of the ophthalmic artery, and a contralateral middle cerebral artery aneurysm. Magnetic resonance imaging showed that the ACA passed below the ipsilateral optic nerve, anterior to the optic chiasm, to join the normally positioned anterior communicating artery above the optic chiasm.

  20. Feasibility of the combination of 3D CTA and 2D CT imaging guidance for clipping microsurgery of anterior communicating artery aneurysm.

    Science.gov (United States)

    Wada, Kojiro; Nawashiro, Hiroshi; Ohkawa, Hidenori; Arimoto, Hirohiko; Takeuchi, Satoru; Mori, Kentaro

    2015-04-01

    We report the technique of three-dimensional computed tomography angiography (3D CTA)+two-dimensional computed tomographic (2D CT) imaging as an adjunct in early surgery for a ruptured anterior communicating artery (ACoA) aneurysm by adopting an anterior interhemispheric approach. These combined imaging modalities provide accurate intraoperative anatomical information. To produce images for an anterior interhemispheric approach, 3D CTA+2D coronal CT images, which are perpendicular to the direction of the surgical approach at three levels (brain surface, genu of the corpus callosum and aneurysm neck), were constructed. We also produced two 3D CTA+2D CT images of the lamina terminalis, with a horizontal 10-degree difference, to clarify the vascular architecture around the aneurysm stereotactically, as well as the dissection point and direction to open the lamina terminalis. Furthermore, we produced a 3D CTA+2D sagittal CT image at the midline, which allowed us to understand the anatomical architecture of the aneurysm, planum sphenoidale and tuberculum sellae. In addition, four different 3D CTA aneurysm images were produced for deciding the clip size preoperatively. The imaging findings in 28 patients with 28 ACoA aneurysms facilitated early clipping. Based on these 3D CTA+2D CT images, we conducted aneurysm surgery, and successfully performed neck clipping via an anterior interhemispheric approach. The combination of 3D CTA and 2D CT images is a feasible and useful method of image guidance for ACoA aneurysm microsurgery.

  1. Subcallosal artery stroke: infarction of the fornix and the genu of the corpus callosum. The importance of the anterior communicating artery complex. Case series and review of the literature.

    Science.gov (United States)

    Meila, Dan; Saliou, Guillaume; Krings, Timo

    2015-01-01

    Despite the variable anatomy of the anterior communicating artery (AcoA) complex, three main perforating branches can be typically identified the largest of which being the subcallosal artery (ScA). We present a case series of infarction in the vascular territory of the ScA to highlight the anatomy, the clinical symptomatology, and the presumed pathophysiology as it pertains to endovascular and surgical management of vascular pathology in this region. In this retrospective multicenter case series study of patients who were diagnosed with symptomatic ScA stroke, we analyzed all available clinical records, MRI, and angiographic details. Additionally, a review of the literature is provided. We identified five different cases of ScA stroke, leading to a subsequent infarction of the fornix and the genu of the corpus callosum. The presumed pathophysiology in non-iatrogenic cases is microangiopathy, rather than embolic events; iatrogenic SCA occlusion can present after both surgical and endovascular treatment of AcoA aneurysms that may occur with or without occlusion of the AcoA. Stroke in the vascular territory of the ScA leads to a characteristic imaging and clinical pattern. Ischemia involves the anterior columns of the fornix and the genu of the corpus callosum, and patients present with a Korsakoff's syndrome including disturbances of short-term memory and cognitive changes. We conclude that despite its small size, the ScA is an important artery to watch out for during surgical or endovascular treatment of AcoA aneurysms.

  2. Anterior Tibial Artery Pseudoaneurysm: Case Report

    Directory of Open Access Journals (Sweden)

    Funda Tor

    2012-06-01

    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  3. Traumatic Anterior Cerebral Artery Pseudoaneurysmal Epistaxis.

    Science.gov (United States)

    Liu, Qing Lin; Xue, Hao; Qi, Chang Jing; Zhao, Peng; Wang, Dong Hai; Li, Gang

    2017-04-01

    Pseudoaneurysmal epistaxis is a rare but emergent condition. We report a case of traumatic anterior cerebral artery pseudoaneurysmal epistaxis and review the published literature. A 49-year-old man sustained severe head trauma. He was diagnosed with multiple skull bone fractures, left subdural hematoma, subarachnoid hemorrhage, pneumocephalus, and right frontal hematoma. Subdural hematoma evacuation was done at a local hospital. In the following months, he experienced repeated epistaxis that required nasal packing to stop the bleeding. Digital subtraction angiography showed an anterior cerebral artery pseudoaneurysm protruding into the posterior ethmoid sinus. Embolization of the aneurysm was performed with microcoils, and the parent artery was occluded by thrombosis. The patient presented 1 month later with another epistaxis episode. Digital subtraction angiography showed recanalization of the parent artery and recurrence of the aneurysm. The parent artery was occluded for the second time with coils and Onyx embolic agent. Pseudoaneurysmal epistaxis is rare, and this is the first report of an anterior cerebral artery pseudoaneurysm that manifested with epistaxis. Endovascular intervention has become the first choice of treatment for this disease. The high recurrence rate is the main disadvantage of endovascular intervention. Aneurysm trapping with bypass surgery is another treatment option. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Microsurgical Clipping of an Anterior Communicating Artery Aneurysm Using a Novel Robotic Visualization Tool in Lieu of the Binocular Operating Microscope: Operative Video.

    Science.gov (United States)

    Klinger, Daniel R; Reinard, Kevin A; Ajayi, Olaide O; Delashaw, Johnny B

    2018-01-01

    The binocular operating microscope has been the visualization instrument of choice for microsurgical clipping of intracranial aneurysms for many decades. To discuss recent technological advances that have provided novel visualization tools, which may prove to be superior to the binocular operating microscope in many regards. We present an operative video and our operative experience with the BrightMatterTM Servo System (Synaptive Medical, Toronto, Ontario, Canada) during the microsurgical clipping of an anterior communicating artery aneurysm. To the best of our knowledge, the use of this device for the microsurgical clipping of an intracranial aneurysm has never been described in the literature. The BrightMatterTM Servo System (Synaptive Medical) is a surgical exoscope which avoids many of the ergonomic constraints of the binocular operating microscope, but is associated with a steep learning curve. The BrightMatterTM Servo System (Synaptive Medical) is a maneuverable surgical exoscope that is positioned with a directional aiming device and a surgeon-controlled foot pedal. While utilizing this device comes with a steep learning curve typical of any new technology, the BrightMatterTM Servo System (Synaptive Medical) has several advantages over the conventional surgical microscope, which include a relatively unobstructed surgical field, provision of high-definition images, and visualization of difficult angles/trajectories. This device can easily be utilized as a visualization tool for a variety of cranial and spinal procedures in lieu of the binocular operating microscope. We anticipate that this technology will soon become an integral part of the neurosurgeon's armamentarium. Copyright © 2017 by the Congress of Neurological Surgeons

  5. Pseudoaneurysm of the anterior superficial temporal artery.

    Science.gov (United States)

    Han, K; Borah, G L

    1996-12-01

    Pseudoaneurysm of the superficial temporal artery must be considered in the differential diagnosis of masses of the lateral forehead and temporal fossa. While the first reported case of a temporal artery aneurysm was reported by Thomas Bartholin in 1740, there is scant mention of this lesion in the plastic and maxillofacial surgical literature. Pseudoaneurysms can arise in the forehead and scalp as a result of blunt traumatic impingement of the superficial temporal artery against the calvarium. The anterior branch of the artery is most vulnerable, because in the lateral forehead it courses over the frontal osseous ridge in the galea aponeurotica formed by the fusion line of the deep and superficial temporalis muscle fascia. This dense fascial investment has a tethering effect in the gap between the temporalis and frontalis muscles and prevents the artery from displacing laterally in response to traumatic forces. A history of recent blunt trauma or surgery to the forehead, combined with a pulsatile bruit, should direct the physician to the diagnosis of pseudoaneurysm of the superficial temporal artery. Treatment is surgical resection of the involved segment without the need for reconstruction. This report includes a review of the literature and presents the first documented case of a bicycle helmet as the cause of a superficial temporal artery pseudoaneurysm.

  6. Microneurosurgical management of anterior choroid artery aneurysms.

    Science.gov (United States)

    Lehecka, Martin; Dashti, Reza; Laakso, Aki; van Popta, Jouke S; Romani, Rossana; Navratil, Ondrej; Kivipelto, Leena; Kivisaari, Riku; Foroughi, Mansoor; Kokuzawa, Jouji; Lehto, Hanna; Niemelä, Mika; Rinne, Jaakko; Ronkainen, Antti; Koivisto, Timo; Jääskelainen, Juha E; Hernesniemi, Juha

    2010-05-01

    Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs. This review, and the whole series on intracranial aneurysms (IAs), are mainly based on the personal microneurosurgical experience of the senior author (J.H.) in two Finnish centers (Helsinki and Kuopio) that serve, without patient selection, the catchment area in Southern and Eastern Finland. These two centers have treated more than 10,000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 patients (28%) had altogether 980 internal carotid artery (ICA) aneurysms, of whom 95 patients had 99 (2%) AChAAs. Ruptured AChAAs, found in 39 patients (41%), with median size of 6 mm (range = 2-19 mm), were associated with intracerebral hematoma (ICH) in only 1 (3%) patient. Multiple aneurysms were seen in 58 (61%) patients. The main difficulty in microneurosurgical management of AChAAs is to preserve flow in the anterior choroid artery originating at the base and often attached to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3 dimensional angioarchitecture and proper orientation during the microsurgical dissection. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms.

    Science.gov (United States)

    Park, Jaechan; Son, Wonsoo; Goh, Duck-Ho; Kang, Dong-Hun; Lee, Joomi; Shin, Im Hee

    2016-03-01

    The highest incidence of olfactory dysfunction following a pterional approach and its modifications for an intracranial aneurysm has been reported in cases of anterior communicating artery (ACoA) aneurysms. The radiological characteristics of unruptured ACoA aneurysms affecting the extent of retraction of the frontal lobe and olfactory nerve were investigated as risk factors for postoperative olfactory dysfunction. A total of 102 patients who underwent a pterional or superciliary keyhole approach to clip an unruptured ACoA aneurysm from 2006 to 2013 were included in this study. Those patients who complained of permanent olfactory dysfunction after their aneurysm surgery, during a postoperative office visit or a telephone interview, were invited to undergo an olfactory test, the Korean version of the Sniffin' Sticks test. In addition, the angiographic characteristics of ACoA aneurysms, including the maximum diameter, the projecting direction of the aneurysm, and the height of the neck of the aneurysm, were all recorded based on digital subtraction angiography and sagittal brain images reconstructed using CT angiography. Furthermore, the extent of the brain retraction was estimated based on the height of the ACoA aneurysm neck. Eleven patients (10.8%) exhibited objective olfactory dysfunction in the Sniffin' Sticks test, among whom 9 were anosmic and 2 were hyposmic. Univariate and multivariate analyses revealed that the direction of the ACoA aneurysm, ACoA aneurysm neck height, and estimated extent of brain retraction were statistically significant risk factors for postoperative olfactory dysfunction. Based on a receiver operating characteristic (ROC) analysis, an ACoA aneurysm neck height > 9 mm and estimated brain retraction > 12 mm were chosen as the optimal cutoff values for differentiating anosmic/hyposmic from normosmic patients. The values for the area under the ROC curves were 0.939 and 0.961, respectively. In cases of unruptured ACoA aneurysm surgery, the

  8. Agenesis of internal carotid artery associated with congenital anterior hypopituitarism

    Energy Technology Data Exchange (ETDEWEB)

    Moon, W.-J. [Department of Diagnostic Radiology, Samsung Medical Center, Seoul (Korea); Institute of Neuroradiology, University of Frankfurt (Germany); Porto, L.; Lanfermann, H.; Zanella, F.E. [Institute of Neuroradiology, University of Frankfurt (Germany); Weis, R. [Department of Pediatric Neurology, University of Frankfurt (Germany)

    2002-02-01

    We report a rare case of unilateral agenesis of the internal carotid artery in association with congenital anterior hypopituitarism. The collateral circulation is supplied by a transsellar intercavernous anastomotic vessel connecting the internal carotid arteries. These abnormalities are well depicted on MRI and MRA. The agenesis of the internal carotid artery may explain the pathogenesis of some of congenital anterior hypopituitarism. (orig.)

  9. Agenesis of internal carotid artery associated with congenital anterior hypopituitarism

    International Nuclear Information System (INIS)

    Moon, W.-J.; Porto, L.; Lanfermann, H.; Zanella, F.E.; Weis, R.

    2002-01-01

    We report a rare case of unilateral agenesis of the internal carotid artery in association with congenital anterior hypopituitarism. The collateral circulation is supplied by a transsellar intercavernous anastomotic vessel connecting the internal carotid arteries. These abnormalities are well depicted on MRI and MRA. The agenesis of the internal carotid artery may explain the pathogenesis of some of congenital anterior hypopituitarism. (orig.)

  10. The intramyocardial left anterior descending artery: Prevalence and ...

    African Journals Online (AJOL)

    The intramyocardial left anterior descending artery: Prevalence and surgical considerations in coronary artery bypass grafting. ... The left anterior descending (LAD) artery is the most commonly bridged vessel. Its prevalence ... Techniques are described to address this anatomical variation when it is encountered at surgery.

  11. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  12. Symptomatic Type IV Dual Left Anterior Descending Coronary Artery

    Directory of Open Access Journals (Sweden)

    Kyriacos Papadopoulos MD

    2016-12-01

    Full Text Available Dual left anterior descending coronary artery is a rare congenital anomaly with 4 subtypes. Double left anterior descending coronary artery originating from the left main stem and the right coronary artery (type IV dual left anterior descending artery has been reported to occur in 0.01% to 0.7% of patients undergoing cardiac catheterization. We report a case of a 49-year-old woman who was found to have this anomaly during coronary angiography. The patient had been complaining of chest pain that mimics angina pectoris and exercise tolerance test was positive for myocardial ischemia.

  13. Anterior ethmoidal artery evaluation on coronal CT scans.

    Science.gov (United States)

    Souza, Soraia Ale; Souza, Marcia Maria Ale de; Gregório, Luís Carlos; Ajzen, Sergio

    2009-01-01

    The anterior ethmoidal artery (AEA) is an important point for frontal and ethmoid sinuses surgery. CT scans can identify landmarks to help the surgeon find the AEA. To identify the landmarks of the AEA on the orbital medial wall and on the lateral wall of the olfactory fossa. and to correlate the presence of supraorbital ethmoidal cells with spotting the anterior ethmoidal artery canal. Retrospective review of 198 direct coronal paranasal sinuses computed tomography (CT) scans from August to December, 2006. Supraorbital pneumatization was seen in 35% (70 scans). The AEA canal was seen in 41% (81 scans). The anterior ethmoidal sulcus was seen in 98% (194 scans) and the anterior ethmoidal foramen was seen in all the scans (100%). The anterior ethmoidal foramen and the anterior ethmoidal sulcus were anatomical landmarks present in almost 100% of the scans studied. There was a correlation between the presence of supraorbital pneumatization and AEA canal visualization.

  14. Giant left anterior descending artery aneurysm resulting in sudden death

    Directory of Open Access Journals (Sweden)

    Chan-Hee Lee

    2016-07-01

    Full Text Available Coronary artery aneurysm is a rare congenital or vascular inflammation-based anomaly for which the clinical course and optimal timing of treatment remain unclear. Here, we report a case of sudden death caused by a giant coronary artery aneurysm of the left anterior descending artery that presented with chest pain. This case suggests that urgent interventional or surgical repair is needed when a large coronary aneurysm presents with acute ischemic symptoms.

  15. Transluminal color-coded three-dimensional magnetic resonance angiography for visualization of signal Intensity distribution pattern within an unruptured cerebral aneurysm: preliminarily assessment with anterior communicating artery aneurysms

    International Nuclear Information System (INIS)

    Satoh, T.; Ekino, C.; Ohsako, C.

    2004-01-01

    The natural history of unruptured cerebral aneurysm is not known; also unknown is the potential growth and rupture in any individual aneurysm. The authors have developed transluminal color-coded three-dimensional magnetic resonance angiography (MRA) obtained by a time-of-flight sequence to investigate the interaction between the intra-aneurysmal signal intensity distribution patterns and configuration of unruptured cerebral aneurysms. Transluminal color-coded images were reconstructed from volume data of source magnetic resonance angiography by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a numerical threshold range from a signal intensity opacity chart of the three-dimensional volume-rendering dataset several areas of signal intensity were depicted, assigned different colors, and visualized transparently through the walls of parent arteries and an aneurysm. Patterns of signal intensity distribution were analyzed with three operated cases of an unruptured anterior communicating artery aneurysm and compared with the actual configurations observed at microneurosurgery. A little difference in marginal features of an aneurysm was observed; however, transluminal color-coded images visualized the complex signal intensity distribution within an aneurysm in conjunction with aneurysmal geometry. Transluminal color-coded three-dimensional magnetic resonance angiography can thus provide numerical analysis of the interaction between spatial signal intensity distribution patterns and aneurysmal configurations and may offer an alternative and practical method to investigate the patient-specific natural history of individual unruptured cerebral aneurysms. (orig.)

  16. [Post-traumatic occlusion of the anterior cerebral artery].

    Science.gov (United States)

    Amagasa, M; Sato, S; Shimizu, Y; Otabe, K; Onuma, T

    1988-01-01

    A rare case with cerebral infarction in the region of the anterior cerebral artery after minor head injury is reported. A 44-year-old male sustained a blow in the occipital area and became unconscious for a moment when he was driving a car and was involved in a rear-end collision. There being no significant signs, he drove home. About 30 minutes after the traffic accident, he felt weakness in the right limbs and speech difficulty and immediately visited our clinic. The patient was alert, but right hemiparesis and mild motor aphasia were present. There was no apparent evidence of head injury. A plain skull roentgenogram revealed no fracture. Computed tomography two hours after the trauma was normal. A left carotid angiogram showed an evident dilatation of A2 and the proximal portion of A3 of the anterior cerebral artery, tapering off to an occlusion of the callosomarginal artery in the arterial phase, delayed filling of the anterior cerebral artery in the capillary phase, and pooling of the callosomarginal artery in the venous phase. Three days later, computed tomography showed a low density area on the medial surface of the left frontal lobe. The symptoms of the patient improved with conservative treatment. Sequential changes in angiographic findings were observed. One month after admission, severe irregularity and stenosis of the pericallosal artery and revascularization of the callosomarginal artery was noted. By this time most of his symptoms had disappeared. Two months after admission, stenosis of the pericallosal artery increased. Three months after admission the stenosis improved slightly. The patient was discharged with no neurological deficit. Seven months after the initial trauma, a left carotid angiogram showed further regression of the stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Reflux of Anterior Spinal Artery Predicts Recurrent Posterior Circulation Stroke in Bilateral Vertebral Artery Disease.

    Science.gov (United States)

    Fukuda, Hitoshi; Hayashi, Kosuke; Handa, Akira; Kurosaki, Yoshitaka; Lo, Benjamin; Yamagata, Sen

    2015-11-01

    Predictive value of reflux of anterior spinal artery for recurrent posterior circulation ischemia in bilateral vertebral arteries steno-occlusive disease was evaluated. We retrospectively reviewed 55 patients with symptomatic posterior circulation stroke caused by bilateral stenotic (>70%) lesions of the vertebral artery. We investigated any correlation of clinical and angiographic characteristics including collateral flow patterns, with recurrent stroke. Risk factors for poor 3-month functional outcome were also evaluated. Recurrent posterior circulation stroke was observed in 15 (27.3%) patients. Multivariable analysis using Cox proportional hazards model showed anterior spinal artery reflux as a significant risk factor for stroke recurrence (adjusted hazard ratio, 19.3 [95% confidence interval, 5.35-69.9]; Pdisease, anterior spinal artery reflux predicted recurrent posterior circulation stroke and poor functional outcome. © 2015 American Heart Association, Inc.

  18. Aneurysm of Anterior Inferior Cerebellar Artery-posterior Inferior Cerebellar Artery Variant

    Science.gov (United States)

    Ansari, Khursheed Ahmad; Menon, Girish; Nair, Suresh; Abraham, Mathew

    2018-01-01

    Aneurysms arising from anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) variant are extremely rare. They usually present with subarachnoid hemorrhage. This is probably the second case report of a large thrombosed AICA-PICA variant aneurysm presenting as a cerebellopontine angle mass lesion with cranial nerve palsy, managed successfully by surgical clipping. PMID:29492120

  19. Anterior Inferior cerebellar artery infarction misdiagnosed as inner ear disease.

    Science.gov (United States)

    Yoshida, T; Ikemiyagi, Y; Ikemiyagi, F; Tamura, Y; Suzuki, M; Tsuyusaki, Y

    2016-08-01

    Anterior Inferior cerebellar artery infarction misdiagnosed as inner ear disease. The clinical >resentation of anterior inferior cerebellar artery (AICA) infarction may mimic that of inner ear disease. lethodology: This report presents two patients with cerebellar artery infarction initially misdiagnosed with inner ear lisease. ase Report: Both the patients presented with sudden hearing loss and vertigo. The patient in case 1 was initially liagnosed with idiopathic sudden sensorineural hearing loss. The patient in case 2 presented with 17 days of vertigo and iearing loss. Both were correctly diagnosed with AICA infarction after performing magnetic resonance imaging. esults and Conclusions: We differentiated AICA from inner ear disease based on the variability in degree and frequency ange of hearing loss, the duration of vertigo, and the manifestation of nystagmus. Because cases of AICA infarction and nner ear disease may present with si'milar symptoms, a detailed examination including clinical course assessments, aboratory findings, and neurological imaging is essential for appropriate diagnosis and treatment.

  20. Anomalous origin of the left anterior descending coronary artery from the right coronary artery

    Directory of Open Access Journals (Sweden)

    Kyriacos Papadopoulos

    2013-01-01

    Full Text Available Dual left anterior descending coronary artery (LAD originating from the left main stem and the right coronary artery (RCA (Type IV dual LAD is a very rare coronary artery anomaly. In this report, we describe a 49 year old woman presenting with unstable angina and positive for myocardial ischemia exercise tolerance test who subsequently was found to have this coronary anomaly.The diagnosis was made with coronary angiography.This anomaly has been reported to occur in 0.01 — 0.7% of patients under going cardiac catheterization. To our knowledge, only a few such cases have been published in the literature so far.

  1. Infra-optic Course of Both Anterior Cerebral Arteries Associated with a Middle Cerebral Artery Aneurysm and an Aortic Coarctation

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    Ji, Cheol; Ahn, Jae Geun; Cho, Song Mee [Catholic University, St. Paul' s Hospital, Seoul (Korea, Republic of)

    2009-06-15

    A ruptured aneurysm at the bifurcation of the left middle cerebral artery with an infra- optic course of the bilateral anterior cerebral arteries was found in a 28-year-old woman. Both abnormal anterior cerebral arteries arose from the ipsilateral internal carotid arteries, at the level of the origin of ophthalmic arteries, passed underneath the ipsilateral optic nerves and turned upward at the ventral portion of the optic chiasm. In addition, an aortic coarctation was found with the use of thoracic aortography. An infra-optic course of the bilateral anterior cerebral arteries is an extremely rare anomaly. An infra-optic course of the bilateral anterior cerebral arteries is frequently associated with cerebral aneurysms and possibly with a coarctation aorta. The clinical features, radiological findings and possible genesis of this anomaly are presented.

  2. Anterior inferior cerebellar artery aneurysms mimicking vestibular schwannomas.

    Science.gov (United States)

    Marchini, Aïda Kawkabani; Mosimann, Pascal J; Guichard, Jean-Pierre; Boukobza, Monique; Houdart, Emmanuel

    2014-01-01

    Unruptured anterior inferior cerebellar artery (AICA) aneurysms are rare but potentially lethal cerebellopontine angle (CPA) lesions that may be misdiagnosed as vestibular schwannomas when they present with vestibulo-cochlear symptoms. We report two cases of unruptured but symptomatic AICA aneurysms initially referred to us as atypical vestibular schwannomas requiring surgery. Two discriminant MR features are described. One patient refused treatment. The other was successfully treated by coil occlusion. Caution is advised before suspecting a CPA mass to be a purely extra-canalicular schwannoma, given its extreme rarity. Deafness and cerebellar ischemia may be prevented if AICA aneurysms are correctly identified preoperatively. In the absence of specific arterial imaging, two MR features may distinguish them from vestibular schwannomas: (1) the absence of internal auditory canal enlargement and (2) the "blurry dot sign," representing blood flow artefacts on pre- and postcontrast studies. Copyright © 2013 by the American Society of Neuroimaging.

  3. Anterior humeral circumflex artery avulsion with brachial plexus injury following an isolated traumatic anterior shoulder dislocation.

    Science.gov (United States)

    Shah, Rohi; Koris, Jacob; Wazir, Akhlaq; Srinivasan, Shyamsundar S

    2016-03-11

    A 70-year-old man presented to accident and emergency with an isolated anteriorly dislocated shoulder, in the absence of a concomitant fracture. There was no neurovascular deficit at presentation, and the shoulder was reduced under sedation, using the Kocher's technique. Following this, the patient developed signs of hypovolaemic shock. Clinical examination revealed an expanding fullness in the deltopectoral area, with compromise of the limb neurovascular status. CT imaging confirmed an expanding haematoma from the axillary vessels, restricting left lung expansion. Once resuscitated, the patient was transferred to theatre for exploration of the bleeding vessels. Intraoperative findings included an avulsed anterior circumflex humeral artery that was subsequently ligated. Postoperatively, the patient developed axillary, radial, median and ulnar nerve neuropraxia, which improved clinically prior to discharge. The patient was ultimately discharged home after a lengthy inpatient stay. 2016 BMJ Publishing Group Ltd.

  4. Anatomy and radiology of the anterior inferior cerebellar artery

    International Nuclear Information System (INIS)

    Heimans, J.J.

    1983-01-01

    This study describes the variations of the Anterior Inferior Cerebellar Artery (AICA) and identifies its types of appearance in normal angiograms as well as in angiograms of patients suffering from posterior fossa tumours or from ischemic lesions in the vertebro-basilar territory. For this purpose a study of 20 normal specimens was undertaken. Four main types of the AICA are distinguished. One hundred normal vertebral angiograms, made between 1976 and 1982 in the Valeriuskliniek and the Academisch Ziekenhuis der Vrije Univesiteit are reviewed. The AICA's are classified in the same way as in the anatomical study. The same classification was used in the analysis of 41 vertebral angiograms of patients with posterior fossa tumours and nine angiograms of patients with ischemic disturbances in the posterior cranial fossa. (Auth.)

  5. Dual (type IV) left anterior descending artery | Baskan | SA Journal of ...

    African Journals Online (AJOL)

    Congenital coronary artery anomalies are uncommon. Dual left anterior descending coronary artery (LAD) is defined as the presence of two LADs within the anterior interventricular sulcus (AIVS), and is classified into four types. Type IV is a rarely reported subtype and differs from the others, with a long LAD originating from ...

  6. Anterior Hox Genes in Cardiac Development and Great Artery Patterning

    Directory of Open Access Journals (Sweden)

    Brigitte Laforest

    2014-03-01

    Full Text Available During early development, the heart tube grows by progressive addition of progenitor cells to the arterial and venous poles. These cardiac progenitor cells, originally identified in 2001, are located in the splanchnic mesoderm in a region termed the second heart field (SHF. Since its discovery, our view of heart development has been refined and it is well established that perturbation in the addition of SHF cells results in a spectrum of congenital heart defects. We have previously shown that anterior Hox genes, including Hoxb1, Hoxa1 and Hoxa3, are expressed in distinct subdomains of the SHF that contribute to atrial and subpulmonary myocardium. It is well known that Hox proteins exert their function through interaction with members of the TALE family, including Pbx and Meis factors. The expression profile of Pbx and Meis factors overlaps with that of anterior Hox factors in the embryonic heart, and recent data suggest that they may interact together during cardiac development. This review aims to bring together recent findings in vertebrates that strongly suggest an important function for Hox, Pbx and Meis factors in heart development and disease.

  7. Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction.

    Science.gov (United States)

    N'da, Hermann Adonis; Chenin, Louis; Capel, Cyril; Havet, Eric; Le Gars, Daniel; Peltier, Johann

    2016-07-01

    The aim of this study is to describe the anterior spinal artery-Adamkiewicz artery (ASA-AKA) junction and establish a classification allowing defining the neurological risk in either thoracoabdominal aorta aneurysm treatment and in anterior or transforaminal thoracolumbar spine surgery. Fifteen spinal cords of fresh cadavers were dissected. Both lumbar arteries and ASA were injected with strongly diluted red-colored silicon. The dural crossing of AKA was located on the left side in 86 % of cases, between T8 and T10 in 73.33 % of cases and L1-L2 in 26.67 % of cases. The average diameter of the ascending branch of AKA was 1.10 mm (range 0.8-1.9 mm), and its average length was 30.27 mm (range 12.3-60 mm). The AKA's arch average diameter was 11.3 mm (range 9-20 mm) with an open downward angle average of 20.1° (range 11°-30°). The descending branch of AKA which was a continuation of ASA had an average diameter of 1.33 mm (range 0.8-1.86 mm). The ASA at the top of the arch had an average diameter of 0.74 mm (range 0.2-1.77 mm). According to these findings, we have proposed a new classification with two types of junctions. The type I and its variant correlated to high neurological risk were present in 93.33 % of cases. The type II, correlated to medium or low neurological risk, was present in 6.67 % of cases. These anatomical findings allow a planning of the neurological risk before thoracoabdominal aorta aneurysm or thoracolumbar anterior or transforaminal spine surgery.

  8. Occipital artery-anterior inferior cerebellar artery bypass with microsurgical trapping for exclusively intra-meatal anterior inferior cerebellar artery aneurysm manifesting as subarachnoid hemorrhage. Case report.

    Science.gov (United States)

    Fujimura, Miki; Inoue, Takashi; Shimizu, Hiroaki; Tominaga, Teiji

    2012-01-01

    A 77-year-old woman presented with an extremely rare exclusively intra-meatal anterior inferior cerebellar artery (AICA) aneurysm manifesting as subarachnoid hemorrhage. The aneurysm was located at a non-branching site of its meatal loop, deeply inside the internal auditory canal. The ipsilateral posterior inferior cerebellar artery was hypoplastic and the affected AICA supplied a wide vascular territory in the right cerebellum. The patient underwent microsurgical trapping of the distal AICA aneurysm in the acute stage. Collateral back flow to the parent artery was poor, so right occipital artery (OA)-AICA anastomosis was performed prior to aneurysm trapping. The postoperative course was uneventful, and magnetic resonance imaging after surgery did not demonstrate any ischemic change. Postoperative angiography showed complete disappearance of the AICA aneurysm and the apparently patent OA-AICA bypass. She did not suffer neurological deficit except for right incomplete hearing disturbance, and postoperative single photon emission computed tomography demonstrated absence of hemodynamic compromise in the cerebellum. OA-AICA anastomosis with aneurysm trapping could be the optimal surgical management of the AICA aneurysm located exclusively inside the internal auditory canal, especially if the parent artery supplies a wide vascular territory.

  9. Endovascular treatment for ruptured distal anterior inferior cerebellar artery aneurysm.

    Science.gov (United States)

    Oh, Jae-Sang; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack-Gun; Yoon, Il-Gyu

    2014-03-01

    A 42-year-old woman presented with Hunt and Hess grade (HHG) III subarachnoid hemorrhage (SAH) caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin SAH on the cerebellopontine angle cistern, and small vermian intracerebral hemorrhage and intraventricular hemorrhage in the fourth ventricle. Digital subtraction angiography revealed the aneurysm on the postmeatal segment of left distal AICA, a branching point of rostrolateral and caudomedial branch of the left distal AICA. Despite thin caliber, tortuous running course and far distal location, the AICA aneurysm was obliterated successfully with endovascular coils without compromising AICA flow. However, the patient developed left side sensorineural hearing loss postoperatively, in spite of definite patency of distal AICA on the final angiogram. She was discharged home without neurologic sequela except hearing loss and tinnitus. Endovascular treatment of distal AICA aneurysm, beyond the meatal loop, is feasible while preserving the AICA flow. However, because the cochlear hair cell is vulnerable to ischemia, unilateral hearing loss can occur, possibly caused by the temporary occlusion of AICA flow by microcatheter during endovascular treatment.

  10. Value of internal thoracic artery grafting to the left anterior descending coronary artery at coronary reoperation.

    Science.gov (United States)

    Sabik, Joseph F; Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Lytle, Bruce W

    2013-01-22

    The study sought to determine if left internal thoracic artery (LITA) grafting of the left anterior descending (LAD) at reoperative coronary artery bypass grafting (CABG) improves patient outcomes. LITA grafting to the LAD is the gold standard for primary CABG, but its value for reoperative CABG is unknown. From January 1985 to January 2007, reoperative CABG was performed in 3,473 patients who did not receive a LITA during their primary CABG and whose anterior myocardium (LAD) was at risk at reoperation: 2,389 had LITA grafting and 1,084 saphenous vein (SV) grafting to the LAD. Propensity matching (908 matched pairs) was used for balanced comparison of outcomes. Follow-up was continued to 20 years post-operatively, with a mean follow-up of 11 ± 8.2 years. Unadjusted hospital mortality was 2.2% and 6.5% in the LITA and SV groups, respectively (p grafting of the LAD at reoperation resulted in an absolute mortality risk reduction of 6.0% and a hazard ratio of 0.85, with number needed to treat of 16 patients. LITA-to-LAD grafting at reoperation is safe and confers a risk-adjusted survival advantage. When appropriate, a LITA should be used to revascularize the LAD at coronary reoperations. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Distal anterior inferior cerebellar artery syndrome after acoustic neuroma surgery.

    Science.gov (United States)

    Hegarty, Joseph L; Jackler, Robert K; Rigby, Peter L; Pitts, Lawrence H; Cheung, Steven W

    2002-07-01

    To define a clinicopathologic syndrome associated with persistent cerebellar dysfunction after acoustic neuroma (AN) excision. Case series derived from radiographic and clinical chart review. Tertiary referral center. In 12 patients with AN, persistent cerebellar dysfunction developed after AN removal. Each case demonstrated abnormality in the ipsilateral cerebellar peduncle on postoperative magnetic resonance imaging. Cerebellar function and ambulatory status over the first postoperative year. On magnetic resonance imaging scans, the extent of cerebellar peduncle infarcts was variable. It ranged from focal brain injury (2 cm) spanning the full thickness of the peduncle. Peduncular infarcts were associated with large tumor size (average 3.8 cm, range 2.0-5.5 cm diameter). The long-term functional outcomes (>1 yr) varied. Dysmetria was unchanged or improved in over half of the patients (6 of 11 patients). Gait recovered to normal or to preoperative levels in 5 patients. In the 6 patients with persistent impaired mobility, 2 had mild gait disturbance, 3 required regular use of a cane, and 1 has been dependent on a walker. One patient had sustained mild motor weakness. Three of 11 patients remained dependent on others for activities of daily living. Peduncle injury most likely stems from interruption of distal branches of the anterior inferior cerebellar artery (AICA). These small vessels are intimately related to the capsule of the tumor and may supply both the neoplasm and the brain parenchyma. It has long been recognized that interruption of the proximal segment of the AICA results in severe injury to the pons, with devastating neurologic sequelae. A limited AICA syndrome caused by loss of its distal ramifications seems a more plausible explanation for peduncular infarction than either venous insufficiency or direct surgical trauma.

  12. Myocardial Bridges and their Relationship to the Anterior Interventricular Branch of the Left Coronary Artery

    Directory of Open Access Journals (Sweden)

    Lima Vanildo Júnior de Melo

    2002-01-01

    Full Text Available OBJECTIVE: To analyze the relationship between myocardial bridges and the anterior interventricular branch (anterior descending of the left coronary artery. METHODS: The study was carried out with postmortem material, and methods of dissection and observation were used. We assessed the perimeter of the anterior interventricular branch of the left coronary artery using a pachymeter, calculated its proximal and distal diameters in relation to the myocardial bridge, and also its diameter under the myocardial bridge in 30 hearts. We also observed the position of the myocardial bridge in relation to the origin of the anterior interventricular branch. RESULTS: The diameters of the anterior interventricular branch were as follows: the mean proximal diameter was 2.76±0.76 mm; the mean diameter under the myocardial bridge was 2.08±0.54 mm; and the mean distal diameter was 1.98±0.59 mm. In 33.33% (10/30 of the cases, the diameter of the anterior interventricular branch under the myocardial bridge was lower than the diameter of the anterior interventricular branch distal to the myocardial bridge. In 3.33% (1/30 of the cases, an atherosclerotic plaque was found in the segment under the myocardial bridge. The myocardial bridge was located in the middle third of the anterior interventricular branch in 86.66% (26/30 of the cases. CONCLUSION: Myocardial bridges are more frequently found in the middle third of the anterior interventricular branch of the left coronary artery. The diameter of the anterior interventricular branch of the left coronary artery under the myocardial bridge may be smaller than after the bridge. Myocardial bridges may not provide protection against the formation of atherosclerotic plaque inside the anterior interventricular branch of the left coronary artery.

  13. The energy loss may predict rupture risks of anterior communicating aneurysms: a preliminary result.

    Science.gov (United States)

    Hu, Peng; Qian, Yi; Lee, Chong-Joon; Zhang, Hong-Qi; Ling, Feng

    2015-01-01

    Anterior communicating artery (ACoA) aneurysms are well documented to have a higher rupture risk compared with aneurysms at other locations. However, the risk predicting factors for these aneurysms still remain unclear due to the complex arteries geometries and flow patterns involved. The authors introduce a comprehensive method to quantitatively illustrate the development of ACoA aneurysms using a computational fluid dynamics (CFD) approach. Seven ACoA aneurysms, which included 2 ruptured and 5 unruptured aneurysms, were employed. Patient-specific whole anterior circulation geometries were segmented to simulate the real circumstances in vivo. The energy losses (EL) and flow architectures of these 7 aneurysms were evaluated using an algorithm modality. Overall, the 2 ruptured aneurysms, along with 1 unruptured aneurysm that was defined as highly likely to rupture due to ACoA location and a bleb sitting at the top of the dome, had a significantly larger EL and more complex and unstable flow architecture than the others. Two aneurysms had a negative value of EL indicating that the geometries with aneurysms of the anterior communicating complex (ACC) had a smaller loss of energy than the geometries without aneurysms. Despite a small sample size resulting in a low statistical significance, EL may serve as a development predictor of ACoA aneurysms.

  14. Topography of The Posterior Communicating Artery in a Kenyan ...

    African Journals Online (AJOL)

    *Note: B= Basillar artery ICA= Internal Carotid Artery. PCA= Posterior Cerebral artery. CN III= 3rd cranial nerve. A - Hypoplastic configuration. C- Transitional configuration. B- Co-existence of Adult [(PComA (A)] and fetal [PComA (F)] configuration. Topography of The Posterior Communicating Artery in a Kenyan Population.

  15. Bilateral Segmental Agenesis of Carotid and Vertebral Arteries with Rete Mirabile and the Prominent Anterior and Posterior Spinal Arteries as Compensations

    Science.gov (United States)

    Lu, Jun; Liu, Jiachun; Wang, Lijun; Qi, Peng; Wang, Daming

    2014-01-01

    Summary Agenesis of carotid or vertebrobasilar arteries with rete formation is rare. The anterior spinal artery or posterior spinal arteries supplying the posterior circulation with steno-occlusion or agenesis of bilateral vertebral arteries is also uncommon. Here, we describe a very rare case of concomitant segmental agenesis of bilateral carotid and vertebral arteries with collateral compensations from the prominent anterior spinal artery and posterior spinal arteries, as well as some transdural arterial networks which were considered a rete mirabile. We discuss its embryological and anatomic significance. PMID:24556295

  16. Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Y. Alsancak

    2015-01-01

    Full Text Available Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.

  17. Assessment of the Endoscopic Endonasal Transclival Approach for Surgical Clipping of Anterior Pontine Anterior-Inferior Cerebellar Artery Aneurysms.

    Science.gov (United States)

    Sanmillan, Jose L; Lawton, Michael T; Rincon-Torroella, Jordina; El-Sayed, Ivan H; Zhang, Xin; Meybodi, Ali Tayebi; Gabarros, Andreu; Benet, Arnau

    2016-05-01

    Aneurysms of the anterior pontine segment of the anterior-inferior cerebellar artery (AICA) are uncommon. Their treatment is challenging because critical neurovascular structures are adjacent to it and the available surgical corridors are narrow and deep. Although endoscopic endonasal approaches are accepted for treating midline skull base lesions, their role in the treatment vascular lesions remains undefined. The present study is aimed to assess the anatomic feasibility of the endoscopic endonasal transclival (EET) approach for treating anterior pontine AICA aneurysms and compare it with the subtemporal anterior transpetrosal (SAT) approach. Twelve cadaveric specimens were prepared for surgical simulation. The AICAs were exposed using both EET and SAT approaches. Surgical window area and the length of the exposed artery were measured. The distance from the origin of the artery to the clip applied for proximal control was measured. The number of AICA perforators exposed and the anatomic features of each AICA were recorded. The EET approach provided a wider surgical window area compared with the SAT (P AICA perforators were visualized using the EET approach (P AICA, an aneurysm clip could be applied closer to the origin of AICA using EET (0.2 ± 0.42 mm) compared with SAT (6.26 ± 3.4 mm) (P AICA aneurysms using the EET approach is feasible. Compared with SAT, the EET approach provides advantages in surgical window area, ensuring proximal control before aneurysm dissection, visualization of perforating branches, and better proximal control. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Ophthalmic artery originating from the anterior cerebral artery: anatomo-radiological study, histological analysis, and literature review.

    Science.gov (United States)

    Belotti, Francesco; Ferrari, Marco; Doglietto, Francesco; Cocchi, Marco Angelo; Lancini, Davide; Buffoli, Barbara; Nicolai, Piero; Fontanella, Marco Maria; Maroldi, Roberto; Tschabitscher, Manfred; Rodella, Luigi Fabrizio

    2016-07-01

    The ophthalmic artery has an anomalous origin in 2-3 % of cases and rarely arises from the anterior cerebral artery. Herein, we provide the first anatomical, radiological, and histological description of such an anomalous origin, together with a literature review. During the anatomical dissection of an 81-year-old Caucasian male, the absence of the right ophthalmic artery in its usual location was evident from an endonasal transsphenoidal perspective. The specimen was then studied in detail, through multiple dissections, corrosion casting, high-resolution CT, and histological analysis. The English literature on anomalous origins of the ophthalmic artery was reviewed, together with reported associated pathologies. Anatomo-radiological analysis documented that the right ophthalmic artery arose from the inferior surface of A1 tract of the anterior cerebral artery (A1) and passed over the optic nerve in its subarachnoid tract. A meningo-ophthalmic artery was evident on the same side and reached the orbit through the superior orbital fissure. Histological examination of both internal carotid artery (ICA) walls documented a significantly decreased thickness of the tunica media and adventitia on the side of the anomalous ophthalmic artery, with a significantly different content of collagen types I and III. The literature review documented an association of aneurysms and anomalous ophthalmic arteries. To the best of our knowledge, this is the first anatomical report that includes a radiological and arterial wall analysis of a persistent ventral ophthalmic artery. The latter provides histological data that support the clinical evidence of a higher association of aneurysms with anomalous origins of the ophthalmic artery.

  19. Relationship between the morphology of A-1 segment of anterior ...

    African Journals Online (AJOL)

    Relationship between the morphology of A-1 segment of anterior cerebral artery and anterior communicating artery aneurysms. Wenfeng Feng, Long Zhang, Weiguang Li, Guozhong Zhang, Xiaoyan He, Gang Wang, Mingzhou Li, Songtao Qi ...

  20. Traumatic Left Anterior Descending Coronary Artery-Right Ventricle Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sheikhi

    2011-06-01

    Full Text Available Traumatic coronary artery-cameral fistulas (TCAF are rare and may present secondary to penetrating injuries (80% or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

  1. Traumatic Left Anterior Descending Coronary Artery-Right Ventricle Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Rezaee

    2011-05-01

    Full Text Available Traumatic coronary artery-cameral fistulas (TCAF are rare and may present secondary to penetrating injuries (80%or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

  2. Research article: clinical characteristics of isolated anterior cerebral artery territory infarction due to arterial dissection.

    Science.gov (United States)

    Nagamine, Yuito; Fukuoka, Takuya; Hayashi, Takeshi; Kato, Yuji; Deguchi, Ichiro; Maruyama, Hajime; Horiuchi, Yohsuke; Sano, Hiroyasu; Mizuno, Satoko; Tanahashi, Norio

    2014-01-01

    Isolated brain infarction in the anterior cerebral artery (ACA) territory is rare, and its etiology has not yet been fully elucidated. Thus, we aimed to determine the etiologic and clinical characteristics of patients with isolated ACA territory infarction due to arterial dissection. Of 2315 patients with acute cerebral infarction admitted to our hospital between April 2007 and September 2013, 34 patients (1.5%; 28 men, 6 women; mean age, 65 ± 15 years) suffered isolated ACA territory infarction. We performed cranial magnetic resonance (MR) imaging and MR angiography for all the patients. Whenever possible, we also performed 3-dimensional computed tomography angiography, digital subtraction angiography, and MR cisternography to diagnose the stroke subtype. The stroke subtypes of the 34 patients with isolated ACA territory infarction were atherothrombotic infarction, cardioembolic infarction, arterial dissection, and unclassified in 11 patients (32%), 11 patients (32%), 11 patients (32%), and 1 patient (3%), respectively. The mean ages at onset were 48 ± 9 and 72 ± 11 years in the dissection and nondissection groups, respectively (P < .001). Headaches were present at onset in 4 patients (36%) and 1 patient (4%) with and without dissection, respectively (P = .026). Blood pressure at onset was significantly higher among patients with dissection (systolic, 179 ± 34 mm Hg; diastolic, 102 ± 17 mm Hg) than among patients without dissection (systolic, 155 ± 30 mm Hg; diastolic, 86 ± 21 mm Hg; P < .05), and d-dimer values were significantly lower among patients with dissection (P = .034). Favorable clinical outcome (modified Rankin Scale score, 0-2) at discharge was achieved in 9 patients (82%) and 10 patients (43%) with and without dissection, respectively (P = .035). Patients with isolated ACA territory infarction demonstrated a relatively high frequency of dissection (32%). Patients with dissection were younger, had a higher frequency of headaches, and

  3. Review of the Anatomy of the Distal Anterior Cerebral Artery and Its Anomalies.

    Science.gov (United States)

    Cilliers, Karen; Page, Benedict John

    2016-01-01

    The anterior cerebral artery (ACA) varies considerably and this complicates the description of the normal anatomy. The segmentation of the ACA is mostly agreed on by different authors, although the relationship of the pericallosal and callosomarginal arteries (CmA) is not agreed upon. The two basic configurations of the ACA are determined by the presence or absence of the CmA. The diameter, length and origin of the cortical branches have been measured and described by various authors and display great variability. Common anomalies of the ACA include the azygos, bihemispheric, and median anterior cerebral arteries. A pilot study was done on 19 hemispheres to assess the variation of the branches of the ACA. The most common variations included absence and duplication. The inferior internal parietal artery and the CmA were most commonly absent and the paracentral lobule artery was the most frequently duplicated (36.8%). The inferior internal parietal artery originated from the posterior cerebral artery in 40.0% and this was the most unusual origin observed. It is important to be aware of the possibility of variations since these variations can have serious clinical implications. The knowledge of these variations can be helpful to clinicians and neurosurgeons. The aim of this article is to review the anatomy and variations of the anterior cerebral artery, as described in the literature. This was also compared to the results from a pilot study.

  4. Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report.

    Science.gov (United States)

    Lee, Bryan S; Witek, Alex M; Moore, Nina Z; Bain, Mark D

    2017-12-30

    Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity. To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed. The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips. A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery. The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy. Copyright © 2017 by the Congress of Neurological Surgeons

  5. Ruptured partially thrombosed anterior inferior cerebellar artery aneurysms: two case reports and review of literature.

    Science.gov (United States)

    Kanamori, Fumiaki; Kawabata, Teppei; Muraoka, Shinsuke; Kojima, Takao; Watanabe, Tadashi; Hatano, Norikazu; Seki, Yukio

    2016-12-01

    Aneurysms arising from the distal anterior inferior cerebellar artery (AICA) are very rare. When the parent artery is an AICA-posterior inferior cerebellar artery (PICA) variant, occlusion of the artery, even distal to the meatal loop, leads to a significant area of cerebellar infarction. We report two cases of ruptured partially thrombosed distal AICA aneurysms. In both cases, the parent artery was an AICA-PICA variant. The aneurysms were clipped in one case and trapped following occipital artery (OA)-AICA anastomosis in another case. It is important to keep the OA as a donor artery for revascularization in the treatment of the AICA-PICA variant aneurysms, especially when the absence of intra-aneurysmal thrombus is not comfirmed preoperatively.

  6. Access to the ophthalmic artery by retrograde approach through the posterior communicating artery for intra-arterial chemotherapy of retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Pham, Chi-Tuan; Blanc, Raphael; Pistocchi, Silvia; Bartolini, Bruno; Piotin, Michel [Fondation Rothschild Hospital, Department of Interventional Neuroradiology, Paris (France); Lumbroso-Le Rouic, Livia [Institut Curie, Department of Ocular Oncology, Paris (France)

    2012-08-15

    Intra-arterial infusion of chemotherapy into the ophthalmic artery for treatment of retinoblastoma has been realized after catheterization of the internal carotid and temporary balloon occlusion beyond the orifice of the ophthalmic artery, or more recently after superselective canulation of the ophthalmic artery by a microcatheter. The superselective catheterization of the ophthalmic artery could be cumbersome because of the implantation of the ostium on the carotid siphon or because of the tortuosity of the carotid siphon. We report our experience of using a retrograde approach through the posterior communicating artery that allows a more direct angle of access to the origin of the ophthalmic artery. (orig.)

  7. Topography of The Posterior Communicating Artery in a Kenyan ...

    African Journals Online (AJOL)

    pattern of the posterior communication artery in a Kenyan population. Materials and Methods. Eighty four posterior communicating arteries obtained from Depart- ment of Human Anatomy were studied. The configuration and number of branches in each third and length of the longest perforator free zone of the posterior ...

  8. Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study.

    Science.gov (United States)

    Araujo Filho, Bernardo Cunha; Weber, Raimar; Pinheiro Neto, Carlos Diógenes; Lessa, Marcus Miranda; Voegels, Richard Louis; Butugan, Ossamu

    2006-01-01

    The anterior ethmoidal artery (AEA) is an important point of anatomical reference in order to locate the frontal sinus and the skull base. Notwithstanding, despite numerous endoscopic studies in cadavers, we still lack an anatomical study on the AEA in the western population. to determine reference points used to locate the artery, study its relationship with the skull base and its degree of dehiscence, as well as to study intra and inter individual variations. we dissected the nasal fossae belonging to 25 cadavers. the average intranasal length of the anterior ethmoidal artery was 5.2 mm. The anterior ethmoidal canal presented some degree of dehiscence in 66.7%. The average distance between the artery middle point to the anterior nasal spine was of 61.72 mm (sd=4.18 mm); to the lateral nasal wall (nasal axilla) was of 64.04 mm (sd=4.69 mm); and from the anterior axilla to the middle turbinate was of 21.14 mm (sd=3.25 mm). For all the measures there was no statistically significant measures when both sides were compared (p>0.05). We concluded that the middle conchae axilla is the most reliable point of reference to locate the AEA.

  9. Local intra-arterial thrombolysis in acute ischemic stroke of the anterior circulation

    International Nuclear Information System (INIS)

    Zhang Yongwei; Liu Jianmin; Hong Bo; Deng Benqiang; Xu Yi; Ding Suju

    2003-01-01

    Objective: To evaluate the safety and efficacy of local intra-arterial thrombolysis (LIT) using urokinase in patients with acute ischemic stroke of the anterior circulation. Methods: Fifty-four patients were treated with LIT using urokinase. The locations of occlusion included 3 of internal carotid artery (ICA), 46 of middle cerebral artery (MCA) and 5 of anterior cerebral artery. Results: Outcome was good in 41 patients (75.9%). Recanalization >50% was obtained in 72.2% of patients and <50% recanalization in 27.8% of patients. Cerebral hemorrhage occurred in 11 patients (20.4%). Four patients died (7.4%). Conclusion: LIT using urokinase can improve the recanalization rate and achieve better functional recovery in patients of acute ischemic stroke

  10. Resection of left anterior descending coronary artery aneurysm on a beating heart.

    Science.gov (United States)

    Misthos, P; Kokotsakis, J N; Lioulias, A G; Skouteli, E A

    2009-01-01

    We report on the case of a 65-year-old man with unstable angina due to a left anterior descending (LAD) coronary artery single aneurysm. On a beating heart, the aneurysm was partially resected and the left internal thoracic artery was grafted in situ as a patch to the LAD opening. The patient remains well and free of symptoms two years after the operation.

  11. Double origin and early bifurcation of the anterior inferior cerebellar artery diagnosed by CT angiography.

    Science.gov (United States)

    Pekcevik, Yeliz

    2015-11-01

    Due to the technical improvements, anatomical variations of the small arteries, those were previously reported on cadaveric series, can also be evaluated on CT angiography. Absence of the anterior inferior cerebellar artery (AICA) is the most common variation of the AICA. Duplication and fenestration of the AICA can be rarely seen. In this report, two new variations, early bifurcation and double origin of the AICA, were described on CT angiography.

  12. CASE REPORT Dual (type IV) left anterior descending artery

    African Journals Online (AJOL)

    about 1.38%. [1,3] This anomaly is seen relatively often with congenital malformations such as complete transposition of the great arteries and tetralogy of Fallot.[2]. When a short or hypoplastic LAD is detected, a differential diagnosis should be sought. There may be a long dominant posterior descending branch of the RCA, ...

  13. Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report

    Directory of Open Access Journals (Sweden)

    Salvador Loris

    2008-02-01

    Full Text Available Abstract With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

  14. Anterior temporal artery tap to identify systemic interference using short-separation NIRS measurements

    DEFF Research Database (Denmark)

    Sood, Mehak; Jindal, Utkarsh; Chowdhury, Shubhajit Roy

    2015-01-01

    that are also affected by tDCS. An approach may be to use short optode separations to measure systemic hemodynamic fluctuations occurring in the superficial layers which can then be used as regressors to remove the systemic contamination. Here, we demonstrate that temporal artery tap may be used to better...... change in the mean rSO2 better correlated with the corresponding percent change in log-transformed mean-power of EEG within 0.5 Hz-11.25 Hz frequency band after removing the systemic contamination using the temporal artery tap method. Based on our findings, we propose that anterior temporal artery tap...

  15. ranching pattern of the left anterior descending coronary artery in a ...

    African Journals Online (AJOL)

    Branching pattern of the left anterior descending coronary artery is important in explaining variations in occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease is ...

  16. The Changed Route of Anterior Tibial Artery due to Healed Fracture

    Directory of Open Access Journals (Sweden)

    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  17. MRI of anterior spinal artery syndrome of the cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, S. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Yamada, T. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Ishii, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Saito, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Tanji, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Kobayashi, T. (Inst. of Rehabilitation Medicine, Tohoku Univ. School of Medicine, Miyagi (Japan)); Soma, Y. (Div. of Neurology, Takeda Hospital, Aizuwakamatsu (Japan)); Sakamoto, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan))

    1992-12-01

    Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

  18. MRI of anterior spinal artery syndrome of the cervical spinal cord

    International Nuclear Information System (INIS)

    Takahashi, S.; Yamada, T.; Ishii, K.; Saito, H.; Tanji, H.; Kobayashi, T.; Soma, Y.; Sakamoto, K.

    1992-01-01

    Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

  19. Acute Hearing Loss Caused by Decreasing Anterior Inferior Cerebellar Arterial Perfusion in a Patient with Vertebral Artery Stenosis.

    Science.gov (United States)

    Fukuda, Rintaro; Miyamoto, Nobukazu; Hayashida, Arisa; Ueno, Yuji; Yamashiro, Kazuo; Tanaka, Ryota; Hattori, Nobutaka

    2017-06-01

    We report a case of bilateral hearing loss caused by decreased vascular flow in the anterior inferior cerebellar artery (AICA) territory. A 74-year-old man who experienced right hearing loss 5 months ago presented with bilateral deafness and right cerebellar ataxia; however, no ischemic lesion was detected in the bilateral AICA area. After stroke treatment, hearing loss was improved. One month later, we obtained blood flow improvement in the left AICA territory on single-photon-emission computed tomography and vertebral artery stenosis on magnetic resonance angiography. Therefore, clinicians should recognize that bilateral hearing loss may be related to stroke in the vertebrobasilar artery area. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature.

    Science.gov (United States)

    Bambakidis, Nicholas C; Manjila, Sunil; Dashti, Shervin; Tarr, Robert; Megerian, Cliff A

    2009-05-01

    Aneurysms of the anterior inferior cerebellar artery (AICA) are relatively rare among intracranial aneurysms. They can occur in 1 of 3 regions of the AICA: 1) craniocaudal (high or low riding), 2) mediolateral-premeatal (proximal), and 3) meatal-postmeatal (distal). The management strategies for treatment differ according to the location and configuration of the aneurysm. The existing body of neurosurgical literature contains articles published on aneurysms arising from the AICA near the basilar artery (BA), intracanalicular/meatal aneurysms, and distal AICA. Several therapeutic options exist, encompassing microsurgical and endovascular techniques. The authors describe a case of treatment involving a large BA-AICA aneurysm approached via exposure of the presigmoid dura using a retromastoid suboccipital craniectomy and partial petrosectomy. Treatment of these lesions requires detailed knowledge of the anatomy, and an anatomical overview of the AICA with its arterial loops and significant branches is presented, including a discussion of the internal auditory (labyrinthine) artery, recurrent perforating arteries, subarcuate artery, and cerebellosubarcuate artery. The authors discuss the various surgical approaches (retromastoid, far lateral, subtemporal, and transclival) with appropriate illustrations, citing the advantages and disadvantages in accessing these AICA lesions in relation to these approaches. The complications of these different surgical techniques and possible clinical effects of parent artery occlusion during AICA surgery are highlighted.

  1. Double inter-internal carotid artery communication through intercavernous anastomosis and posterior communicating artery associated with multiple intracranial artery segmental agenesis/aplasia.

    Science.gov (United States)

    Park, Yae Won; Yoo, Joonsang; Kim, Dong Joon

    2018-02-01

    Segmental internal carotid artery (ICA) and basilar artery (BA) agenesis/aplasia are rare vascular anomalies. We report an extremely rare case of combined ICA, BA, and A1 segmental absence presenting with double inter-ICA collateral communication through the intercavernous anastomosis and posterior communicating arteries. The patient presented with diplopia and transient ischemic attack. The pathogenesis of the anatomic anomalies and clinical symptoms are discussed.

  2. A case of angiographically occult, distal small anterior inferior cerebellar artery aneurysm

    Science.gov (United States)

    Kubota, Hisashi; Sanada, Yasuhiro; Nagatsuka, Kazuhiro; Kato, Amami

    2015-01-01

    Background: A small aneurysm at an unusual location, such as a distal anterior inferior cerebellar artery (AICA) aneurysm, may conceal as a computed tomography angiography (CTA) and digital subtraction angiography (DSA)-occult aneurysm. Case Description: We herein present the case of a patient suffering from a subarachnoid hemorrhage (SAH) with two aneurysms in which the AICA aneurysm was negative by CTA and DSA. CTA demonstrated a right anterior choroidal artery aneurysm, which was revealed to be an unruptured aneurysm after surgical exploration. A small distal AICA aneurysm was detected by 3D rotational angiography (3DRA). The patient fully recovered except for left-side hearing loss four months after the second operation. Conclusion: We recommend a meticulous diagnosis by 3DRA in patients with SAH in which the distribution is not coincident with a typical aneurysmal location. PMID:26110079

  3. KIR channels tune electrical communication in cerebral arteries

    DEFF Research Database (Denmark)

    Sancho, Maria; Samson, Nina C; Hald, Bjorn O

    2017-01-01

    The conducted vasomotor response reflects electrical communication in the arterial wall and the distance signals spread is regulated by three factors including resident ion channels. This study defined the role of inward-rectifying K(+) channels (KIR) in governing electrical communication along...... hamster cerebral arteries. Focal KCl application induced a vasoconstriction that conducted robustly, indicative of electrical communication among cells. Inhibiting dominant K(+) conductances had no attenuating effect, the exception being Ba(2+) blockade of KIR Electrophysiology and Q-PCR analysis...... and the increased feedback arising from voltage-dependent-K(+) channels. In summary, this study shows that two KIR populations work collaboratively to govern electrical communication and the spread of vasomotor responses along cerebral arteries....

  4. The anterior cerebral artery: II. A computer model of its cortical branches estereotaxically obtained from anatomical specimens

    Directory of Open Access Journals (Sweden)

    Raul Marino Jr

    1979-12-01

    Full Text Available This article is a corrollary of a previously published anatomical study of the anterior cerebral artery. The authors propose a method to obtain a computer model of the anterior cerebral artery, based on a combined system of stereotaxic coordinates and a specially developed computer program. The graphic analysis, thus obtained, is projected on a model atlas brain and an ideal diagram of this anatomical structure is obtained. Forty anatomical specimens were used for this study.

  5. Impacts of a Size Ratio on Outcome in Patients with Surgically Treated Unruptured Nondissecting Anterior Cerebral Artery Aneurysms.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Kamiyama, Hiroyasu; Miyazaki, Takanori; Kinoshita, Yu; Noda, Kosumo; Ota, Nakao; Saito, Norihiro; Takeda, Rihee; Tokuda, Sadahisa; Tanikawa, Rokuya

    2018-03-01

    Anterior cerebral artery aneurysms (ACAs) are characterized by higher rupture rate and small size at rupture. It was shown that the aneurysm/vessel size ratio, and not the absolute size, might predict the risk of rupture in small unruptured intracranial aneurysms. The present study aimed to investigate the relationship between a size ratio and outcome in patients with unruptured nondissecting ACA aneurysms (UNDAs). A total of 187 consecutive patients with 12 A1 (6.2%), 149 anterior communicating artery (77%), and 33 distal ACA (17%) aneurysms were retrospectively evaluated. The size ratio was defined as (size of aneurysm)/(size of parent artery). Neurologic worsening (NW) was defined as an increase in score of 1 or more on the modified Rankin Scale (mRS). The mean age of the patient population was 63 ± 11 years and 132 UNDAs (68%) were seen in women. Complete, partial neck clipping, and aneurysm trapping were archived in 188 (97%), 2 (1.0%), and 4 (2.1%) UNDAs, respectively. An excellent outcome (mRS score 0) at 12 months was archived in 177 (93%) UNDAs overall and 177 (95%) in UNDAs with preoperative mRS score of 0 (n = 186). Postoperative ischemic lesions (odds ratio, 193; 95% confidence interval, 17-2205; P 3.0 (odds ratio, 11; 95% confidence interval, 1.2-105; P = 0.031) were related to 12-month NW on multivariate analysis. The aneurysm size was not related to 12-month NW. The present study showed that the size ratio, and not the absolute size, was related to 12-month NW in surgically treated UNDAs. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Topographic Surgical Anatomy of the Parasylvian Anterior Temporal Artery for Intracranial-Intracranial Bypass.

    Science.gov (United States)

    Meybodi, Ali Tayebi; Griswold, Dylan; Tabani, Halima; Lawton, Michael T; Mokhtari, Pooneh; Payman, Andre; Benet, Arnau

    2016-09-01

    The anterior temporal artery (ATA) is an appealing donor artery for intracranial-intracranial bypass procedures. However, its identification may be difficult. Current literature lacks useful landmarks to help identify the ATA at the surface of the sylvian fissure. The objective of this study was to define the topographic anatomy of the cortical segment of the ATA relative to constant landmarks exposed during the pterional approach. The temporopolar artery (TPA), ATA, and middle temporal artery (MTA) were examined in 16 cadaveric specimens. The topographic anatomy and key landmarks of the arteries at the sylvian fissure were recorded. The distance between the point of emergence from the sylvian fissure to the lesser sphenoid wing and anterior tip of the temporal lobe was measured. The features of the inferior frontal gyrus relative to each of the arteries at the sylvian fissure were also recorded. The average distances from the lesser sphenoid wing to the TPA, ATA, and MTA were 3.7 mm, 21.2 mm, and 37 mm. The mean distances from the temporal pole were TPA, 14.7 mm; ATA, 32.0 mm; and MTA, 45.4 mm. The differences between the average distances were statistically significant (P < 0.0001). The ATA most frequently faced pars triangularis, whereas the TPA always faced pars orbitalis. The MTA was always found posterior to the junction of pars triangularis and pars opercularis. This article provides topographic evidence for efficient identification of the ATA in the parasylvian space. The key relationship and landmarks identified in this study may increase efficiency and safety when harvesting the ATA for intracranial-intracranial bypass. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. [Posttraumatic pseudoaneurysms of the anterior tibial artery: a review of the literature and a clinical case report].

    Science.gov (United States)

    Stio, F; Ortensi, A; Battisti, G; Felici, A; Marigliani, M; Gallinacci, E; De Vita, M; Finizio, R; Fabrizio, G; Porcelli, C

    1993-02-01

    The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.

  8. Anterior Spinal Artery Syndrome: Reversible Paraplegia after Minimally Invasive Spine Surgery

    Directory of Open Access Journals (Sweden)

    J. Bredow

    2014-01-01

    Full Text Available Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery.

  9. Tibia Bone Microvascular Flow Dynamics as Compared to Anterior Tibial Artery Flow During Body Tilt.

    Science.gov (United States)

    Becker, Rachel L; Siamwala, Jamila H; Macias, Brandon R; Hargens, Alan R

    2018-04-01

    We compared microvascular and macrovascular blood flows of the tibia and anterior tibial artery during graded whole-body tilt. We hypothesized equal responses for bone microvascular and macrovascular blood flows during varying angles of tilt. There were 18 volunteers who were randomly positioned in the following postures: supine, 15° head-up tilt, 6° head-up tilt, 6° head-down tilt, and 15° head-down tilt using an inversion table with reference to seated posture (baseline control). Ultrasonography quantified anterior tibial arterial diameter and peak systolic velocity, enabling calculation of macrovascular blood flow to the tibia. Tibial bone microvascular blood flow was measured noninvasively using photoplethysmography in the same leg. Transitioning from a seated position to a supine position, macrovascular blood flow did not change significantly (1.81 ± 1.18 to 2.80 ± 1.74cm 3 · s-1). However, bone microvascular flow increased significantly (0.36 ± 0.23 to 1.11 ± 0.79 V) from the seated to the supine position. Transitioning from a seated posture to 15° head-down tilt, both arterial macrovascular and bone microvascular flows increased significantly (1.81 ± 1.18 to 3.32 ± 2.08 cm3 · s-1 and 0.36 ± 0.23 V to 2.99 ± 2.71 V, respectively). The normalized flow for microvascular blood flow as a function of body tilt was significantly greater than that for macrovascular blood flow at 6° and 15° head-down tilt. These data do not support our hypothesis that bone microvascular flow and arterial macrovascular flow share equal responses to altered body tilt. Therefore, for a given decrease in local blood pressure in the leg with head-down body tilt, the magnitude of increase in blood flow is greater in the microcirculation as compared to the feeding artery.Becker RL, Siamwala JH, Macias BR, Hargens AR. Tibia bone microvascular flow dynamics as compared to anterior tibial artery flow during body tilt. Aerosp Med Hum Perform. 2018; 89(4):357-364.

  10. Scuba diving, acute left anterior descending artery occlusion and normal ECG

    Science.gov (United States)

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-01

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day  4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results. PMID:23376677

  11. International Frontal Sinus Anatomy Classification and anatomic predictors of low-lying anterior ethmoidal arteries.

    Science.gov (United States)

    Sjogren, Phayvanh P; Waghela, Rajendra; Ashby, Shaelene; Wiggins, Richard H; Orlandi, Richard R; Alt, Jeremiah A

    2017-05-01

    The International Frontal Sinus Anatomy Classification (IFAC) was introduced to more accurately characterize ethmoid and frontal sinus pneumatization patterns. The prevalence of IFAC cells and their anatomic associations have not been described. The goal was to examine the prevalence of IFAC cells and determine radiologic features associated with a low-lying anterior ethmoidal artery (LAEA). Imaging of adult patients who underwent computed tomographies from January 2015 to March 2016 were retrospectively reviewed by using the IFAC classification. We also measured the distance from the skull base to the anterior ethmoidal artery (AEA), the height of the lateral lamella of the cribriform plate, and anterior-posterior diameter from the anterior wall of the frontal sinus to the skull base (APF). Patients with a history of sinus surgery, trauma, malignancy, or congenital anomaly were excluded. Statistical analysis was performed by using Pearson correlation coefficients and χ2 tests. A total of 95 patients met the inclusion criteria. There was a significant association between supraorbital ethmoid cells and an LAEA (p < 0.001), with a significant effect size (φ = 0.276, p = 0.007). An inverse relationship was observed between Keros type I classification I and an LAEA (p < 0.001), with a significant effect size (φ = -0.414, p = 0.000). Significant associations were found between the AEA distance from the skull base and the cribriform lateral lamella height (R = 0.576, p < 0.001). In addition, there was a significant association between the AEA distance from the skull base and the APF (R = 0.497, p < 0.001). The presence of a supraorbital ethmoid cell and a wide APF were associated with an LAEA. There was a significant relationship between Keros type I classification and the AEA adjacent to the skull base. Delineation of these anatomic relationships may be helpful during endoscopic sinus surgery to avoid complications.

  12. [Four cases of direct surgery for anterior inferior cerebellar artery aneurysms].

    Science.gov (United States)

    Gi, Hidefuku; Inoha, Satoshi; Uno, Jyunji; Ikai, Yoshiaki; Koga, Hiromichi; Yamaguchi, Shinya; Nagaoka, Shintaro

    2007-06-01

    Anterior inferior cerebellar artery (AICA) aneurysms are very rare. We carried out four direct operations for AICA aneurysms including two distal AICA aneurysms using lateral suboccipital retrosigmoid approaches (LSRA). We successfully performed the clipping by LSRA. but hearing loss occurred except in one of our cases which involved a chronic term operation in in our cases, In a 72 years old female with a ruptured dissecting aneurysm of the AICA anterior pontine segment, we performed the OA-PICA anastomosis first because of its being an AICA-PICA type, and then we continued to carry out the trapping operation of dissecting artery on day 0. She left our hospital cheerfully but hearing loss persisted on the operated side. Four examples of the dissecting aneurysm of AICA anterior pontine segment have been reported, but only our case involved the trapping with revascularization in acute stage. At the moment, there is no clinical or useful classification for distal AICA aneurysm because it is extremely rare. We will now propose a new classification. This classification is divided into two groups, (1) P (pons) -group and (2) C (cerebellum) -group. The P-group consists of pA (AICA anterior pontine segment). pL (lateral branch on the pons to the meatal loop) and pM (medial branch on the pons). C-group consists of m-loop (meatal loop), cL (lateral branch post meatal loop) and cM (medial branch on the cerebellum). From results of case reports (75 distal AICA aneurysms), we found that pA: 5 (6.7%), pL: 2 (2.8%), pM: 0, m-loop: 54 (72%), cL: 8 (11%), cM: 6 (8.3%). The followings factors were also found. (1) Occlusion of the parent artery of P-group without revascularization of peripheral circulation may entail the risk of death. (2) On the other hand, as for the C-group, the parent artery was able to be occluded without severe consequences, but hearing loss and/or cerebellar infarction occurred. We believe that this classification is simple and very useful for therapeutic

  13. A case of anterior cerebral artery dissection caused by scuba diving.

    Science.gov (United States)

    Fukuoka, Takuya; Kato, Yuji; Ohe, Yasuko; Deguchi, Ichiro; Maruyama, Hajime; Hayashi, Takeshi; Tanahashi, Norio

    2014-08-01

    A 51-year-old man was admitted with right hemiparesis during scuba diving, without headache. Brain magnetic resonance (MR) imaging depicted high-intensity areas in the left superior frontal and cingulate gyri on diffusion-weighted imaging. Dissection of the anterior cerebral artery (ACA) was detected using axial MR angiography and 3-dimensional MR cisternography. Dissection of the ACA during and after scuba diving has not been reported before. Dissection of the arteries should be included in the differential diagnosis when neurologic symptoms occur both during and after scuba diving, even if the patient does not experience headache. Furthermore, the combination of MR cisternography and MR angiography is useful to detect ACA dissection. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Topography of The Posterior Communicating Artery in a Kenyan ...

    African Journals Online (AJOL)

    Background Configuration and branching pattern of the posterior communicating artery influence occurrence and approaches to management of aneurysms. Distribution of the various configurations and branching patterns shows population variations but reports from Africa are scanty. Objective To determine the prevalence ...

  15. Posterior Communicating Artery Aneurysm in a 20 Year Old Boy ...

    African Journals Online (AJOL)

    Result: A clinical diagnosis of left third and fourth cranial nerve palsies from intracranial space-occupying lesion was made. Computed tomography and computed tomography angiography confirmed left posterior communicating artery aneurysm. Conclusion: Any degree of pupillary involvement in third nerve palsy, whether ...

  16. Avaliação da artéria etmoidal anterior pela tomografia computadorizada no plano coronal Anterior ethmoidal artery evaluation on coronal CT scans

    Directory of Open Access Journals (Sweden)

    Soraia Ale Souza

    2009-02-01

    Full Text Available O conhecimento da localização da artéria etmoidal anterior (AEA constitui etapa importante na cirurgia do recesso do seio frontal e do etmóide anterior. A tomografia computadorizada (TC, em especial no plano coronal pode fornecer reparos anatômicos que identificam o trajeto da AEA. OBJETIVO: Identificar os reparos anatômicos que caracterizam o trajeto da AEA na parede medial da órbita e na parede lateral da fossa olfatória. Verificar a correlação entre a presença de pneumatização supra-orbitária e a visualização do etmoidal anterior (canal da AEA. CASUÍSTICA E MÉTODOS: Estudo retrospectivo de 198 tomografias computadorizadas dos seios paranasais no plano coronal do período de agosto a dezembro de 2006. RESULTADOS: Pneumatização supra-orbitária foi identificada em 35% (70 exames. O canal da AEA foi caracterizado em 41% (81 exames. O sulco etmoidal anterior foi visualizado em 98% (194 dos exames e o forame etmoidal anterior foi identificado em todos os exames (100%. CONCLUSÃO: O forame etmoidal anterior e o sulco etmoidal anterior foram referências anatômicas presentes em quase 100% dos exames avaliados. Houve correlação entre a presença de pneumatização supra-orbitária e a caracterização do canal da AEA.The anterior ethmoidal artery (AEA is an important point for frontal and ethmoid sinuses surgery. CT scans can identify landmarks to help the surgeon find the AEA. AIM: To identify the landmarks of the AEA on the orbital medial wall and on the lateral wall of the olfactory fossa. and to correlate the presence of supraorbital ethmoidal cells with spotting the anterior ethmoidal artery canal. MATERIALS AND METHODS: Retrospective review of 198 direct coronal paranasal sinuses computed tomography (CT scans from August to December, 2006. RESULTS: Supraorbital pneumatization was seen in 35% (70 scans. The AEA canal was seen in 41% (81 scans. The anterior ethmoidal sulcus was seen in 98% (194 scans and the anterior

  17. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature.

    Science.gov (United States)

    Akhtar, Saad; Azeem, Abdul; Jiwani, Amyna; Javed, Gohar

    2016-01-01

    There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20-24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements

    Science.gov (United States)

    Lv, Xianli; Ge, Huijian; He, Hongwei; Jiang, Chuhan

    2016-01-01

    Background Anterior inferior cerebellar artery (AICA) aneurysms are rare and published clinical experience with these aneurysms is limited. Objective The objective of this article is to report angiographic characteristics and results associated with premeatal, meatal and postmeatal segments, surgical and endovascular therapies. Methods A literature review was performed through PubMed using “anterior inferior cerebellar artery aneurysm” through January 2016. Clinical data, angiograms, management techniques, and patient outcomes were reviewed for 47 collected cases in 30 previous reports. Results Of these aneurysms, 21 (44.7%) were associated with meatal segment, 10 (21.3%) were postmeatal and 16 (34.0%) were premeatal. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy (77.8%). Patient outcomes of meatal aneurysms presented with more neuropathies (51.7%) and cerebellar symptoms (14.3%) (p = 0.049). Four cases of meatal aneurysm with preoperative cranial nerve deficits (two VII and two VIII) showed improvement after surgery. Endovascular treatment achieved outcomes similar to surgical treatment (p = 0.327). Conclusions AICA aneurysms have a predilection for meatal segment. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy. Patient outcomes of meatal aneurysms presented with more neuropathies and cerebellar symptoms. Endovascular treatment achieved outcomes similar to surgical treatment. PMID:27485045

  19. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms

    Directory of Open Access Journals (Sweden)

    Luiz de Abreu Junior

    Full Text Available Abstract Objective: To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods: We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results: The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion: Vascular loops do not appear to be associated with otoneurological manifestations.

  20. Clinical Study of Seven Patients with Infarction in Territories of the Anterior Inferior Cerebellar Artery.

    Science.gov (United States)

    Ogawa, Katsuhiko; Suzuki, Yutaka; Takahashi, Keiko; Akimoto, Takayoshi; Kamei, Satoshi; Soma, Masayoshi

    2017-03-01

    The prominent features of anterior inferior cerebellar artery (AICA) infarction are vertigo, cerebellar ataxia, and impaired hearing. The present study investigated neurological characteristics associated with AICA infarction. The locations of infarcts in 7 patients (age, 32-72 years) with AICA infarction were divided into the lower lateral pons, the middle cerebellar peduncle (MCP), and the cerebellum. Ischemic lesions were located in the MCP in 6 patients, spread to the lower lateral pons in 3, and involved the cerebellum in 4 patients. Standing posture and gait were impaired in all patients. Five and 4 patients had impaired hearing and vertigo, respectively. Two patients had only symptoms of labyrinthine disease, and 1 had these symptoms accompanied by impaired hearing. The symptoms in 2 patients with the lesion in the lateral pons were consistent with those in Gasperini syndrome. Two of 3 patients without vertigo had ataxia of the extremities. Stenosis of the vertebral artery or basilar artery in 5 patients indicated that the etiology was branch atheromatous disease. The most prominent symptom of truncal and gait ataxia and the frequent association between vertigo and impaired hearing were consistent with the characteristics of AICA infarction. Two patients without vertigo had ataxia of the trunk and extremities that might have been due to involvement of the dorsal spinocerebellar tract in the inferior cerebellar peduncle. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Ruptured intrameatal aneurysm of the anterior inferior cerebellar artery accompanying an arteriovenous malformation: a case report.

    Science.gov (United States)

    Lee, Sun Joo; Koh, Jun Seok; Ryu, Chang Woo; Lee, Seung Hwan

    2012-09-01

    The distal anterior inferior cerebellar artery (AICA) aneurysms located inside the internal auditory canal are rare. The association of the distal AICA aneurysms and an arteriovenous malformation (AVM) on the same arterial trunk is exceptional. Eight reports of a total of ten cases have been published and all of the reported aneurysms were located in the meatal or postmeatal segment of the AICA. Herein, we report a case of ruptured aneurysm in the intrameatal portion of the AICA accompanying an AVM fed by the same artery. A 55-year-old man suffering from subarachnoid hemorrhage due to a ruptured intrameatal aneurysm with a small AVM underwent surgical trapping of the meatal loop, resulting in uneventful recovery. Follow-up angiography demonstrated neither aneurysm nor residual AVM nidus. We propose that trapping of the meatal loop could be a safe and feasible alternative to unroofing followed by neck clipping in selected patients with an intrameatal aneurysm of the AICA. We also review here the relevant literature.

  2. Pseudoaneurysm of the anterior spinal artery in a patient with Moyamoya: an unusual cause of subarachnoid hemorrhage.

    Science.gov (United States)

    Walz, D M; Woldenberg, R F; Setton, A

    2006-08-01

    Subarachnoid hemorrhage (SAH) is a recognized presentation of Moyamoya disease in adults. Because there are extensive collateral networks and potential complications that develop, a thorough investigation of the intracranial and extracranial circulation is necessary to exclude a treatable cause when these patients present with SAH. We present a case of SAH due to a ruptured pseudoaneurysm of the anterior spinal artery arising from the supreme intercostal artery, which was the sole source of blood supply to the intracranial circulation.

  3. Clinical presentation and treatment of distal anterior inferior cerebellar artery aneurysms.

    Science.gov (United States)

    Tokimura, Hiroshi; Ishigami, Takashi; Yamahata, Hitoshi; Yonezawa, Hajime; Yokoyama, Shunichi; Haruzono, Akihiro; Obara, Soichi; Nishimuta, Yosuke; Nagayama, Tetsuya; Hirahara, Kazuho; Kamezawa, Takashi; Sugata, Sei; Arita, Kazunori

    2012-10-01

    Aneurysms located at the distal portion of the anterior inferior cerebellar artery (AICA) are rare, and their clinical features are not fully understood. We report the clinical features and management of nine distal AICA aneurysms in nine patients treated during the past decade at Kagoshima University Hospital and affiliated hospitals. Our series includes seven women and two men. Of their nine aneurysms, eight were ruptured and one was unruptured; six were saccular and three were dissecting aneurysms. The most prevalent location was the meatal loop (n = 5) followed by the postmeatal (n = 3) and premeatal segment (n = 1) of the AICA, suggesting hemodynamic stress as an etiology of these distal AICA aneurysms. Of the nine patients, five presented with angiographic features suggestive of increased hemodynamic stress to the AICA and the common trunk of the posterior inferior cerebellar artery, with vertebral artery stenosis, marked laterality, and a primitive hypoglossal artery. We addressed eight aneurysms (eight patients) surgically; one aneurysm in one patient disappeared in the course of 3 months without surgical treatment. Of the eight surgically treated aneurysms, seven were ruptured and one was unruptured, five were clipped via lateral suboccipital craniotomy, two were trapped via lateral suboccipital craniotomy, and one was embolized. Good outcomes were obtained in six of the eight patients who underwent operation (75 %). We consider increased hemodynamic stress attributable to anatomic variations in the AICA and related posterior circulation to be the predominant contributor to the development of distal AICA aneurysms. Direct clipping and trapping yielded favorable outcomes in our series.

  4. Missed Anterior Inferior Cerebellar Artery Aneurysm Mimicking Vestibular Neuritis-Clues to Prevent Misdiagnosis.

    Science.gov (United States)

    Willms, Jan-Folkard; Baltsavias, Gerasimos; Burkhardt, Jan-Karl; Ernst, Silvia; Tarnutzer, Alexander A

    2016-12-01

    We discuss a case with combined vestibulocochlear and facial neuropathy mimicking a less urgent peripheral vestibular pattern of acute vestibular syndrome (AVS). With initial magnetic resonance imaging read as normal, the patient was treated for vestibular neuropathy until headaches worsened and a diagnosis of subarachnoid hemorrhage was made. On conventional angiography, a ruptured distal right-sided aneurysm of the anterior inferior cerebellar artery was diagnosed and coiled. Whereas acute vestibular loss usually points to a benign peripheral cause of AVS, combined neuropathy of the vestibulocochlear and the facial nerve requires immediate neuroimaging focusing on the cerebellopontine angle. Imaging should be assessed jointly by neuroradiologists and the clinicians in charge to take the clinical context into account. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. An unusual, duplicate origin of the anterior choroidal artery with aneurysm: a case report.

    Science.gov (United States)

    Chenin, Louis; Chivot, Cyril; Toussaint, Patrick; Deramond, Hervé; Peltier, Johann

    2015-12-01

    Aneurysms of the anterior choroidal artery (AChoA) are rare and often difficult to treat. Variations may be present and must be identified prior to treatment. We report a unique case of a ruptured aneurysm located at the origin of a duplicate branch of the AChoA. A 56-year-old male was admitted to our university hospital for coma. A brain CT scan showed a subarachnoid hemorrhage, and CT angiography revealed a duplication of the right AChoA, with an aneurysm located at the branch's origin. We decided to embolize this aneurysm. Four weeks later, our patient was able to transfer to the rehabilitation unit. To the best of our knowledge, this is one of the first descriptions of an aneurysm located at the origin of a duplicate branch of the AChoA.

  6. Intrameatal thrombosed anterior inferior cerebellar artery aneurysm mimicking a vestibular schwannoma.

    Science.gov (United States)

    Päsler, Dennis; Baldauf, Jörg; Runge, Uwe; Schroeder, Henry W S

    2011-04-01

    Aneurysms of the anterior inferior cerebellar artery (AICA) are a rare entity. Purely intrameatal aneurysms are even rarer. The authors report an intrameatal thrombosed AICA aneurysm mimicking a vestibular schwannoma that was treated by resection and end-to-end anastomosis. This 22-year-old man presented with acute hearing loss, vertigo, and moderate facial palsy. Magnetic resonance imaging showed an atypical intrameatal lesion with dilation of the internal auditory canal. Microsurgical inspection via a retrosigmoid approach and drilling of the posterior wall of the internal auditory canal revealed a thrombosed AICA aneurysm. The aneurysm was excised, and an end-to-end suture was performed to restore AICA continuity. Intraoperative indocyanine green videoangiography as well as postoperative digital substraction angiography showed a good revascularization. Intrameatal AICA aneurysms may present with symptoms similar to vestibular schwannomas. End-to-end reanastomosis after aneurysm resection is a treatment option when clipping is impossible.

  7. Dissecting Aneurysm of Anterior Inferior Cerebellar Artery Initially Presenting with Nonhemorrhagic Symptom.

    Science.gov (United States)

    Sasame, Jo; Nomura, Motohiro

    2015-08-01

    We report a patient with a probable dissecting aneurysm of the anterior inferior cerebellar artery (AICA) initially presenting with a nonhemorrhagic symptom, which resulted in subarachnoid hemorrhage. A 61-year-old woman suddenly experienced nausea. Computed tomography (CT) on admission showed a high-density mass with a double lumen in the right cerebellopontine angle without subarachnoid hemorrhage. Five days after the onset, she suddenly lost consciousness. CT demonstrated subarachnoid hemorrhage. Emergency angiography revealed a probable dissecting aneurysm at the lateral pontomedullary segment of the right AICA. Although the initial symptom is not hemorrhage, an unruptured dissecting aneurysm of the AICA may have a high risk of rupture. Immediate radical treatment to prevent subsequent rupture is necessary for even an unruptured dissecting aneurysm of the AICA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Endovascular management of distal anterior inferior cerebellar artery aneurysms: Report of two cases and review of the literature

    Science.gov (United States)

    Santillan, Alejandro; Gobin, Y. Pierre; Patsalides, Athos; Riina, Howard A.; Rosengart, Axel; Stieg, Philip E.

    2011-01-01

    Background: Aneurysms of the anterior inferior cerebellar artery (AICA), especially those located in the distal portion of the AICA, are rare. There are few reported cases treated with surgery or endovascular embolization. Case Description: We report two cases of fusiform distal AICA aneurysms presenting with subarachnoid hemorrhage. Parent artery occlusion with coils and n-butyl cyanoacrilate (n-BCA) resulted in complete aneurysm occlusion and prevented rebleeding. Both patients presented postprocedure neurological deficits, but have made a good recovery at 4 and 10 months, respectively. Conclusion: Occlusion of the parent artery for the treatment of ruptured fusiform distal AICA aneurysms is effective but has significant neurological risks. PMID:21748047

  9. Risks for Vascular Injury During Anterior Cervical Spine Surgery: Prevalence of a Medial Loop of Vertebral Artery and Internal Carotid Artery.

    Science.gov (United States)

    Wakao, Norimitsu; Takeuchi, Mikinobu; Nishimura, Manabu; Riew, K Daniel; Kamiya, Mitsuhiro; Hirasawa, Atsuhiko; Imagama, Shiro; Kawanami, Katsuhisa; Murotani, Kenta; Takayasu, Masakazu

    2016-02-01

    Observational study using a retrospective single-institute database. To investigate the prevalence of a medial loop (ML) of the vertebral artery (VA) and internal carotid artery (ICA), which might be an anatomical risk factor for arterial injury in anterior cervical surgeries. Anterior cervical spine surgeries are generally considered to be safe and effective. VA injury is one of the most serious complications during anterior procedures. Several articles have reported this complication, which might be because of the anomalous course of VA at V2 segment. The prevalence and anatomical features of those high-risk cases were, however, not investigated. Consecutive Japanese subjects, who underwent contrast-enhanced computed tomography (CT) or computed tomographic angiography (CTA) for reasons other than evaluation of cervical artery disease from November 2011 to October 2012 in our institution, were reviewed. Exclusion criteria included poor images, past surgery, and endovascular intervention of cervical spine and its vessels. The definition of ML was set as the course of VA and ICA extended medially inside the uncovertebral joint. We also investigated whether those anomalous courses were detectable by plain CT. A total of 1251 subjects with age ranging from 14 to 93 years with a mean of 56.1 years were surveyed. Among them, 1054 subjects were eligible and the others were excluded. A total of 421 subjects were male, and 633 were female. There were 10 cases (1%) with an ML of the VA, and 2 (0.2%) cases with a medial loop of internal carotid artery. Five of the 10 cases with a medial loop of vertebral artery were aberrant into the vertebral body, which were detectable by plain CT. Importantly, the other five cases could not be seen on the CT. One percent of all subjects showed higher anatomical risk for VA and ICA injury during anterior surgery, half of which were undetectable by plain CT. Preoperative evaluation for vascular anatomy may be necessary for safer surgical

  10. Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions.

    Science.gov (United States)

    Alonso de Leciñana, María; Kawiorski, Michal M; Ximénez-Carrillo, Álvaro; Cruz-Culebras, Antonio; García-Pastor, Andrés; Martínez-Sánchez, Patricia; Fernández-Prieto, Andrés; Caniego, José Luis; Méndez, Jose Carlos; Zapata-Wainberg, Gustavo; De Felipe-Mimbrera, Alicia; Díaz-Otero, Fernando; Ruiz-Ares, Gerardo; Frutos, Remedios; Bárcena-Ruiz, Eduardo; Fandiño, Eduardo; Marín, Begoña; Vivancos, José; Masjuan, Jaime; Gil-Nuñez, Antonio; Díez-Tejedor, Exuperio; Fuentes, Blanca

    2017-12-01

    The benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions. Data from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months. Of 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320-540) vs 315 min (240-415), p<0.001), as was the duration of the procedures (100 min (40-130) vs 60 min (39-90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0-2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO. MT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Audiovestibular loss in anterior inferior cerebellar artery territory infarction: a window to early detection?

    Science.gov (United States)

    Lee, Hyung

    2012-02-15

    Acute audiovestibular loss is a common neurotological condition that is characterized by sudden onset of severe prolonged (lasting days) vertigo and hearing loss and is diagnosed by the presence of canal paresis to caloric stimulation and sensorineural hearing loss on pure tone audiogram. Before 2000, papers on anterior inferior cerebellar artery (AICA) territory infarction focused mostly on associated brainstem and cerebellar findings, without a detailed description of neurotological findings. Since 2000, several reports have demonstrated that acute audiovestibular loss is an important sign for the diagnosis of AICA territory infarction. To date, at least eight subgroups of AICA infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Because audiovestibular loss may occur in isolation before ponto-cerebellar infarction involving AICA distribution, audiovestibular loss may serve as a window to prevent the progression of acute audiovestibular loss into more widespread areas of infarction in posterior circulation (mainly in the AICA territory). Clinician should keep in mind that acute audiovestibular loss may herald impending AICA territory infarction, especially when patients had basilar artery occlusive disease presumably close to the origin of the AICA on brain MRA, even if other central signs are absent and MRI does not demonstrate acute infarction. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery in a Patient with Ascending Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Ufuk Gürkan

    2012-04-01

    Full Text Available The incidence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiographic series and 0.3% in autopsy series. An isolated single coronary artery (SCA is even a rarer congenital anomaly occurring in approximately 0.02% of the population. The ectopic origin of the right coronary artery (RCA from the left anterior descending (LAD artery is relatively rare and more benign than other types of anomalous origin of the RCAs. We report a case of an adult male patient with SCA anomaly in which the RCA takes off from the mid LAD. To the best of our knowledge, SCA anomaly coinciding with ascending aortic aneurysm which was treated with Bentall operation has never been described before.

  13. Communication Apprehension and Resting Alpha Range Asymmetry in the Anterior Cortex

    Science.gov (United States)

    Beatty, Michael J.; Heisel, Alan D.; Lewis, Robert J.; Pence, Michelle E.; Reinhart, Amber; Tian, Yan

    2011-01-01

    In this study, we examined the relationship between trait-like communication apprehension (CA) and resting alpha range asymmetry in the anterior cortex (AC). Although theory and research in cognitive neuroscience suggest that asymmetry in the AC constitutes a relatively stable, inborn, substrate of emotion, some studies indicate that asymmetry can…

  14. Transthoracic Doppler echocardiographic assessment of left anterior descending coronary artery and intramyocardial artery predicts left ventricular remodeling and wall-motion recovery after acute myocardial infarction.

    Science.gov (United States)

    Tani, Tomoko; Tanabe, Kazuaki; Kureha, Fumie; Katayama, Minako; Kinoshita, Makoto; Tamita, Koichi; Oda, Tomoyuki; Ehara, Natsuhiko; Kaji, Shuichiro; Yamamuro, Atsushi; Morioka, Shigefumi; Kihara, Yasuki

    2007-07-01

    Previous studies reported that a coronary flow velocity (FV) pattern with a rapid diastolic deceleration time (DDT) immediately after percutaneous coronary intervention implies advanced microvascular damage in patients who have experienced an acute myocardial infarction (AMI). Using transthoracic echocardiography, we recorded the coronary FV in the left anterior descending coronary artery (LAD) and the FV in the intramyocardial artery 2 days after successful percutaneous coronary intervention in 24 patients who had experienced an anterior AMI. We measured the DDT of the LAD and the intramyocardial artery. DDT of the LAD and the intramyocardial artery was detected in the anteroseptal lesion, the wall motion of which revealed severe hypokinesis or akinesis. We performed echocardiography during both the acute phase and 6 months after the AMI. Patients were divided into two groups (group A: DDT of the LAD or = 600 milliseconds [n = 14]). DDT of the LAD and the intramyocardial artery was significantly shorter for group A than group B (373 +/- 223 vs 786 +/- 105 milliseconds, P < .0001). In the acute phase, there were no significant differences in left ventricular (LV) wall-motion score index (WMSI), LV end-diastolic volume (EDV), or ejection fraction (WMSI: 2.38 +/- 0.24 vs 2.08 +/- 0.58, P = .20; LV EDV: 160 +/- 41 vs 154 +/- 34 mL; ejection fraction: 45 +/- 11 vs 46 +/- 5%). However, WMSI and LV EDV in group A were significantly greater than in group B (WMSI: 2.47 +/- 0.16 vs 1.84 +/- 0.57, P = .01; LV EDV: 198 +/- 28 vs 132 +/- 37 mL, P = .0004) and the ejection fraction in group A was significantly lower than in group B (38 +/- 9 vs 55 +/- 10%, P = .001) during the chronic phase. In patients who had experienced an anterior AMI, we could predict wall-motion recovery of the infarcted area by using the coronary FV of the LAD and FV of the intramyocardial artery.

  15. Arnold–Chiari malformation type 1 complicated by sudden onset anterior spinal artery thrombosis, tetraparesis and respiratory arrest

    Science.gov (United States)

    Wani, Abdul Majid; Zayyani, Najah R; Al Miamini, Wail; Khoujah, Amer M; Alharbi, Zeyad; Diari, Mohd S

    2011-01-01

    Chiari in 1891 described a constellation of anomalies at the base of the brain inherited congenitally, the characteristic of which are (1) extension of a tongue of cerebellar tissue posterior to the medulla and cord that extends into the cervical spinal canal; (2) caudal displacement of the medulla and the inferior part of the fourth ventricle into the cervical canal; and (3) a frequent but not invariable association with syringomyelia or a spinal developmental abnormality. Chiari recognized four types of abnormalities. Presently, the term has come to be restricted to Chiari’s types I and II, that is, to cerebellomedullary descent without and with a meningomyelocele, respectively. The association of Arnold–Chairi malformation and high cervical cord infarction is unusual. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischaemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, postsurgical, sepsis, hypotension and thromboembolic disorders. The authors present an interesting case of cervical cord infarction due to anterior spinal artery thrombosis in a patient of type 1 Arnold–Chiari malformation without any of the above predisposing factors. PMID:22701030

  16. Arnold-Chiari malformation type 1 complicated by sudden onset anterior spinal artery thrombosis, tetraparesis and respiratory arrest.

    Science.gov (United States)

    Wani, Abdul Majid; Zayyani, Najah R; Al Miamini, Wail; Khoujah, Amer M; Alharbi, Zeyad; Diari, Mohd S

    2011-04-15

    Chiari in 1891 described a constellation of anomalies at the base of the brain inherited congenitally, the characteristic of which are (1) extension of a tongue of cerebellar tissue posterior to the medulla and cord that extends into the cervical spinal canal; (2) caudal displacement of the medulla and the inferior part of the fourth ventricle into the cervical canal; and (3) a frequent but not invariable association with syringomyelia or a spinal developmental abnormality. Chiari recognized four types of abnormalities. Presently, the term has come to be restricted to Chiari's types I and II, that is, to cerebellomedullary descent without and with a meningomyelocele, respectively. The association of Arnold-Chairi malformation and high cervical cord infarction is unusual. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischaemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, postsurgical, sepsis, hypotension and thromboembolic disorders. The authors present an interesting case of cervical cord infarction due to anterior spinal artery thrombosis in a patient of type 1 Arnold-Chiari malformation without any of the above predisposing factors.

  17. Giant Coronary Arterial Aneurysm of the Proximal Left Anterior Descending Artery as the Cause of Wide Splitting of the Second Heart Sound.

    Science.gov (United States)

    Nagasawa, Akira; Mori, Shumpei; Akita, Tomomi; Yamada, Haruhi; Oki, Tsumugi; Nishii, Tatsuya; Yamashita, Tomoya; Okita, Yutaka; Hirata, Ken-Ichi

    2017-12-21

    Even in modern clinical cardiology, basic auscultation skill is not obsolete and is still important because it can always provide a clue to an underlying pathophysiology. We demonstrate an unusual mechanism of pathological wide splitting of the second heart sound due to external compression of the pulmonary trunk in a patient with a giant coronary arterial aneurysm of the proximal left anterior descending artery. Echocardiography, when combined with a three-dimensional anatomical analysis with cardiac computed tomography, was useful for elucidating the mechanism of the abnormal heart sounds.

  18. Percutaneous coronary intervention with ABSORB biodegradable vascular scaffold in patients with left anterior descending artery disease

    Directory of Open Access Journals (Sweden)

    К. М. Ваккосов

    2017-04-01

    Full Text Available Aim. The article evaluates 30-day results of percutaneous coronary intervention (PCI with ABSORB biodegradable vascular scaffold (BVS implanted in the case of stenosis of the left anterior descending (LAD coronary artery in patients with stable angina.Methods. 64 patients with significant (≥ 70% LAD disease were included in the study. At 30 days, scaffold thrombosis and major adverse cardiovascular events (all-cause mortality, myocardial infarction, stroke, target vessel revascularization were evaluated. The indicator of successful percutaneous coronary intervention (residual stenosis ≤20% in the presence of counterpulsation corresponding to TIMI 3rd Grade and in the absence of significant in-patient clinical complications and successful intervention assessed by clinical criteria (successful percutaneous coronary intervention alongside with a decrease in objective and subjective symptoms of myocardial ischemia, or their complete disappearance were also analyzed. Results. Mean age of patients was 61.6±8.5 years, with males accounting for 64%; 33% had earlier MI, 14% – diabetes mellitus. Mean left ventricular ejection fraction was 61.3±6.8%. Left anterior descending artery disease was presented in 89% of patients with SYNTAX Score 6.6±2.2. Mean number of implanted stents was 1.2±0.4, with mean length of the stented segment equal to18.7±1.8 mm and mean diameter 3.2±0.3 mm. At 30-day follow-up, the success of intervention assessed by clinical criteria amounted to 96.9% (n=62; that of myocardial infarction 3.1% (n=2; stent thrombosis 1.56% (n=1; repeated revascularization 1.56% (n=1; major adverse cardiovascular events (MACE 3.1%.Conclusion. The implantation of everolimus-eluting BVS for LAD stenosis demonstrates satisfactory results at 30-day follow-up.Received 16 January 2017. Accepted 21 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  19. Iatrogenic Vertebral Artery Injury During Anterior Cervical Spine Surgery: A Systematic Review.

    Science.gov (United States)

    Guan, Qing; Chen, Long; Long, Ye; Xiang, Zhou

    2017-10-01

    Iatrogenic vertebral artery injury (VAI) during anterior cervical surgery is rare but potentially catastrophic. Causes, presentation, diagnosis, management, prognosis, and prevention of VAI were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language studies and case reports published from 1980 to 2017 were retrieved. Data on diagnosis, surgical procedures and approach, site and cause of VAI, management, outcomes, and vertebral artery (VA) status were extracted. In 25 articles including 54 patients, VAI was diagnosed during or after surgery commonly indicated for cervical degenerative diseases (64%), tumors (14%), and trauma (9%). The incidence of VAI for each side was similar regardless of approach. Common presentations were unexpected copious surgical bleeding, delayed hemorrhage of pseudoaneurysm with neck swelling, dyspnea, hypotension, and cervical bruits caused by arteriovenous fistula. Causes included drilling (61%), instrumentation (16%), and soft tissue retraction (8%). Direct exposure or angiography confirmed VAI. Ten patients had VA anomalies; collateral status was verified in 9 before definitive treatment. Tamponade was adopted for urgent hemostasis in most cases but with a high incidence of pseudoaneurysm (48%). Unknown VA status increased occlusion risk and neurologic sequelae (41%). VA repair and stent placement had excellent outcomes. Extensive lateral decompression, loss of landmarks, and anatomic variations or pathologic status of VA increased VAI risk. Evaluation of collateral vessels before definitive treatment helped determine appropriate management and avoid neurologic sequelae. Tamponade was not recommended as definitive treatment. Meticulous preoperative evaluation, cautious intraoperative manipulation, and real-time radiographic guidance reduced VAI risk. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Physiologic capacity of well-developed collaterals in patients with isolated left anterior descending artery disease

    International Nuclear Information System (INIS)

    Sakata, Kazuyuki; Yoshida, Hiroshi; Ono, Norihisa; Ohtani, Seiji; Mori, Noriko; Yokoyama, Shoichi; Hoshino, Tsuneo; Kaburagi, Tsuneo; Kurata, Chinori.

    1992-01-01

    To assess the physiologic significance of well-developed collaterals, 34 patients, with isolated left anterior descending artery disease (LAD) and without overt prior myocardial infarction, underwent cardiac catheterization and exercise thallium-201 emission computed tomography. The patients were divided into 3 groups: 11 patients with 90% stenosis of the proximal LAD and without collaterals (group 1), 11 with 99% stenosis of the proximal LAD, and without collaterals (group 2) and 12 with a total occlusion of the proximal LAD which was completely filled by well-developed collaterals (group 3). On left ventriculography, shortening fractions of the anterior wall were significantly reduced in group 2 as compared to groups 1 and 3 (group 1 vs group 2: p<0.01, group 2 vs group 3: p<0.05), which reflected the lower ejection fraction of group 2 (p<0.01 and p<0.05, respectively). The perfusion defects of the anterior wall on both the initial and the delayed images were severer in groups 2 and 3 than in group 1 (group 1 vs group 2 and group 1 vs group 3 on the initial image: p<0.01, for both, group 1 vs group 2 and group 1 vs group 3 on the delayed image: p<0.05, for both). However, recovery of the perfusion defects from the initial image to the delayed image was better in group 3 than in groups 1 and 2 (group 1 vs group 2 and group 1 vs group 3: p<0.05, for both). Therefore, coronary blood flow through well-developed collaterals was considered to be comparable to the flow through a diseased vessel with 90% stenosis at rest. During maximal exercise, blood flow through well-developed collaterals was considered to be comparable to the flow through a diseased vessel with 99% stenosis, although the blood flow through well-developed collaterals was considered to be better than that through 99% stenosis during the recovery period. These findings suggest that patients with well-developed collaterals must be treated like those with severe stenosis. (author)

  1. Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up.

    Science.gov (United States)

    Kühn, Anna Luisa; Hou, Samuel Y; Perras, Mary; Brooks, Christopher; Gounis, Matthew J; Wakhloo, Ajay K; Puri, Ajit S

    2015-09-01

    Anterior circulation perforating artery aneurysms including anterior choroidal artery and lenticulostriate artery aneurysms are rare. Injury to these vessels can lead to severe debilitating symptoms. To present a new approach to treatment using flow diversion technology. Patients treated with a Pipeline embolization device (PED) for perforator artery aneurysms at our institution between June 2012 and May 2013 were identified and included in our retrospective analysis. We evaluated patient vascular risk factors; family history of aneurysms; aneurysm characteristics; National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on admission; and angiography follow-up and patient clinical outcome at discharge, 6 months, and 1 year. We included four patients with a mean age of 59.8 years. Two patients had a positive family history of aneurysms. Patient vascular risk factors included smoking, dyslipidemia, and hypertension. All patients presented with a NIHSS and mRS of 0 on admission. Aneurysms were located at the anterior choroidal (n=2) or lenticulostriate artery (n=2) and were treated with a single PED. No periprocedural or postprocedural complications occurred. The patients were discharged with no change in NHISS or mRS score. Six-month and 1-year follow-up angiography showed complete aneurysm occlusion. Mild intimal hyperplasia was seen in 2 cases at 6 months, but was resolved at the 1-year follow-up. No re-treatment was necessary. NIHSS and mRS remained 0 at follow-up time points. Our preliminary results show that flow diversion technology is an effective and safe therapy for complex, hard-to-treat aneurysms in perforating arteries. Larger studies with long-term follow-up are needed to validate our promising results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. The risk of iatrogenic injury to anterior tibial artery variations during tibial nail distal interlocking.

    Science.gov (United States)

    Fanter, Nathan J; Inouye, Sandra E; Beiser, Christopher W

    2017-01-01

    Tibial intramedullary nailing remains a common tibial fracture fixation method. Tibial nailing indications continue to expand. Neurovascular complications from tibial nailing have been described; however, the proximity of distal tibial locking bolts to the anterior tibial artery (ATA) variants has not. 52 cadaveric legs were dissected identifying three common ATA variants. Each ATA variant received an intraluminal wire to facilitate fluoroscopic identification. Three different intramedullary tibial nails were inserted in each of the three ATA variant specimens. With fluoroscopy, the proximity of the distal locking holes of each tibial nail to the intraluminal wire representing the ATA variant course was measured. Of the 40 measurements, the intraluminal wire was directly in the bolt insertional path in 8 of 40 (20%) and within 5 mm in 16 of 40 (40%). All specimens had the wire cross the locking bolt insertional path at least once in each of the nails. The ATA variant taking a more lateral course deep to the extensor digitorum longus and peroneus tertius to overlay the lateral malleolus had the highest occurrence of measurements less than 5 mm. The close proximity of tibial nail distal locking bolt holes to ATA variants presents a risk for iatrogenic vascular injury during insertion. The coronal locking bolts pose the greatest iatrogenic risk to the most laterally positioned ATA variant.

  3. Mapping affected territory of anterior/posterior inferior cerebellar artery infarction using a vestibular test battery.

    Science.gov (United States)

    Weng, Yu-Cheng; Young, Yi-Ho

    2014-03-01

    Although the affected territory in the posterior/anterior inferior cerebellar artery (PICA/AICA) infarction could not be meticulously demonstrated by magnetic resonance imaging (MRI), it could be picked up by the results of a vestibular test battery comprising caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests. This study applied audiometry and caloric, oVEMP, and cVEMP tests to map affected territory in patients with PICA/AICA infarction. Fourteen patients, including 11 with PICA infarction and 3 with AICA infarction, were enrolled in this study during the last 8 years. Each patient underwent audiometry, caloric test, oVEMP test, and cVEMP test. In the PICA group, 8 (36%) of 22 ears had a mean hearing level >25 dB. All six ears (100%) in the AICA group had abnormal hearing, and thus both groups revealed a significant difference. Conversely, significant differences were not observed in the vestibular test battery between the PICA and AICA groups. MRI demonstrated infarction at the brainstem for six patients, while one patient also had cerebellar involvement, indicated by loss of visual suppression on caloric nystagmus. Six patients showed infarction at the cerebellum, and four of them had brainstem affliction based on abnormal oVEMP/cVEMP test results.

  4. Successful Endovascular Occlusion of a Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm of the Caudal Trunk: Case Report

    Science.gov (United States)

    Kang, H.-S.; Roh, H.G.; Han, M.H.; Koh, Y.-C.

    2007-01-01

    Summary We report a rare case of a ruptured distal anterior inferior cerebellar artery (possibly dissecting) aneurysm of the caudal trunk, successfully treated by endovascular occlusion. A 41-year-old man presented with sudden severe headache and drowsiness. On the day of ictus, conventional angiography was performed to make the above diagnosis, followed by endovascular occlusion of the sac and the parent artery. The patient recovered completely without any neurologic deficit after treatment. Endovascular occlusion could be a safe and effective treatment option in a case of a ruptured distal AICA aneurysm of the caudal trunk. PMID:20566118

  5. Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman

    Science.gov (United States)

    Papadopoulos, Kyriacos; Azina, Chara

    2016-01-01

    Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature. PMID:27127443

  6. [Embolization for aneurismal dilatation associated with ruptured dissecting anterior inferior cerebellar artery aneurysm with preservation of the parent artery: case report].

    Science.gov (United States)

    Kusaka, Noboru; Maruo, Tomoko; Nishiguchi, Mitsuhisa; Takayama, Kazuhiro; Maeda, Yasuhiko; Ogihara, Kotaro; Nakagawa, Minoru; Gotoh, Masaki; Nishiura, Tsukasa

    2006-07-01

    We report a rare case of a ruptured dissecting anterior inferior cerebellar artery (AICA) aneurysm treated by endosaccular embolization with a Guglielmi detachable coil (GDC). An 85-year-old female presented with headache. Computed tomographic (CT) scan showed subarachnoid hemorrhage and intraventricular hemorrhage in the fourth ventricule. Cerebral angiography and 3D-CT angiography revealed an aneurysmal dilatation at the anterior pontine segment of the right AICA with a diagnosis of arterial dissection. The right posterior inferior cerebellar artery (PICA) was absent and the right AICA supplied the territory normally nourished by the right PICA. The aneurismal dilatation was occluded by endosacullar embolization with preservation of the AICA. The distal AICA aneurysm is rare and only seven cases treated with endovascular embolization have been reported. In these, six cases were treated by parent artery occlusion with coil and the subsequent three cases presented with ischemic complications. Only one case was treated by endosaccular embolization with GDC. To our knowledge, this is the second report of the distal AICA aneurysm treated by endosaccular embolization with GDC. Distal AICA aneurysms are briefly discussed while reviewing the literature.

  7. Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

    Science.gov (United States)

    Dobrowolski, Piotr; Kowalski, Mirosław; Rybicka, Justyna; Lech, Agnieszka; Tyczyński, Paweł; Witkowski, Adam; Hoffman, Piotr

    2016-01-01

    The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

  8. Anterior Inferior Cerebellar Artery Strokes Based on Variant Vascular Anatomy of the Posterior Circulation: Clinical Deficits and Imaging Territories.

    Science.gov (United States)

    Chen, Melissa M; Chen, Stephen R; Diaz-Marchan, Pedro; Schomer, Donald; Kumar, Vinodh A

    2018-04-01

    We report imaging findings of 3 patients with anterior inferior cerebellar artery (AICA) infarcts who presented with atypical clinical findings of cerebellar strokes. AICA strokes are rare, and diagnosis can be difficult because of the high variability of the posterior circulation vascular anatomy. We describe the embryology and variant anatomy of AICA so that clinicians can understand and recognize the patterns of these infarcts. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical - diffusion weighted - MRI study.

    Science.gov (United States)

    Kumral, E; Kisabay, A; Ataç, C

    2006-04-01

    The topography and mechanism of stroke in the anterior inferior cerebellar artery (AICA) territory are delineated before, but the detailed clinical spectrum of lesions involving AICA territory was not studied by diffusion weighted imaging (DWI). We reviewed 1350 patients with posterior circulation ischemic stroke in our registry. We included patients if the diagnosis of AICA territory involvement was confirmed, and DWI, and magnetic resonance angiography were obtained in the 3 days of symptoms onset. The potential feeding arteries of the AICA territory were evaluated on magnetic resonance imaging (MRI) using a three-dimensional rotating cineoangiographic method. There were 23 consecutive patients with lesion involving AICA territory, six with isolated lesion in the AICA territory, six with posterior inferior cerebellar artery, 11 with multiple posterior circulation infarcts (MPCIs). The clinical feature of isolated AICA infarct was vertigo, tinnitus, dysmetria, ataxia, facial weakness, facial sensory deficits, lateral gaze palsy, and sensory-motor deficits in patients with pontine involvement. Patients with largest lesion extending to the anterior and inferolateral cerebellum showed mixed symptomatology of the lateral medullary (Wallenberg's syndrome) and AICA territory involvement. Patients with MPCIs presented various clinical pictures with consciousness disturbances and diverse clinical signs because of involvement of different anatomical structures. Large-artery atherosclerotic disease in the vertebrobasilar system was the main cause of stroke in 12 (52%) patients, cardioembolism (CE) in one (4%), and coexisting large-artery disease and a source of CE in four (17%). The main cause of stroke was atheromatous vertebrobasilar artery disease either in the distal vertebral or proximal basilar artery. The outcome was usually good except those with multiple lesions. The new MRI techniques and clinical correlations allow better definition of the diverse topographical

  10. Tuberothalamic artery infarctions following coil embolization of ruptured posterior communicating artery aneurysms with posterior communicating artery sacrifice.

    Science.gov (United States)

    Endo, H; Sato, K; Kondo, R; Matsumoto, Y; Takahashi, A; Tominaga, T

    2012-03-01

    Ischemic complications after coil embolization of the PcomA aneurysms are not thoroughly understood, especially in cases in which the PcomA is sacrificed. Our purpose was to examine the preoperative angiographic features and pattern of postoperative cerebral infarctions exhibited by patients who underwent embolization of ruptured PcomA aneurysms with PcomA sacrifice. A retrospective review identified 14 patients with ruptured PcomA aneurysms who underwent embolization of the aneurysms in combination with PcomA sacrifice. Preoperative angiographic data, including the Allcock test, postoperative DWI, and neurologic status, were examined. Elimination of the aneurysm was complete in all cases. Postoperative DWI indicated 7 cases with infarctions (infarction group) and 7 cases without infarctions (noninfarction group). All patients in the infarction group developed infarctions in the vicinity of the tuberothalamic artery. In all 14 cases, a preoperative Allcock test demonstrated a retrograde filling of the PcomA through the P1 segment. The incidence of negative visualizations of the P1 segment on vertebral angiograms was significantly higher in the infarction group (100%) than in the noninfarction group (0%; P = .00058). The mean PcomA diameters, PcomA/P1 ratios, and aneurysm sizes observed in the infarction group were significantly greater than those in the noninfarction group (P sacrifice, tuberothalamic artery infarctions tended to occur in cases exhibiting negative visualization of the P1 segment, even when collateral flow was observed with the Allcock test.

  11. Indocyanine Green Videoangiography for Surgery of a Ruptured Dissecting Aneurysm in the Precommunicating Anterior Cerebral Artery: A Technical Case Report.

    Science.gov (United States)

    Nagai, Yasunori; Goto, Masanori; Toda, Hiroki; Nishida, Namiko; Yoshimoto, Naoya; Iwasaki, Koichi

    2017-08-01

    Indocyanine green videoangiography (ICG-VA) is an important intraoperative adjunct for saccular aneurysm surgery, but its efficacy in surgery for dissecting aneurysms has rarely been reported. The authors describe the usefulness of preclipping ICG-VA in a rare case of a ruptured dissecting aneurysm located at the precommunicating (A1) segment of the anterior cerebral artery. A 52-year-old woman, with no history of connective tissue diseases or vascular disorders, presented with sudden headache and convulsion. The CT scan showed that the patient had subarachnoid hemorrhage. Angiography showed a dissecting aneurysm in the left A1 segment of the anterior cerebral artery. Thus, the patient underwent trapping of the dissecting aneurysm. ICG-VA was used as an intraoperative adjunct before and after clipping. The preclipping ICG-VA showed the heterogeneously bright dissecting aneurysm and branching arteries even in the presence of hematoma. Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms. Copyright © 2017 by the Congress of Neurological Surgeons

  12. Surgical Resection of Idiopathic Distal Anterior Choroidal Artery Aneurysm Assisted by Frameless Stereotactic System Guidance: Case Report and Literature Review.

    Science.gov (United States)

    Ye, Feng; Tao, Chuanyuan; Xiong, Shenghua; You, Chao

    2017-01-01

    Idiopathic distal anterior choroidal artery (AChoA) aneurysms are particularly rare. Their diagnosis and treatment are difficult because of the particular characteristic of pathological anatomy. Our case mainly presented with intraventricular hemorrhage. His idiopathic aneurysm was located in the trigone of the undilated ventricle. Computed tomographic angiography demonstrated both the precise aneurysm and parent artery even when there was no dilated parent artery for the first time. It is also the first time this tiny aneurysm was resected assisted by frameless stereotactic guidance during operation after absorption of intraventricular blood. Computed tomographic angiography and frameless stereotactic guidance benefit the diagnosis and treatment of this kind of aneurysm. Sacrificing plexual AChoA did not cause any neurologic deficit.

  13. Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki.

    Science.gov (United States)

    Thiarawat, Peeraphong; Jahromi, Behnam Rezai; Kozyrev, Danil A; Intarakhao, Patcharin; Teo, Mario K; Choque-Velasquez, Joham; Hernesniemi, Juha

    2017-05-01

    The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs). We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014. From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P < 0.001) and Liliequist membrane fenestration (OR, 19.62; P < 0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P < 0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P < 0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction. For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Axillary artery injury after an anterior shoulder fracture dislocation and “periosteal sleeve avulsion of the rotator cuff” (SARC. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ash Chehata

    2017-04-01

    Full Text Available We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC. We review the literature and discuss the cause of this unusual injury pattern. Keywords: Axillary artery, Shoulder fracture dislocation, Periosteal sleeve avulsion, SARC

  15. Aneurysm of the anterior inferior cerebellar artery (AICA) associated with high-flow lesion: report of two cases and review of literature.

    NARCIS (Netherlands)

    Menovsky, T.; Grotenhuis, J.A.; Bartels, R.H.M.A.

    2002-01-01

    OBJECTIVE AND IMPORTANCE: Although aneurysms of the anterior inferior cerebellar artery (AICA) are rare lesions, their occurrence in combination with high-flow lesions in the same arterial territory is even more striking. Two cases of an AICA aneurysm in combination with a high -flow lesion are

  16. Reversible Akinetic Mutism after Aneurysmal Subarachnoid Haemorrhage in the Territory of the Anterior Cerebral Artery without Permanent Ischaemic Damage to Anterior Cingulate Gyri

    Directory of Open Access Journals (Sweden)

    François-Xavier Sibille

    2016-01-01

    Full Text Available We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of the anterior cerebral artery (ACA. In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Both patients shared common radiological features: a hydrocephalus due to haemorrhagic contamination of the ventricular system and a mass effect of a subpial hematoma on the borders of the corpus callosum. Patients were also investigated using auditory event-related evoked potentials at acute stage. In contrast to previous observations of akinetic mutism, P300 wave could not be recorded. Both patients had good recovery and we hypothesized that this unexpectedly favourable outcome was due to the absence of permanent structural damage to the ACA territory, with only transient dysfunction due to a reversible mass effect on cingulate gyri.

  17. Close Proximity of Left Anterior Descending Artery to the Right Ventricular Lead Apparently Implanted into the Mid-septum

    Directory of Open Access Journals (Sweden)

    Pavel Osmancik, MD, PhD, FESC, Petr Stros, MD

    2014-03-01

    Full Text Available Right ventricular (RV mid-septal pacing should have fewer negative effects on left ventricular function compared to apical pacing. However, targeting the mid-septum may be technically challenging since it is usually done with two-dimensional fluoroscopy. The rotation of the heart and various shapes of the RV make it difficult to assess, whether the lead is really anchored in the septum. Many leads, apparently anchored in the septum, are in fact anchored in the anterior wall or anteroseptal groove, and some can get anchored in close proximity to the left anterior descending artery (LAD. We report three cases from our series of 51 patients, in whom the RV lead thought to be implanted in the mid-septum was in fact anchored in close proximity of LAD when assessed using computed tomography.

  18. Endovascular strategies for treatment of posterior communicating artery aneurysm according to angiographic architecture: Preservation vs. sacrifice of posterior communication artery.

    Science.gov (United States)

    Ko, Jung Ho; Kim, Young-Joon

    2017-12-01

    We report ischemic complications related to obstruction of the posterior communicating artery (PcomA) and suggest treatment strategies according to the angiographic characteristics of the PcomA and the posterior cerebral artery (PCA). Twenty-one patients with PcomA aneurysm who had initially undergone endovascular treatment and had an identifiable PcomA occlusion on immediate or follow-up angiography were enrolled. We classified PcomA aneurysm according to the characteristics of the PcomA and PCA (P1) on baseline angiography, as follows: type I was defined as PcomA aneurysm with an absent PcomA and a normal-sized P1. Type II was defined as a hypoplastic PcomA and a normal-sized P1. Type III was defined as a normal-sized PcomA and an absent P1. Type IV was defined as a normal-sized PcomA and a hypoplastic P1. Type V was a normal-sized PcomA and a normal-sized P1. Among all cases of PcomA obstruction, 15 (71.4%) were type II PcomA aneurysms, four were type IV, one was type III, and one was type V. Ischemic events related to PcomA obstruction occurred in three cases (type II, III and VI), which included two tuberothalamic infarctions (type III and IV) and one cortical infarction in the territory of the PCA (type II). Follow-up angiographies showed flow change in the PcomA in 14 cases. It is relatively safe to sacrifice type II PcomA if necessary. However, physicians should pay attention to unexpected flow changes, such as recanalization or occlusion of the PcomA, which are possible after treatment.

  19. Significance of Anomalous Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Common Trunk Compression in Microvascular Decompression for Hemifacial Spasm.

    Science.gov (United States)

    Shimano, Hiroshi; Kondo, Akinori; Yasuda, Soichiro; Inoue, Hiroto; Morioka, Jun; Miwa, Hiroshi; Kawakami, Osamu; Murao, Kenichi

    2016-08-01

    The anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk anomaly is reportedly one of the most common vessel variants in the posterior circulation, but reports of hemifacial spasm (HFS) associated with AICA-PICA common trunk are very rare. In the present study, we describe methods of microvascular decompression (MVD) for HFS caused by AICA-PICA common trunk compression. Among 159 patients who underwent MVD for HFS, 16 patients had compression of the root exit zone by the AICA-PICA common trunk anomaly. The types of compression were classified into 2 groups: common trunk artery compression group and branching vessel compression group. The common trunk artery compression group consisted of 11 patients (69%), and the branching vessel compression group consisted of 5 patients (31%). The rostral branch (feeding the original AICA territory) coursed between the seventh and eighth cranial nerves in 5 patients, and in 13 patients (81%), the offending vessel harbored perforators around the root exit zone. Among 16 patients, 14 (87.5%) required interposition of the common trunk or the branching vessel, and in 2 patients, decompression was completed by the transposition method. Fifteen patients experienced sufficient results, and 1 had severe residual spasm. Transient facial palsy developed in 2 patients. No patients encountered recurrence. Reports concerning decompression methods of AICA-PICA common trunk anomaly are very rare. The tortuosity of the common trunk and perforators from the offending vessel make the usual repositioning of the offending artery much more difficult, and adequate decompression techniques are required for successful MVD. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Stent assisted coil embolization of wide-necked bilobed anterior inferior cerebellar artery aneurysm with incorporated artery arising from the dome: a technical note.

    Science.gov (United States)

    Sabharwal, Paramveer Singh; Saini, Jitender; Hanumanthapura Ramalingaiah, Arvinda

    2013-09-01

    A technique for stent-assisted coil embolization of a bilobed wide-necked saccular aneurysm of the anterior inferior cerebellar artery (AICA) with the AICA arising from the dome of the aneurysm is described. A middle-aged patient was referred for treatment of a bilobed saccular aneurysm identified on a CT angiogram performed for a subarachnoid hemorrhage which occurred 20 days prior to presentation. A diagnostic angiogram showed a bilobed wide-necked saccular aneurysm at the AICA origin with the AICA arising from the dome of the aneurysm and also supplying the territory of the posterior inferior cerebellar artery. The therapeutic procedure involved trans-aneurysmal cannulation of the AICA with the microcatheter left in situ. Another microcatheter was maneuvered into the larger dome of the aneurysm. A stent was then deployed in the basilar artery, jailing the previous microcatheter in the aneurysm. Helical Guglielmi detachable coils were deployed in the aneurysm resulting in complete occlusion of the aneurysm with preservation of the AICA. It is important to preserve a normal branch arising from the dome of an aneurysm although it is technically demanding and a relative limitation. This case report describes a technique of coiling a bilobed aneurysm with a vital branch arising from the dome, with preservation of the branch and complete occlusion of the aneurysm using two microcatheters and a stent. This expands the repertoire of endovascular treatment of complex aneurysms.

  1. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

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    James J McCarthy

    2011-05-01

    Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

  2. Median Supraorbital Keyhole Approach for Clipping Ruptured Distal Anterior Cerebral Artery Aneurysm: Technical Report with Review of Literature.

    Science.gov (United States)

    Dhandapani, Sivashanmugam; Sahoo, Sushant Kumar

    2018-04-01

    The minimally invasive approach to distal anterior cerebral artery (DACA) aneurysms has not gained much acceptance due to difficulties associated with the conventional frontal paramedian approach. The more proximal basal interhemispheric approach, however, necessitates extensive dissection of soft tissues. We describe a novel minimally invasive median supraorbital keyhole craniotomy with a basal interhemispheric approach for clipping a ruptured DACA aneurysm. A 62-year-old patient presented with subarachnoid hemorrhage. Computed tomography angiography revealed a DACA aneurysm. The surgical technique involved a keyhole craniotomy made via an eyebrow incision extending between the supraorbital notches, and flush with the anterior cranial fossa. The dura was opened at the anterior part, the falx was cut, an interhemispheric dissection was carried out, adequate proximal control was obtained, and the aneurysm neck was dissected and clipped. A relevant review of the literature was carried out. The patient recovered well, with no residual aneurysm or forehead numbness, with good cosmesis. Compared with the previously described "keyhole unilateral interhemispheric" approaches, our technique has less likelihood of encountering bridging veins; easier cisternal cerebrospinal fluid release, making it feasible even in swollen brain; better proximal vascular control; and trajectory toward the neck rather than dome. The median supraorbital keyhole approach is a minimally invasive technique sufficient for clipping most DACA aneurysms, with easier access, better proximal control, and good cosmesis. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Transverse process anatomy as a guide to vertebral artery exposure during anterior cervical spine approach: A Cadaveric Study.

    Science.gov (United States)

    Nourbakhsh, Ali; Yang, Jinping; Mcmahan, Howard; Garges, Kim

    2017-05-01

    Safe exposure of the vertebral artery (VA) is needed during resection of tumors close to the artery and during repair of lacerations. We defined the anatomy of the anterior root of each transverse process (TP) from C3 to C6 for identification and exposure of the VA during the anterior approach. We examined the anatomy of the TP and assessed two approaches for safe identification of the VA, lateral to medial and medial to lateral dissection of the TP, in 20 cadavers. The safe zone at each level of the cervical spine was defined as an area in which the surgeon can start to dissect at the midline of that level on the TP and safely cross the VA laterally. For the lateral to medial approach the surgical safe zone lies between the mid axis of the TPs and a line 2 mm parallel to and above it. The average TP angle was 11 ± 10.2 degrees. The mean distance of the lateral border of the VA from the TP tip was 3.78-5.28 mm. For the medial to lateral approach, staying at the level of the upper vertebral end plate will lead the surgeon to the tip of the TP. From that point, dissection can be carried out as described above. This study examined the anatomy of the TP and defined the approach to expose the VA safely during anterior cervical spine exposure. Clin. Anat. 30:492-497, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  4. Safety and Tolerability of SonoVue® in Patients with Large Artery Anterior Circulation Acute Stroke.

    Science.gov (United States)

    Baracchini, Claudio; Viaro, Federica; Favaretto, Silvia; Palmieri, Anna; Kulyk, Caterina; Causin, Francesco; Farina, Filippo; Ballotta, Enzo

    2017-07-01

    Ultrasound contrast agents (UCAs) are routinely used to improve the visualization of intracranial arteries. Since a higher rate of intracranial hemorrhage (ICH) has been observed in patients undergoing sonothrombolysis in combination with UCAs, we conducted this study with the aim of assessing safety and tolerability of SonoVue® in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) and eligible to intravenous thrombolysis and/or mechanical thrombectomy. Among 474 patients consecutively admitted to our Stroke Unit with anterior circulation ischemic stroke, SonoVue® was administered during transcranial ultrasound evaluation to 48 patients with suspected LAO for diagnostic confirmation (group I) and to 44 patients with inadequate temporal bone window. Forty-eight stroke patients with LAO diagnosed only by computed tomography (CT) angiography /magnetic resonance (MR) angiography and matched for age, gender, and National Institutes of Health Stroke Scale score with group I represented the control group (group II). Thrombolysis, thrombectomy, or combined treatment were offered to all eligible patients. Brain MR imaging/CT was performed in both groups in case of neurological deterioration or after 1 week to check for ICH. SonoVue® did not cause any serious adverse event; only mild and transient side effects were reported in six cases (6.5%). Among patients in groups I and II, there were 31 (32.3%) secondary cerebral bleedings with no statistically significant difference between the groups, but only 2 (2.1%) were symptomatic. According to our study, SonoVue® can be safely administered to acute ischemic stroke patients with suspected anterior circulation LAO and/or inadequate temporal bone window. Copyright © 2016 by the American Society of Neuroimaging.

  5. Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms.

    Directory of Open Access Journals (Sweden)

    Jinyu Xu

    Full Text Available BACKGROUND AND PURPOSE: Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. MATERIALS AND METHODS: 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs. Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. RESULTS: The normalized mean wall shear stress (WSS of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012. The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018. The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012. By contrast, parameters that had no significant differences between the two groups were OSI (P = .674, aneurysm size (P = .327, size ratio (P = .779, vessel angle (P = 1.000 and aneurysm inclination angle (P = 1.000. CONCLUSIONS: Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status.

  6. Derivation of flow related risk indices for stenosed left anterior descending coronary arteries with the use of computer simulations.

    Science.gov (United States)

    Papadopoulos, Konstantinos P; Gavaises, Manolis; Pantos, Ioannis; Katritsis, Demosthenes G; Mitroglou, Nicholas

    2016-09-01

    The geometry of the coronary vessel network is believed to play a decisive role in the initiation, progression and outcome of coronary artery disease (CAD) and the occurrence of acute coronary syndromes (ACS). It also determines the flow field in the coronary artery which can be linked to CAD evolution. In this work geometric 3D models of left anterior descending (LAD) coronary arteries associated with either myocardial infarction (MI) or stable (STA) CAD were constructed. Transient numerical simulations of the flow for each model showed that specific flow patterns develop in different extent in the different groups examined. Recirculation zones, present distal the stenosis in all models, had larger extent and duration in MI cases. For mild stenosis (up to 50%) areas with low time averaged wall shear stress TAWSS (3Pa) appeared only in MI models; in moderate and severe stenosis (>50%) these areas were present in all models but were significantly larger for MI than STA models. These differentiations were expressed via numerical indices based on TAWSS, oscillating shear index (OSI) and relative residence time (RRT). Additionally we introduced the coagulation activation index (CAI), based on the threshold behaviour of coagulation initiation, which exceeded the suggested threshold only for MI models with intermediate stenosis (up to 50%). These results show that numerical simulations of flow can produce arithmetic indices linked with the risk of CAD complications. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  7. Age-Specific And Sexual Variability Of Morphological And Biomechanical Parameters Of Anterior Cerebral Artery Of Adults

    Directory of Open Access Journals (Sweden)

    I.V. Kirillova

    2009-12-01

    Full Text Available In the experiment on monoaxonic longitudinal distension by tensile-testing machine Tira Test 28005 (Germany with loading unit - 100 N the general rigidity, breaking point and relative lengthening of anterior cerebral artery (АСА of adult people have been under study. Under the microscope on transverse sections the external diameter of the artery, its wall thickness have been measured and diameter of lumen have been calculated. In total 228 АСА (132 - from corpses of men, 92-from corpses of women have been investigated. They have been received in 16 hours after autopsy of adult people whose cause of death has not been connected with vascular cerebral pathology. It has been revealed that right АСА is longer and narrower than left one. ACA's wall length and thickness predominate in men in comparison with women in average of 5,4 - 13,0%. With years АСА lengthens, its external diameter increases. Biomechanical parameters of ACA's wall do not have any authentic sexual differences, they don't depend on the side of the arterial ring. With years the rigidity of АСА decreases, especially in middle age. In old age its general rigidity increases. It is connected with the increase of ACA's wall thickness. The ability of АСА to lengthening doesn't depend upon age. Experimental findings may be used as criteria of age standard of morphological and biomechanical parameters of АСА

  8. A safe approach to explore/identify the V(2) segment of the vertebral artery during anterior approaches to cervical spine and/or arterial repairs: anatomical study.

    Science.gov (United States)

    Nourbakhsh, Ali; Yang, Jinping; Gallagher, Sean; Nanda, Anil; Vannemreddy, Prasad; Garges, Kim J

    2010-01-01

    The purpose of this study was to find a landmark according to which the surgeon can dissect the cervical spine safely, with the lowest possibility of damaging the vertebral artery (VA) during anterior approaches to the cervical spine or the VA. The "safe zone" for each level of the cervical spine was described as an area where the surgeon can start from the midline in that zone and dissect the soft tissue laterally to end up on the transverse process and cross the VA while still on the transverse process. In other words, safe zone signifies the narrowest width of the transverse process at each level. In such an approach, the VA is protected from the inadvertent deep penetration of the instruments by the transverse process. The surgical safe zone for each level was the common area among at least 95% of the safe zones for that level. For the purpose of defining the upper and lower borders of the safe zone for each level, the line passing from the upper vertebral border perpendicular to the midline (upper vertebral border line) was used as a reference. Cervical spines of 64 formalin-fixed cadavers were dissected. The soft tissue in front of the transverse process and intertransverse space was removed. Digital pictures of the specimens were taken before and after removal of the transverse processes, and the distance to the upper and lower border of the safe zone from the upper vertebral border line was measured on the digital pictures with Image J software. The VA diameter and distance from the midline at each level were also measured. To compare the means, the authors used t-test and ANOVA. The surgical safe zone lies between 1 mm above and 1 mm below the upper vertebral border at the fourth vertebra, 2 mm above and 1 mm below the upper vertebral border at the fifth vertebra, and 1 mm above and 2 mm below the upper vertebral border of the sixth vertebra. The VA was observed to be tortuous in 13% of the intertransverse spaces. There is a positive association between

  9. Communication between the right and circumflex coronary arteries discovered incidentally by multidetector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Se Hwan; Kim, Eui Jong; Woo, Jong Shin; Kim, Soo Joong; Youn, Hyo Chul; Oh, Joo Hyeong [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2016-09-15

    Intercoronary communication is a rare congenital coronary anomaly. We present a case of a 48-year-old man with an incidentally discovered communication between the right and circumflex coronary arteries, who was admitted with chest tightness and exertional dyspnea. The initial diagnosis was made using electrocardiogram-gated multidetector computed tomography.

  10. Coronary artery fistulas: symptoms may not correlate to size. An emblematic case and literature review

    OpenAIRE

    Buccheri, D; Pisano, c; Piraino, D; Cortese, B; Dendramis, G; Chirco, PR; Balistreri, CR; Andolina, G; Argano, V; Ruvolo, G

    2015-01-01

    Fistulous communication of coronary with pulmonary arteries in the adults is a common type of coronary artery fistula (CAF)1—3. In most reported cases, the fistula usually arises from the proximal left and/or right coronary arteries via the anterior conal branches that connect to the anterior wall of the main pulmonary artery. These anteriorly located abnormal communications are usually asymptomatic and are incidentally found during an angiography of the coronary arteries in 0.2—0.3% of the e...

  11. Detection of significant stenosis in the left anterior descending artery by 'virtual myocardial perfusion' bolus tracking, 320 slice computed tomography.

    Science.gov (United States)

    Takaoka, Hiroyuki; Funabashi, Nobusada; Fujimoto, Yoshihide; Kobayashi, Yoshio

    2014-12-20

    We used bolus-tracking CT-images, which are usually used only to detect contrast-material in target organs for optimal-starting of acquisition, as virtual first pass myocardial perfusion images. Retrospective-analysis of 14 patients (10 male, 63 ± 10 years) diagnosed with ≥ 75% stenosis confined to left-anterior-descending-artery (LAD) (7 patients, Group-1) or insignificant stenosis of any coronary artery (7 patients Group-2) diagnosed using invasive-coronary-angiograms (ICA) and enhanced 320-slice-CT within 3-months and without incident between examinations. Bolus-tracking CT-images were acquired at mid-level left-ventricle (LV) until CT-attenuation of descending-aorta increased to 200 HU. We measured CT-attenuation (HU) in the LV anterior-wall (AW), the basal inter-ventricular-septum (BIVS), and LV basal lateral-wall (BLW) in end-systole using both bolus-tracking images and routine, enhanced, early-phase CT-images. In the bolus-tracking images, the Group-1 LV AW, BIVS, BLW CT-attenuation and ratio of LV AW CT attenuation to the average of BIVS and BLW were 36 ± 7HU, 62 ± 11HU, 58 ± 25HU, and 0.6 ± 0.1 respectively. In Group-2, they were 53 ± 14HU, 56 ± 9HU, 54 ± 15HU, and 1.0 ± 0.3 respectively. LV AW CT attenuation and the ratio of LV AW CT values to the average of BIVS and BLW, were significantly lower in Group-1 (both P BLW and without the need for drugs, exercise or additional radiation-exposure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. The cutaneous arteries of the anterior abdominal wall: a three-dimensional study.

    Science.gov (United States)

    Tregaskiss, Ashley P; Goodwin, Adam N; Acland, Robert D

    2007-08-01

    Abdominal perforator flaps represent a natural progression in the quest to minimize abdominal wall morbidity. Their one disadvantage is the significant rate of vascular complications to which they are subject in some series. The authors examined the vascular anatomy of the abdominal integument, to determine why such complications occur and how they may be prevented. In 10 fresh cadavers, major arteries supplying the abdominal wall were injected with a lead-based contrast medium. The abdominal integument of each cadaver was imaged using a 16-slice spiral computed tomography scanner, to produce three-dimensional reconstructions of the arterial anatomy. Reconstructions were observed for orientation, course, and morphology of the major perforators within the abdominal integument. Perforators of the deep inferior epigastric artery (DIEA) varied markedly in their orientation, course, and morphology among specimens. By contrast, perforators of the superior epigastric artery (SEA) were relatively consistent in their morphology and orientation. In eight of 10 specimens, SEA perforators with extensive anatomical "territories" orientated toward the umbilicus were present. These SEA perforators pierced the rectus sheath within 4 cm of the costal margin and were present bilaterally in seven of eight specimens. The unpredictable orientation and course of DIEA perforators indicate that the blood supply of abdominal perforator flaps, raised without clear knowledge of their unique vascular anatomy, may often be more random than axial. This may account for much of the ischemia-related morbidity observed with DIEA-based perforator flaps. Preservation of SEA perforators adjacent to the costal margin during abdominoplasty will likely improve abdominal wall perfusion and reduce donor-site morbidity.

  13. Gravity-dependent nystagmus and inner-ear dysfunction suggest anterior and posterior inferior cerebellar artery infarct.

    Science.gov (United States)

    Shaikh, Aasef G; Miller, Benjamin R; Sundararajan, Sophia; Katirji, Bashar

    2014-04-01

    Cerebellar lesions may present with gravity-dependent nystagmus, where the direction and velocity of the drifts change with alterations in head position. Two patients had acute onset of hearing loss, vertigo, oscillopsia, nausea, and vomiting. Examination revealed gravity-dependent nystagmus, unilateral hypoactive vestibulo-ocular reflex (VOR), and hearing loss ipsilateral to the VOR hypofunction. Traditionally, the hypoactive VOR and hearing loss suggest inner-ear dysfunction. Vertigo, nausea, vomiting, and nystagmus may suggest peripheral or central vestibulopathy. The gravity-dependent modulation of nystagmus, however, localizes to the posterior cerebellar vermis. Magnetic resonance imaging in our patients revealed acute cerebellar infarct affecting posterior cerebellar vermis, in the vascular distribution of the posterior inferior cerebellar artery (PICA). This lesion explains the gravity-dependent nystagmus, nausea, and vomiting. Acute onset of unilateral hearing loss and VOR hypofunction could be the manifestation of inner-ear ischemic injury secondary to the anterior inferior cerebellar artery (AICA) compromise. In cases of combined AICA and PICA infarction, the symptoms of peripheral vestibulopathy might masquerade the central vestibular syndrome and harbor a cerebellar stroke. However, the gravity-dependent nystagmus allows prompt identification of acute cerebellar infarct. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Iodine-123 IMP SPECT before and after bypass surgery in a patient with occlusion of left anterior and middle cerebral arteries with basal abnormal telangiectasis (unilateral Moyamoya disease)

    International Nuclear Information System (INIS)

    Honda, Norinari; Machida, Kikuo; Takishima, Teruo; Kaizu, Hiroyuki; Sugimoto, Eiichi

    1987-01-01

    A case of left anterior and middle cerebral arterial occlusion with angiographic features similar to Moyamoya disease was reported. IMP SPECT of the patient revealed the success of bypass surgery clearly. The patient complained of transient right hemiparesis with aphasia 4 times. The cerebral arteriography disclosed occlusions of left anterior and middle cerebral arteries at their proximal portions. Right internal carotid and its branches were normal. I-123 IMP SPECT study showed hypoperfusion in left temporal lobe, basal ganglia with incomplete reperfusion on the delayed (4 hours after injection) SPECT images. After the superficial temporal-middle cerebral artery anastomosis, I-123 IMP SPECT showed improvement of the brain blood flow. I-123 IMP SPECT was very useful in detecting the ischemic areas and evaluating the revascularizing surgery in this case. (author)

  15. External iliac artery thrombus masquerading as sciatic nerve palsy in anterior column fracture of the acetabulum

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    Narender Kumar Magu

    2015-01-01

    Full Text Available We report a case of ischemic neuropathy of the sciatic nerve in a patient with an anterior column fracture of the acetabulum operated by ilioinguinal approach. It resulted from occlusion of the blood supply to the sciatic nerve. There were no signs of a vascular insult until ischemic changes ensued on the 6 th postoperative day on the lateral part of great toe. The patient underwent crossover femoro-femoral bypass grafting and there was a complete reversal of the ischemic changes at 6 months. The sciatic nerve palsy continued to recover until the end of 1 year; by which time the only deficit was a Grade 4 power in the extensor hallucis longus (EHL and the extensor digitorum longus (EDL. There was no further recovery at 2 years followup.

  16. Aortic arch origin of the left vertebral artery: An Anatomical and Radiological Study with Significance for Avoiding Complications with Anterior Approaches to the Cervical Spine.

    Science.gov (United States)

    Tardieu, Gabrielle G; Edwards, Bryan; Alonso, Fernando; Watanabe, Koichi; Saga, Tsuyoshi; Nakamura, Moriyoshi; Motomura, Mayuko; Sampath, Raghuram; Iwanaga, Joe; Goren, Oded; Monteith, Stephen; Oskouian, Rod J; Loukas, Marios; Tubbs, R Shane

    2017-09-01

    Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811-816, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage?

    Science.gov (United States)

    Raja, Shahzad G; Benedetto, Umberto; Husain, Mubassher; Soliman, Rafik; De Robertis, Fabio; Amrani, Mohamed

    2014-10-01

    Despite their well-established advantages, bilateral internal thoracic arteries (BITA) are still largely underused. This is partly because of the technical complexities associated with the use of the right internal thoracic artery (RITA) to guarantee the universally accepted gold standard left internal thoracic artery (LITA) to left anterior descending artery (LAD) graft. The use of the in situ RITA for LAD grafting is a less technically demanding strategy. The impact of this strategy on early and late outcomes is investigated in the context of BITA usage. Among 1667 patients undergoing first-time isolated coronary artery bypass grafting using BITA, in situ RITA for LAD grafting was used in 546 patients compared with in situ LITA to LAD in 1121 patients. Propensity score matching was carried out to investigate the impact of in situ RITA to LAD on early and late outcomes including mortality and need for repeat revascularization. A total of 546 propensity matched pairs were available for comparison. In the propensity matched cohort, the mean follow-up time was 7.8±3.8 years. RITA to LAD did not increase the risk for late death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.48-1.26), the need for repeat revascularization (HR, 0.83; 95% CI, 0.70-2.42), and the composite of death or repeat revascularization (HR, 0.81; 95% CI, 0.64-1.14). Using in situ BITA with retrosternal in situ RITA for LAD grafting is a technically less demanding, safe, and effective strategy that can increase usage of BITA by avoiding a composite graft configuration or technically challenging retrocaval routing of in situ RITA through the transverse sinus. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  18. Relationship between intravascular ultrasound parameters and fractional flow reserve in intermediate coronary artery stenosis of left anterior descending artery: intravascular ultrasound volumetric analysis.

    Science.gov (United States)

    Yang, Hyoung-Mo; Tahk, Seung-Jea; Lim, Hong-Seok; Yoon, Myeong-Ho; Choi, So-Yeon; Choi, Byoung-Joo; Jin, Xiong Jie; Hwang, Gyo-Seung; Park, Jin-Sun; Shin, Joon-Han

    2014-02-15

    The objective of this study was to assess the relationship between intravascular ultrasound (IVUS) parameters, including volumetric analysis, and fractional flow reserve (FFR). Although it is known that coronary atherosclerosis burden measured by IVUS volumetric analysis is related with clinical outcomes, its relationship with functional significance remains unknown. Both IVUS and FFR were performed in 206 cases of intermediate stenosis of the left anterior descending artery (LAD). Myocardial ischemia was assessed by FFR and maximal hyperemia was induced by continuous intracoronary adenosine infusion. FFR  0.80 were associated with larger plaque volume (181.8 ± 82.3 vs. 125.9 ± 77.9 mm3, P < 0.001) and PAV (58.9 ± 5.6 vs. 53.8 ± 7.9%, P < 0.001). IVUS parameters representing severity and extent of atheromatous plaque correlated with functional significance in LAD lesions with intermediate stenosis.

  19. Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases

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    Hensler, Johannes; Jensen-Kondering, Ulf; Jansen, Olav [University Hospital Schleswig-Holstein (UKSH), Department of Radiology and Neuroradiology, Kiel (Germany); Ulmer, Stephan [Medical Radiological Institute, Neuroradiology, Zurich (Switzerland)

    2016-10-15

    Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought. This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature. Additionally, own observations in three recent representative cases are discussed. Overall, 80 cases from recent literature were included to the meta-analysis. The median age was 51 (35-82) years. Ischemia alone was described in 58 cases (73 %), subarachnoid hemorrhage (SAH) in 8 cases (10 %), and a combination of both in 14 cases (17 %). Radiological diagnosis including use of thin-layered 3T-MRI vessel wall imaging with black blood technique was verified by double lumen, by a string sign or string and pearl sign, or by a vessel wall hematoma in 23 (32 %), 62 (89 %), and 14 (20 %) cases, respectively. Interventional or surgical treatment was performed in 7 cases. A good clinical recovery was achieved in 77 % of cases. Dissections of the ACA mostly cause ischemia, but can cause SAH or a combination of both in a relatively young population. Detailed neuroradiological diagnosis including 3T-MRI vessel wall imaging is required as a double lumen, isolated stenosis due to vessel wall hematoma, or the secondary development of a pseudoaneurysm might occur. Interventional therapy is the primary therapy for these vascular complications. (orig.)

  20. Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases

    International Nuclear Information System (INIS)

    Hensler, Johannes; Jensen-Kondering, Ulf; Jansen, Olav; Ulmer, Stephan

    2016-01-01

    Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought. This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature. Additionally, own observations in three recent representative cases are discussed. Overall, 80 cases from recent literature were included to the meta-analysis. The median age was 51 (35-82) years. Ischemia alone was described in 58 cases (73 %), subarachnoid hemorrhage (SAH) in 8 cases (10 %), and a combination of both in 14 cases (17 %). Radiological diagnosis including use of thin-layered 3T-MRI vessel wall imaging with black blood technique was verified by double lumen, by a string sign or string and pearl sign, or by a vessel wall hematoma in 23 (32 %), 62 (89 %), and 14 (20 %) cases, respectively. Interventional or surgical treatment was performed in 7 cases. A good clinical recovery was achieved in 77 % of cases. Dissections of the ACA mostly cause ischemia, but can cause SAH or a combination of both in a relatively young population. Detailed neuroradiological diagnosis including 3T-MRI vessel wall imaging is required as a double lumen, isolated stenosis due to vessel wall hematoma, or the secondary development of a pseudoaneurysm might occur. Interventional therapy is the primary therapy for these vascular complications. (orig.)

  1. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia.

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    Matthias Gawlitza

    Full Text Available To assess FLAIR vascular hyperintensities (FVH and dynamic (4D angiograms derived from perfusion raw data as proposed magnetic resonance (MR imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA.Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified.Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9 ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7 ml. FVH were observed in 26/41 (63.4% hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01 absolute (ρ = 0.37; P<0.05 and relative mismatch volume (ρ = 0.35; P<0.05. The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01 and positively with relative mismatch (ρ = 0.29; P< 0.05. ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001 and TTP lesion volumes (P<0.05. No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32.FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.

  2. Management of anterior inferior cerebellar artery aneurysms: endovascular treatment and clinical outcome.

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    Suh, S H; Kim, D J; Kim, D I; Kim, B M; Chung, T-S; Hong, C K; Jung, J Y

    2011-01-01

    AICA aneurysms are rare and a challenge to treat surgically. We present our experience of the angiographic results and the clinical outcomes for 9 AICA aneurysms treated by EVT. Between 1997 and 2009, EVT was attempted for 9 AICA aneurysms. Six patients presented with SAH, and 3 aneurysms were found incidentally. The location of the aneurysms was the proximal AICA in 7 and the distal AICA in 2. Five aneurysms originated from an AICA-PICA variant. Clinical outcomes and procedural complications were evaluated, and angiography was performed 6, 12, and 24 months after embolization to confirm recanalization of the coiled aneurysm. EVT was technically successful in 7 patients (78%). Surgical trapping was performed in 1 patient after failure of EVT, and another aneurysm occluded spontaneously, along with the parent artery during EVT. In 7 patients, the AICAs had good patency on postoperative angiography. Stent-assisted coiling was performed in 3 patients. Follow-up angiographies were performed in 7 patients and showed no evidence of recanalization or progressive occlusion with further thrombosis except in 1 patient. There was no evidence of aneurysm rupture during the follow-up period, and 8 patients were able to perform all usual activities (mRS score, 0-1). EVT may provide a feasible and safe option as an alternative, though a microsurgical option is initially considered for the management of AICA aneurysms. Further follow-up and more experience are also necessary.

  3. Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery.

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    Nassar, Yasser; Boudou, Nicolas; Carrie, Didier

    2013-04-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending coronary artery (LAD) specifically is associated with improved long-term 5 years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity. We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. The study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators' initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire (GW) as a simple technique. A total of 30 patients with 30 LAD CTO lesions (100%) were recorded. Mean age was 71.6 + 15 years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients. Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions (83% of total cases), while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction (MI), stent thrombosis, stroke, emergency coronary artery bypass graft (CABG), major bleeding, radiation dermatitis, cardiac tamponade or clinical

  4. Angiographic Assessment of the Right Hepatic Artery for Encasement by Hilar Cholangiocarcinoma: Comparison Between Antero-Posterior and Right Anterior Oblique Projections

    International Nuclear Information System (INIS)

    Furukawa, Hiroyoshi; Iwata, Ryoko; Moriyama, Noriyuki

    2001-01-01

    Purpose: To evaluate the usefulness of right anterior oblique (RAO) arteriography for evaluating encasement of the right hepatic artery (RHA) by hilar cholangiocarcinoma.Methods: Celiac arteriography was performed in both the antero-posterior (AP) and RAO projection in ten patients with cholangiocarcinoma. The lengths of the arteries between the bifurcation of the anterior and posterior branch of the liver and the following points were measured: (a) the bifurcation of the left and right hepatic artery (AP-LR), (b) the bifurcation of the proper hepatic artery and the gastroduodenal artery (AP-PG). Additionally, image quality in investigating the invasion of the RHA was evaluated.Results: On the AP images, the average lengths of AP-LR and AP-PG were 24.5 ± 5.1 mm and 30.0 ± 4.9 mm, respectively. On RAO images, the lengths were 28.2 ± 4.6 mm and 32.7 ± 4.8 mm, respectively. Every length was different between the two projections (p < 0.01). In 6 of 10 patients with hilar cholangiocarcinoma, images in RAO projections were superior to AP images for evaluation of encasement.Conclusion: We conclude that angiography obtained in the RAO projection yields images that are superior to those obtained in the conventional AP projection for assessment of RHA encasement

  5. Anterior Transposition of Anomalous Tortuous Vertebral Artery Causing Cervical Radiculopathy: A Report of 2 Cases and Review of Literature.

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    Wang, Doris D; Burkhardt, Jan-Karl; Magill, Stephen T; Lawton, Michael T

    2017-05-01

    Cervical radiculopathy secondary to compression from vertebral artery (VA) tortuosity is a rare entity. We describe successful transposition through an anterolateral approach of tortuous VA loops causing cervical radiculopathy. Two patients with cervical radiculopathy (first case at C5-6 and second case at C3-4) secondary to anomalous VA loop compression underwent anterolateral approaches to the cervical spine for decompression and VA transposition. The anterior transverse foramina were drilled to unroof the VA loop, which was dissected free from the exiting nerve root. In both cases, the affected cervical nerve root was successfully decompressed with both radiographic and clinical improvements in radiculopathy symptoms. We found 8 other cases of VA transposition via either an anterolateral approach or a posterolateral approach described in the literature. Our second case of anterolateral VA transposition at the C3-4 level is the first case at this level and the highest level reported in the literature. Decompression using an anterolateral approach with direct microvascular transposition of the VA is a safe and effective treatment of this pathology and addresses the cause of radiculopathy more directly than the posterolateral approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Ocular torsion associated with infarction in the territory of the anterior inferior cerebellar artery: frequency, pattern, and a major determinant.

    Science.gov (United States)

    Lee, Hyung; Yi, Hyon-Ah; Lee, Seong-Ryong; Lee, Se-Youp; Park, Byung-Rim

    2008-06-15

    Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) can cause the vestibular dysfunction in the roll plane of the vestibuloocular reflex with abnormal ocular torsion (OT). There has been no systemic study that carefully investigates the nature of OT that occurs with AICA infarction. To investigate the frequency, the characteristic patterns of OT associated with AICA territory infarction, and the crucial site for determining the direction of OT in AICA territory infarction. We studied 12 consecutive cases of infarction in the territory of the AICA diagnosed by brain MRI. Fundus photography, prism cover test, and subjective visual vertical tilting test were performed to evaluate the function of the otolith system. Pure tone audiogram was also performed to evaluate the function of the auditory system. Nine (75%) of 12 patients exhibited pathological ocular torsion (OT). Two types of pathological OT were found: ipsiversive OT accompanying skew deviation (n=6), and contraversive OT only (n=3). Six patients with ipsiversive OT with skew deviation showed an audiovestibular loss with canal paresis and hearing loss ipsilaterally whereas three patients with contraversive OT without skew deviation had a normal audiovestibular response. In all cases with pathological OT, the direction of the subjective visual vertical tilt corresponded to the direction of the OT. Our findings emphasize that the peripheral vestibular structure with inner ear probably plays a crucial role in determining the direction of OT associated with AICA territory infarction.

  7. Cochleovestibular Nerve Compression Syndrome Caused by Intrameatal Anterior Inferior Cerebellar Artery Loop: Synthesis of Best Evidence for Clinical Decisions.

    Science.gov (United States)

    Esposito, Giacomo; Messina, Raffaella; Carai, Andrea; Colafati, Giovanna Stefania; Savioli, Alessandra; Randi, Franco; De Benedictis, Alessandro; Cossu, Silvia; Fontanella, Marco Maria; Marras, Carlo Efisio

    2016-12-01

    Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic to systematically present the best available evidence to guide clinical decisions. We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA)-cochleovestibular nerve neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's College guidelines. We found 35 studies of neurovascular compression of the cochleovestibular nerve by AICA for 536 patients operated on to resolve their neurovascular conflict. Only 4 of these studies describe intrameatal AICA neurovascular conflicts, for 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted of microsurgical mobilization of the AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery. Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long-term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and exercise thallium scintigraphy

    International Nuclear Information System (INIS)

    Reiber, J.H.C.; Serruys, P.W.; Slager, C.J.; Erasmus Univ., Rotterdam

    1986-01-01

    In order to evaluate during cardiac catheterization what constitutes a physiologically significant obstruction to blood flow in the human coronary system, computer based quantitative analysis of coronary angiograms was performed in 31 patients with isolated proximal left anterior descending coronary artery disease. The angiographic severity of the stenosis was compared with the transstenotic pressure gradient measured with the dilatation catheter during angioplasty and the results of exercise thallium scintigraphy. A curvilinear relation was found between the pressure gradient across the stenosis (normalized for the mean aortic pressure) and the residual minimal obstruction area (after subtracting the area of the angioplasty catheter). This relation was best fitted by the equation: normalized mean pressure gradient = a + b · log [obstruction area], r = 0.74. The measurements of the percent area stenosis (cut-off 80%) and of the transstenotic pressure gradient (cut-off 0.30) obtained at rest, correctly predicted the occurrence of thallium perfusion defects induced by exercise in 83% of the patients. (Auth.)

  9. Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and results of exercise thallium scintigraphy

    International Nuclear Information System (INIS)

    Wijns, W.; Serruys, P.W.; Reiber, J.H.; van den Brand, M.; Simoons, M.L.; Kooijman, C.J.; Balakumaran, K.; Hugenholtz, P.G.

    1985-01-01

    To evaluate, during cardiac catheterization, what constitutes a physiologically significant obstruction to blood flow in the human coronary system, computer-based quantitative analysis of coronary angiograms was performed on the angiograms of 31 patients with isolated disease of the proximal left anterior descending coronary artery. The angiographic severity of stenosis was compared with the transstenotic pressure gradient measured with the dilation catheter during angioplasty and with the results of exercise thallium scintigraphy. A curvilinear relationship was found between the pressure gradient across the stenosis (normalized for the mean aortic pressure) and the residual minimal area of obstruction (after subtracting the area of the angioplasty catheter). This relationship was best fitted by the equation: normalized mean pressure gradient . a + b . log [obstruction area], r . .74. The measurements of the percent area of stenosis (cutoff 80%) and of the transstenotic pressure gradient (cutoff 0.30) obtained at rest correctly predicted the occurrence of thallium perfusion defects induced by exercise in 83% of the patients

  10. Anatomia endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study

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    Bernardo Cunha Araujo Filho

    2006-06-01

    Full Text Available INTRODUÇÃO: a artéria etmoidal anterior (AEA é um importante ponto de reparo anatômico para localização do seio frontal e da base de crânio. Entretanto, apesar de diversos estudos endoscópicos em cadáveres, ainda não temos um estudo anatômico sobre AEA na população ocidental. OBJETIVOS: Determinar pontos de reparo para localização da artéria, estudar sua relação com a base do crânio e grau de deiscência, assim como variações intra e interindividuais. CASUÍSTICA E MÉTODOS: Foram realizadas dissecções das fossas nasais em 25 cadáveres. RESULTADOS: O comprimento médio do trajeto intranasal da artéria etmoidal anterior foi de 5,82mm. O canal etmoidal anterior apresentou algum grau de deiscência em 66,7%. A distância média do ponto médio da artéria à espinha nasal anterior foi de 61,72mm (dp = 4,18mm; à axila nasal foi de 64,04mm (dp = 4,69mm; e à axila anterior do corneto médio foi de 21,14mm (dp = 3,25mm. Para todas as medidas, não houve diferença estatisticamente significativa quando comparados os lados direito e esquerdo (p>0,05. CONCLUSÕES: Concluímos que a axila da concha média é o ponto de reparo mais confiável para a localização da AEA.INTRODUCTION: The anterior ethmoidal artery (AEA is an important point of anatomical reference in order to locate the frontal sinus and the skull base. Notwithstanding, despite numerous endoscopic studies in cadavers, we still lack an anatomical study on the AEA in the western population. AIM: to determine reference points used to locate the artery, study its relationship with the skull base and its degree of dehiscence, as well as to study intra and inter individual variations. MATERIALS AND METHODS: we dissected the nasal fossae belonging to 25 cadavers. RESULTS: the average intranasal length of the anterior ethmoidal artery was 5.2 mm. The anterior ethmoidal canal presented some degree of dehiscence in 66.7%. The average distance between the artery middle point

  11. Pseudoaneurysm of the Anterior Tibial Artery following Tibio-Talar-Calcaneum Fusion with a Retrograde Nail: A Rare Case and Literature Review

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    Simon Craxford

    2013-01-01

    Full Text Available This study reports the case of an 87-year-old woman who presented with a nonresolving haematoma 13 weeks following tibiotalar arthrodesis surgery on her right ankle using a retrograde nail. This was revealed by angiography to be a pseudoaneurysm of the anterior tibial artery. The patient subsequently underwent endovascular stenting of the pseudoaneurysm and has had a successful recovery. This case highlights the need for awareness of both the normal arterial supply to the leg and ankle as well as the potential for anatomical variations. Arterial variation may be as high as 6.7% based on published findings from cadaveric studies. As pseudoaneurysm is a rare complication, a high index of suspicion is needed in order to avoid a missed or delayed diagnosis. We urge surgeons to keep in mind the potential for pseudoaneurysm when a patient presents with a nonresolving haematoma and arrange appropriate further investigations as needed.

  12. Guidewires used in first intentional single wiring strategy for chronic total occlusions of the left anterior descending coronary artery.

    Science.gov (United States)

    Nassar, Yasser S; Boudou, Nicolas; Dumonteil, Nicolas; Lhermusier, Thibault; Carrie, Didier

    2013-04-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending (LAD) specifically is associated with improved long-term 5 year survival as compared to PCI failure. The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. A total of 30 patients with LAD CTO lesions (100%), were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW) success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases) while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%), 36% were Soft Non Tapered Pilot 50 (28%), whisper (8%), while 16% were Stiff Non tapered GWs; Miracle 12 (8%), Miracle 6 (4%), Miracle 3 (4%), and 4% were Stiff Tapered GWs; Progress 200 (4%). Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.

  13. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

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    Bendel, Paula; Koskenkorva, Paeivi; Vanninen, Ritva [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Koivisto, Timo; Aeikiae, Marja [Kuopio University Hospital and University of Kuopio, Department of Neurosurgery, Kuopio (Finland); Niskanen, Eini [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Physics, Kuopio (Finland); Koenoenen, Mervi [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Clinical Neurophysiology, Kuopio (Finland); Haenninen, Tuomo [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland)

    2009-11-15

    Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm. Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment. The comparisons between controls and either all patients (n=37) or the subgroup of surgically treated patients (n=17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment. Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms. (orig.)

  14. Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

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    Praisy Joy

    2017-01-01

    Full Text Available Introduction: Injury to the inferior epigastric artery (IEA has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. Materials and Methods: Sixty IEAs of 30 adult cadavers (male = 19; female = 11 were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS and umbilicus. Results: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32% of the distance between the midline and the sagittal plane through ASIS at all levels. Conclusion: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD] away from the midline (or slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains.

  15. Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

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    McAteer Eamon

    2005-10-01

    Full Text Available Abstract Background Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. Case presentation A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. Conclusion Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients.

  16. Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

    Science.gov (United States)

    Marron, Conor D; McKay, Damian; Johnston, Ruth; McAteer, Eamon; Stirling, WJ Ivan

    2005-01-01

    Background Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. Case presentation A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. Conclusion Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients. PMID:16225679

  17. Anterior communicating artery aneurysm clipping versus coiling: a comparative study of 50 cases

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    Kumar Pradeep

    2017-09-01

    Full Text Available Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH remains a devastating and often fatal form of stroke. The aneurysm is targeted for obliteration to prevent re-bleeding and to manage the possible complications from the event. Endovascular coiling has emerged as a less invasive alternative to conventional surgical clipping to treat aneurysms.

  18. Non-functioning posterior communicating arteries of circle of Willis in idiopathic sudden hearing loss.

    Science.gov (United States)

    De Felice, C; De Capua, B; Tassi, R; Mencattini, G; Passàli, D

    2000-10-07

    Most cases of sudden hearing loss have no identifiable cause. A link between compensatory blood flow through the circle of Willis and recovery from sudden hearing loss has, however, been suggested. We assessed 22 patients with sudden hearing loss who had no cerebrovascular disease, and 41 controls matched for age and sex. We took ultrasonographic doppler flow measurements of the extracranial carotid and vertebrobasilar systems and independent audiological measurements. 12 patients with sudden hearing loss, compared with four controls had bilateral non-functioning posterior communicating arteries (p=0.00019). Our findings suggest a strong association between a non-functioning posterior communicating artery of the circle of Willis and sudden hearing loss.

  19. Arterialização seletiva da veia interventricular anterior: opção de revascularização miocárdica Selective arterialization of the anterior interventricular vein: a choice for myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Kubrusly

    1992-12-01

    Full Text Available O objetivo deste trabalho é referir dois casos cirúrgicos, onde, após ressecção de aneurisma de ventrículo esquerdo, a revascularização do miocárdio através da artéria interventricular anterior (AIA não foi possível. Utilizando-se a artéria torácica interna (ATI esquerda, optou-se pela anatomose com a veia interventricular anterior (VIA com ligadura próxima, para estabelecimento do fluxo retrógrado e evitar a formação de fístula artenovenosa. Não houve mortalidade e os resultados a curto prazo são encorajadores. Testes de perfusão miocárdica com radioisótopos no pré e no pós-operatório, assim como angiografia do sistema coronário e da artéria torácica interna esquerda pré e pós-operatória são apresentados e discutidos. O objetivo da cirurgia de aneurisma ventricular é a recomposição geométrica do ventrículo esquerdo e revascularização de possíveis áreas isquémicas. Na impossibilidade de revascularização direta da artéria interventricular anterior, a técnica citada demonstra ser facilmente exeqüível e, a curto prazo, com bons resultados.The purpose of this study is to report two surgical cases, whereby after the repair of the left ventricular aneurysm, the myocardial revascularization of the interventricular anterior artery (IAA was not possible. Using the left internal thoracic artery it was decided to perform anastomosis with the interventricular anterior (IAA and its cephalad ligation, in order to obtain a retrograde flow and to avoid an arteriovenous fistula formation. There was no mortality and the results are optimistic in a short follow-up of these two patients. Myocardial perfusion tests and pre and post-operative angiography of the coronary system and the left internal thoracic artery are assessed and discussed. The geometrical reconstruction of the left ventricle and the revascularization of the ischemic areas play major role in the repair of postinfarction ventricular aneurysm. When it

  20. Large Posterior Communicating Artery Aneurysm: Initial Presentation with Reproducible Facial Pain Without Cranial Nerve Deficit

    OpenAIRE

    Zelman, Stacie; Goebel, Michael C; Hawkins, Seth C

    2016-01-01

    Unruptured posterior communicating artery (PCOM) aneurysms can be difficult to diagnose and, when large (? 7mm), represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without...

  1. Accurate characterization of the main trunk of the anterior cerebral artery by means of intraoperative sononavigation with Doppler sonography: implications for brain tumor surgery.

    Science.gov (United States)

    Shinoura, Nobusada; Takahashi, Masamichi; Yamada, Ryozi

    2005-11-01

    Doppler sonography can be used for real-time intraoperative localization of arteries within or near brain tumors but is less useful for distinguishing between arteries with similar diameters, such as the main trunk and branches of the anterior cerebral artery (ACA). By contrast, sononavigation provides real-time information in alignment with magnetic resonance imaging scans and may be of use in characterizing the identity of individual arteries on Doppler sonographic images. The goal of this study was to determine whether sononavigation can distinguish the main trunk of the ACA from the branches of the ACA on Doppler sonographic images. Doppler sonography was used in 3 patients undergoing surgical resection of brain tumors involving the main trunk of the ACA. The location of the main trunk of the ACA was characterized by sononavigation. With these data, tumor resection was performed with preservation of the main trunk of the ACA. Gross total resection was achieved in 1 case. Intraoperative sononavigation with Doppler sonography accurately localized the main trunk of the ACA and enabled preservation of this structure during tumor resection. This method may be applicable to the characterization of other critical arteries and may allow tumor resection with decreased morbidity.

  2. Congenital absence of the internal carotid artery and the basilar artery with persistent trigeminal artery associated with coarctation of the aorta

    Energy Technology Data Exchange (ETDEWEB)

    Jaeger, H.J.; Mehring, U.M.; Gissler, H.M.; Mathias, K.D. [Dept. of Diagnostic Radiology, Staedtische Kliniken Dortmund (Germany); Dept. of Radiology and MicroTherapy, Univ. of Witten/Herdecke (Germany)

    2000-11-01

    We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. The left cerebral vessels are supplied via the anterior communicating artery and the left persistent trigeminal artery. The coexisting coarctation of the aorta led to a subclavian steal phenomenon. The alteration of the cerebral hemodynamics has to be taken in consideration when performing cerebral angiography and surgical correction in such a case. (orig.)

  3. Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine.

    Science.gov (United States)

    Nagahama, K; Sudo, H; Abumi, K; Ito, M; Takahata, M; Hiratsuka, S; Kuroki, K; Iwasaki, N

    2014-04-01

    We investigated the incidence of anomalies in the vertebral arteries and Circle of Willis with three-dimensional CT angiography in 55 consecutive patients who had undergone an instrumented posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications. The frequency of congenital anomalies was 30.9%, abnormal vertebral artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in 41.8% of patients and bilaterally in 38.2%. Variations in the vertebral arteries and Circle of Willis were not significantly related to the presence or absence of posterior communicating arteries. Importantly, 18.2% of patients showed characteristic variations in the Circle of Willis with unilateral vertebral artery stenosis or a dominant vertebral artery, indicating that injury may cause lethal complications. One patient had post-operative cerebellar symptoms due to intra-operative injury of the vertebral artery, and one underwent a different surgical procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle of Willis is essential if a posterior spinal fusion with instrumentation is to be carried out safely.

  4. Relationship between anterior inferior cerebellar artery and facial-vestibulocochlear nerve complex: an anatomical and magnetic resonance images correlation study.

    Science.gov (United States)

    Yurtseven, T; Savaş, R; Koçak, A; Turhan, T; Aktaş, E O; Işlekel, S

    2004-10-01

    For the successful microneurosurgical treatment of CP angle located pathologies, an understanding of the relationship and variations between neural and vascular structures and a certain diagnosis are the most valuable factors for surgeons. CP angle lesions have now become a visible area by advances in magnetic resonance imaging (MRI) technology. An evaluation of this area and the decision for a neurosurgical decompression procedure are easier than before. Twenty unfixed adult human cadaver specimens, that have no sign of central nervous system pathology, were obtained and dissected bilaterally at routine autopsy. The facial-vestibulocochlear (VII - VIIIth) nerve complex and the anterior inferior cerebellar artery (AICA) were identified in all specimens. Thirteen of the 40 (32.5 %) AICA were situated ventrally and fourteen (35 %) were located dorsally to the VII - VIIIth nerve complex. Thirteen (32.5 %) passed between the VIIth and the VIIIth nerve fibers. Five of the 40 (12.5 %) AICA had a loop near the nerve complex and then passed the nerves ventrally or dorsally. In an MRI study 74 adult persons (148 sides) were investigated by using three-dimensional Fourier transformation constructive interference in the steady state technique (3D FT-CISS) on a 1.5 Tesla MRI system (Siemens Magnetom, Erlangen, Germany). The results were as follows; 48 AICA (32.4 % of all 148 AICA) were situated ventrally to the VII-VIIIth nerve complex, 45 AICA (30.4 %) were situated dorsally to the VII-VIIIth nerve complex, and the AICA passed between the VIIth and VIIIth nerves in 51 samples (34.5 %). In four of the 148 CP angles (2.7 %), the AICA was not identified. There was an AICA loop coursing to the internal acoustic meatus in 15 patients (10.1 %). In this study, we examined the relations between VIIth and VIIIth nerve complex and the AICA in cadaver and MRI materials for an understanding of the value and reliability of the radiological data. This study also shows the anatomical

  5. Follow up CT of the patients who developed mental symptoms after direct operation of ruptured anterior communicating aneurysma

    International Nuclear Information System (INIS)

    Kitaoka, Kenichi; Nakagawa, Yoku; Abe, Hiroshi; Satoh, Masaharu; Miyasaka, Kazuo.

    1985-01-01

    The following conclusions were obtained from the analysis of CT findings of 26 cases with ruptured anterior communicating aneurysm showed postoperative mental symptoms. 1) Many cases with diffuse and symmetrical high density in subarachnoid spaces on CT in the acute stage, showed severe mental symptoms in the chronic stage. In particular, serious mental symptoms of the chronic stage were recognized in cases with high density in not only subarachnoid space but also in brain tissues and ventricles. 2) Mental symptoms of the chronic stage were severe in cases showed relatively large low density area and with low density in frontal lobe. (author)

  6. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  7. Intramedullary fixation of proximal humerus fractures: do locking bolts endanger the axillary nerve or the ascending branch of the anterior circumflex artery? A cadaveric study

    Directory of Open Access Journals (Sweden)

    Sermon An

    2008-12-01

    Full Text Available Abstract Background Proximal humerus fractures are one of the most common fractures. Intramedullary locked nailing is becoming a popular alternative treatment, especially for easier fracture patterns. Although axillary nerve injury has been reported, no study has compared the safety of the proximal locking options relative to the axillary nerve and the ascending branch of the anterior circumflex artery. Method Six different commercially available proximal humeral nails were implanted in 30 shoulders of 18 cadavers. After fluoroscopically guided implantation the shoulders were carefully dissected and the distance between the locking screws, the axillary nerve and the ascending branch of the anterior circumflex artery was measured. Results The course of the axillary nerve varies. A mean distance of 55.8 mm (SD = 5.3 between the lateral edge of the acromions and the axillary nerve at the middle of the humerus in a neutrally rotated position was observed. The minimum distance was 43.4 mm, the maximum 63.9 mm. Bent nails with oblique head interlocking bolts appeared to be the most dangerous in relation to the axillary nerve. The two designs featuring such a bend and oblique bolt showed a mean distance of the locking screw to the axillary nerve of 1 mm and 2.7 mm respectively Sirus (Zimmer® and (Stryker® T2 PHN (Proximal Humeral Nail. Regarding the ascending branch of the anterior circumflex artery, there was no difference between the nails which have an anteroposterior locking option. Conclusion It is of great importance for surgeons treating proximal humerus fractures to understand the relative risk of any procedure they perform. Since the designs of different nailing systems risk damaging the axillary nerve and ascending branch, blunt dissection, the use of protection sleeves during drilling and screw insertion, and individual risk evaluation prior to the use of a proximal humeral nail are advocated.

  8. The Comparison Between Two Surgical Methods for Left Internal Mammary Artery (LIMA) Anastomosis on Left Anterior Descending (LAD) Artery in Patients with Severe Diffuse Lesions: Short to Mid-Term Results.

    Science.gov (United States)

    Zarrabi, Khalil; Dehghani, Pooyan; Abdi Ardekani, Alireza; Zarrabi, Mohammad Amin; Zolghadrasli, Abdoali

    2015-01-01

    Coronary artery disease is the leading cause of death worldwide. In this study, we compared two surgical methods of left internal mammary artery (LIMA) anastomosis on left anterior descending (LAD) artery in patients with severe diffuse lesions. A total of 40 patients were included in our study and randomly assigned into two groups. In group A, after a long arteriotomy on LAD, the posterior surface of left internal mammary artery (LIMA) was opened by the same length and was anastomosed along the LAD course through normal and diseased parts. In group B instead of complete opening of LAD, a small arteriotomy was done only in areas where the wall of the vessel was nearly normal (especially the anterolateral wall), and LIMA was anastomosed to these areas in a sequential (Jump) method. The patients were then followed for post-operation results. The two groups showed equal results regarding early mortality, post-operation bleeding, and infection, pleural and pericardial effusion. There were two cases of myocardial infarction (MI) in group A with one mortality after 18 months, while no MI was reported in group B. Group B demonstrated significantly superior results regarding the rise in ejection fraction and the improvement in functional class. In this study it was demonstrated that diffuse coronary artery lesions of LAD should be preferably operated using LIMA with the sequential-jump anastomoses method and the surgeon should avoid long arteriotomy with single long anastomosis because of lower chance of long-term patency.

  9. The Comparison Between Two Surgical Methods for Left Internal Mammary Artery (LIMA Anastomosis on Left Anterior Descending (LAD Artery in Patients with Severe Diffuse Lesions: Short to Mid-Term Results.

    Directory of Open Access Journals (Sweden)

    Khalil Zarrabi

    2015-06-01

    Full Text Available Coronary artery disease is the leading cause of death worldwide. In this study, we compared two surgical methods of left internal mammary artery (LIMA anastomosis on left anterior descending (LAD artery in patients with severe diffuse lesions. A total of 40 patients were included in our study and randomly assigned into two groups. In group A, after a long arteriotomy on LAD, the posterior surface of left internal mammary artery (LIMA was opened by the same length and was anastomosed along the LAD course through normal and diseased parts. In group B instead of complete opening of LAD, a small arteriotomy was done only in areas where the wall of the vessel was nearly normal (especially the anterolateral wall, and LIMA was anastomosed to these areas in a sequential (Jump method. The patients were then followed for post-operation results. The two groups showed equal results regarding early mortality, post-operation bleeding, and infection, pleural and pericardial effusion. There were two cases of myocardial infarction (MI in group A with one mortality after 18 months, while no MI was reported in group B. Group B demonstrated significantly superior results regarding the rise in ejection fraction and the improvement in functional class. In this study it was demonstrated that diffuse coronary artery lesions of LAD should be preferably operated using LIMA with the sequential-jump anastomoses method and the surgeon should avoid long arteriotomy with single long anastomosis because of lower chance of long-term patency.

  10. A Case of Ruptured Peripheral Aneurysm of the Anterior Inferior Cerebellar Artery Associated with an Arteriovenous Malformation : A Less Invasive Image-Guided Transcortical Approach

    Science.gov (United States)

    Lee, Seung Hwan; Bang, Jae Seung; Kim, Gook Ki

    2009-01-01

    A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases. PMID:20062576

  11. Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death.

    Science.gov (United States)

    Takahashi, Yoichiro; Sano, Rie; Takahashi, Keiko; Kominato, Yoshihiko; Takei, Hiroyuki; Kobayashi, Susumu; Shimada, Takehiro; Tokue, Hiroyuki; Awata, Sachiko; Hirasawa, Satoshi

    2016-03-01

    A 40-year-old man was found dead on a sidewalk in an expressway parking area one hour after he had entered the area on a motorcycle. A medicolegal autopsy was performed to reveal the cause of this sudden and unexpected death. Postmortem coronary CT angiography after introduction of 5% gelatin-barium emulsion as a radiopaque contrast medium into the heart demonstrated a significant arterial luminal filling defect in the left anterior descending (LAD) coronary artery. Macroscopic and microscopic examinations revealed that a thrombus had become deposited on ruptured plaque within the LAD artery, and that a small amount of the contrast medium was present between the thrombus and the vessel endothelium. These histological findings were consistent with incomplete occlusion of the LAD artery in the 3D reconstructed image. The cause of death in this case was definitively determined to be ischemic heart disease. Postmortem angiography played a role in screening of a vascular lesion that was subsequently verified by histology to have been responsible for sudden and unexpected death. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. The blood flow in the posterior communicant artery. Angiographic study by using magnetic resonance

    CERN Document Server

    Portela, L A P

    1995-01-01

    did not change the direction of flow present, in the circumstances of this study. The arterial circle of Willis is the most important collateral pathway for the cerebral vessels when one the afferents is occluded. Its normal function, without vascular compromise, has been considered in conflicting ways in the literature. For centuries after its description by Thomas Willis in 1664 it was considered a flow equalizer, with free admixture of blood within it. Since the beginning of this century the dominant view is one of a potential value only, with null effective flow in the communicating arteries. The premise is included in different experimental models. Alternatively, it was considered that the normal direction of flow is antero-posterior, from carotid to posterior cerebral, since carotid flow is greater. Using phase-contrast magnetic resonance angiography, a non-invasive qualitative method, it was found in 40 patients without morphological brain abnormality and in 10 healthy volunteers that flow can be seen ...

  13. Relationship between the morphology of A-1 segment of anterior ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... Department of Neurosurgery, Nanfang Hospital, 1838 Guang zhou Dadao Road, Guangzhou 510515, China. Abstract: Background: The anterior communicating artery (ACoA) is one of the most frequent sites for cerebral aneurysm. The peculiar directions of projection of aneurysms offer great challenges to ...

  14. Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with {sup 99m}Tc-MAA accumulation in the anterior abdominal wall?

    Energy Technology Data Exchange (ETDEWEB)

    Ahmadzadehfar, Hojjat; Sabet, Amir; Muckle, Marianne; Haslerud, Torjan; Biersack, Hans Juergen; Ezziddin, Samer [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); Moehlenbruch, Markus; Meyer, Carsten; Wilhelm, Kai; Schild, Hans Heinz [University Hospital Bonn, Department of Radiology, Bonn (Germany)

    2011-08-15

    While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in {sup 99m}Tc-macroaggregated albumin ({sup 99m}Tc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of {sup 99m}Tc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours. A total of 224 diagnostic hepatic angiograms combined with {sup 99m}Tc-MAA SPECT/CT were acquired in 192 patients with different types of cancer, of whom 142 were treated with a total of 214 radioembolization procedures. All patients received a whole-body scan, and planar and SPECT/CT scans of the abdomen. Only patients with extrahepatic {sup 99m}Tc-MAA accumulation in the anterior abdominal wall were included in this study. Posttreatment bremsstrahlung SPECT/CT and follow-up results for at least 3 months served as reference standards. Tracer accumulation in the anterior abdominal wall was present in pretreatment {sup 99m}Tc-MAA SPECT/CT images of 18 patients (9.3%). The HFA was found and embolized by radiologists before treatment in one patient. In the remaining patients radioembolization was performed without any modification in the treatment plan despite the previously mentioned extrahepatic accumulation. Only one patient experienced abdominal muscle pain above the navel, which started 24 h after treatment and lasted for 48 h without any skin changes. The remaining patients did not experience any relevant side effects during the follow-up period. Side effects after radioembolization in patients with tracer accumulation in the

  15. Evaluation of Anterior Ethmoidal Artery by 320-Slice CT Angiography with Comparison to Three-Dimensional Spin Digital Subtraction Angiography: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Juan; Sun, Gang; Yu, Bling Bing; Li, Min; Li, Guo Ying; Peng, Zhao Hui; Zhang, Xu Ping [Dept. of Medical Imaging, Jinan Military General Hospital, Jinan (China); Lu, Yang [Dept. of Radiology, University of Illinois College of Medicine, Illinois (United States)

    2012-11-15

    To explore the usefulness of 320-slice CT angiography (CTA) for evaluating the course of the anterior ethmoidal artery (AEA) and its relationship with adjacent structures by using three-dimensional (3D) spin digital subtraction angiography (DSA) as standard reference. From December 2008 to December 2010, 32 patients with cerebrovascular disease, who underwent both cranial 3D spin DSA and 320-slice CTA within a 30 day period from each other, were retrospectively reviewed. AEA course in ethmoid was analyzed in DSA and CTA. In addition, adjacent bony landmarks (bony notch in medial orbital wall, anterior ethmoidal canal, and anterior ethmoidal sulcus) were evaluated with CTA using the MPR technique oriented along the axial, coronal and oblique coronal planes in all patients. The dose length product (DLP) for CTA and the dose-area product (DAP) for 3D spin DSA were recorded. Effective dose (ED) was calculated. The entire course of the AEA was seen in all 32 cases (100%) with 3D spine DSA and in 29 of 32 cases (90.1%) with 320-slice CTA, with no significant difference (p = 0.24). In three cases where AEA was not visualized on 320-slice CTA, two were due to the dominant posterior ethmoidal artery, while the remaining case was due to diminutive AEA. On MPR images of 320-slice CT, a bony notch in the orbital medial walls was detected in all cases (100%, 64 of 64); anterior ethmoidal canal was seen in 28 of 64 cases (43.8%), and the anterior ethmoidal sulcus was seen in 63 of 64 cases (98.4%). The mean effective dose in CTA was 0.6 {+-} 0.25 mSv, which was significantly lower than for 3D spin DSA (1.3 {+-} 0.01 mSv) (p < 0.001). 320-slice CTA has a similar detection rate for AEA to that of 3D spin DSA; however, it is noninvasive, and may be preferentially used for the evaluation of AEA and its adjacent bony variations and pathologic changes in preoperative patients with paranasal sinus diseases.

  16. Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

    International Nuclear Information System (INIS)

    Cho, Sanggeon; Kim, Ju Han; Cho, Jae Young; Kim, Hyeon Sik; Bom, Heeseung

    2013-01-01

    The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80±0.35 vs 2.76±1.13 for pLAD and mdLAD groups, respectively, p=0.034), while global MFR was not different (2.10±1.10 vs 2.34±0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0±11.5 % vs 21-1±15.8 %, p=0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. Conclusions The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion

  17. Comparison of changes in mean flow velocity in anterior cerebral artery before and during cognitive stimulation between non-stroke and post-stroke people

    Science.gov (United States)

    Fitri, F. I.; Erwin, I.; Batubara, C. A.; Rambe, A. S.; Anwar, Y.

    2018-03-01

    Transcranial Doppler (TCD) is a tool that has been used widely to measure cerebral blood flow and changes in the cerebral autoregulatory mechanism that can be observed during cognitive stimulation task as changes in mean flow velocity (MFV). This cross-sectional study was to compare the anterior cerebral arteries (ACA) MFV changes during cognitive stimulation using TCD in post-stroke and control group in Neurology Department Adam Malik General Hospital. From August to December 2016, all subject underwent TCD examination to assess baseline characteristic both side of ACA; then the patients were stimulated using Stroop Task. During stimulation, we measured changes in MFV that were correlated with cerebral autoregulation in total 13 pairs of post-stroke and control recruited. Paired t-test was used to evaluate the difference in baseline and during stimulation for each post stroke and control group while independent t-test was used to determine the MFV changes difference between both groups. There were significant differences for MFV changes in each artery for control [R- ACA (p=0.001), L-ACA (p=0.001)] and post-stroke [R-ACA (p=0.001), L-ACA (p=0.001)]. Meanwhile, there was no significant difference for MFV elevation for arteries compared between groups [R-ACA (p=0.374) and L-ACA (0.272)].

  18. A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male - an increasingly recognized rare disease.

    Science.gov (United States)

    Taha, Mohamed; Latt, Htun; Al-Khafaji, Jaafar; Ali, Mohamed; Seher, Richard

    2018-01-01

    Background : Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCAD Case report : We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels. He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment. Conclusion : Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.

  19. Resolution of an Anterior-Inferior Cerebellar Artery Feeding Aneurysm with the Treatment of a Transverse-Sigmoid Dural Arteriovenous Fistula

    Science.gov (United States)

    Kan, Peter; Stevens, Edwin A.; Warner, Judith; Couldwell, William T.

    2007-01-01

    A 27-year-old man developed an unruptured anterior-inferior cerebellar artery (AICA) feeding aneurysm from a transverse-sigmoid dural arteriovenous malformation. The patient, with a known history of left transverse and sigmoid sinus thrombosis, presented with pulse-synchronous tinnitus. Angiography revealed an extensive dural arteriovenous fistula (AVF), with feeders from both the extracranial and intracranial circulations, involving the right transverse sinus, the torcula, and the left transverse/sigmoid sinuses. Multimodal endovascular and open surgical therapy was used to manage the lesion. Before a planned second-stage treatment for the left sigmoid sinus component, the dural AVF improved significantly. During this interval, however, a small flow-related aneurysm developed on the left AICA feeding the petrous dural region. The aneurysm resolved after resection of the involved sigmoid sinus. This is the first reported case of an unruptured feeding-artery aneurysm in an intracranial dural AVF that resolved spontaneously with treatment of the dural AVF. Until more is known about the natural history, the decisions of when and whether to treat an unruptured dural AVF feeding-artery aneurysm must be made on an individual basis. PMID:17973034

  20. Disabling Vertigo and Tinnitus Caused by Intrameatal Compression of the Anterior Inferior Cerebellar Artery on the Vestibulocochlear Nerve: A Case Report, Surgical Considerations, and Review of the Literature

    Science.gov (United States)

    Borghei-Razavi, Hamid; Darvish, Omid; Schick, Uta

    2013-01-01

    Microvascular compression of the vestibulocochlear nerve is known as a cause of tinnitus and vertigo in the literature, but our review of the literature shows that the compression is usually located in the cerebellopontine angle and not intrameatal. We present a case of intrameatal compression of the anterior inferior cerebellar artery (AICA) on the vestibulocochlear nerve of a 40-year-old woman with symptoms of disabling vertigo and intermittent high-frequency tinnitus on the left side without any hearing loss for ∼ 4 years. Magnetic resonance imaging of the brain did not show any abnormality, but magnetic resonance angiography showed a left intrameatal AICA loop as a possible cause of the disabling symptoms. After the exclusion of other possible reasons for disabling vertigo, surgery was indicated. The intraoperative findings proved the radiologic findings. The large AICA loop was found extending into the internal auditory canal and compressing the vestibulocochlear nerve. The AICA loop was mobilized and separated from the vestibulocochlear nerve. The patient's symptoms resolved immediately after surgery, and no symptoms were noted during 2 years of follow-up in our clinic. Her hearing was not affected by the surgery. In addition to other common reasons, such as acoustic neuroma, disabling vertigo and tinnitus can occur from an intrameatal arterial loop compression of the vestibulocochlear nerve and may be treated successfully by drilling the internal acoustic meatus and separating the arterial conflict from the vestibulocochlear nerve. PMID:25083388

  1. CARDIAC COUNTERCLOCKWISE ROTATION IS A RISK FACTOR FOR HIGH-DOSE IRRADIATION TO THE LEFT ANTERIOR DESCENDING CORONARY ARTERY IN PATIENTS WITH LEFT-SIDED BREAST CANCER WHO RECEIVING ADJUVANT RADIOTHERAPY AFTER BREAST-CONSERVING SURGERY

    OpenAIRE

    TANAKA, HIDEKAZU; HAYASHI, SHINYA; HOSHI, HIROAKI

    2014-01-01

    ABSTRACT Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotat...

  2. Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex.

    Science.gov (United States)

    Alonso, Fernando; Kassem, Mohammad W; Iwanaga, Joe; Oskouian, Rod J; Loukas, Marios; Demerdash, Amin; Tubbs, R Shane

    2017-08-16

    Vascular loops in the cerebellopontine angle (CPA) and their relationship to cranial nerves have been used to explain neurological symptoms. The anterior inferior cerebellar artery (AICA) has variable branches producing vascular loops that can compress the facial cranial nerve (CN) VII and vestibulocochlear (CN VIII) nerves. AICA compression of the facial-vestibulocochlear nerve complex can lead to various clinical presentations, including hemifacial spasm (HFS), tinnitus, and hemiataxia. The formation of arterial loops inside or outside of the internal auditory meatus (IAM) can cause abutment or compression of CN VII and CN VIII. Twenty-five (50 sides) fresh adult cadavers underwent dissection of the cerebellopontine angle in the supine position. In regard to relationships between the AICA and the nerves of the facial/vestibulocochlear complex, 33 arteries (66%) traveled in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Five arteries (10%) traveled below the CN VII/VIII complex, six (12%) traveled posterior to the nerve complex, four (8%) formed a semi-circle around the upper half of the nerve complex, and two (4%) traveled between and partially separated the nervus intermedius and facial nerve proper. Our study found that the majority of AICA will travel in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Although the relationship between the AICA and porus acusticus and AICA and the nerves of the CN VII/VIII complex are variable, based on our findings, some themes exist. Surgeons should consider these with approaches to the cerebellopontine angle.

  3. Exercise echocardiography and single photon emission computed tomography in patients with left anterior descending coronary artery stenosis

    NARCIS (Netherlands)

    A. Salustri (Alessandro); M. Pozzoli (M.); B. Ilmer; W.R.M. Hermans (Walter); A.E.M. Reijs (Ambroos); J.H.C. Reiber (Johan); J.R.T.C. Roelandt (Jos); P.M. Fioretti (Paolo)

    1992-01-01

    textabstractTo compare the diagnostic value of exercise echocardiography and perfusion single photon emission computed tomography (SPECT) in the detection of the presence and the severity of coronary artery disease, we studied 21 patients with isolated stenosis of different degree of the left

  4. [Angioplasty of the anterior descending artery with abnormal origin: use of a new low-profile catheter balloon. A case report].

    Science.gov (United States)

    Tanajura, L F; Maldonado, G; Cano, M N; Mattos, L A; Feres, F; Pinto, I M; Fontes, V F; Souza, A G; Sousa, J E

    1990-03-01

    It is possible to perform transluminal coronary angioplasty (TCA) in thin vessels presenting severe obstructions. One of the achievements that made such procedure possible is the development of a new generation of balloon catheters. In this case report the TCA was performed in a very thin left anterior descending artery with an anomalous origin, a quite rare situation that represents a major problem to the traditional dilator system. The catheter used was a Probe (USCI), which differs of the traditional balloons in a number of characteristics. The authors consider the procedure in detail pointing out the advantages of using of the new generations and discuss the impact that newer technological developments will have in enlarging the indications for TCA and improving the results.

  5. [Communication, language and the brain: from past anterior to near future].

    Science.gov (United States)

    Joanette, Y; Ansaldo, A I; Carbonnel, S; Ska, B; Kahlaoui, K; Nespoulous, J-L

    2008-05-01

    The goal of this article is to share some reflection on the astonishing evolution of the ideas in communication neuroscience and neurolinguistics over the last 30 years, since the founding of the société de neuropsychologie de langue française. in particular, a number of conceptual and methodological advancements have characterized this period, many of which have been lead or heavily contributed by french-speaking research groups in that field. among the advances discussed, are (a) the widening to discourse and pragmatic components of the concept of language, as well as the theoretical and clinical implication of this conceptual extension, (b) the unique contribution of anatomical and functional neuroimaging, (c) the massive impact of the cognitive revolution on theoretical frameworks of language components, and its influence on therapy, (d) the disappearance and the re-appearance of the brain in the main stream research on language over this period, (e) the new perspectives offered though attention put on social aspects of language and the social participation of the individual with language disorders, (f) the emergence of a genuine science of aphasia rehabilitation, and (g) the rediscovery of inter-individual characteristics both genetically- and environmentally- determined. The authors then risk themselves in trying to envision what could characterize the evolution in the field for the next 30 years. Though perilous, this speculative exercise allowed to pinpoint to a number of anticipated advancements including (a) a probable reconciliation between cognitive and connectionist models to the benefit of both visions, (b) an increased contribution of social and emotional neurosciences, (c) some inescapable technological advancements, including light portable neuroimaging devices which will allow to study the neurobiological bases of communication in natural contexts, (d) the integration between communication and aging in cognitive neuroscience and (e) the

  6. Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

    Directory of Open Access Journals (Sweden)

    Fadi J. Sawaya

    2016-01-01

    Full Text Available Unligated side branches of the left internal mammary artery (LIMA have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated.

  7. Large Posterior Communicating Artery Aneurysm: Initial Presentation with Reproducible Facial Pain Without Cranial Nerve Deficit

    Directory of Open Access Journals (Sweden)

    Stacie Zelman

    2016-11-01

    Full Text Available Unruptured posterior communicating artery (PCOM aneurysms can be difficult to diagnose and, when large (≥ 7mm, represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA, visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without other associated cranial nerve palsies or neurologic deficits. The patient returned to the emergency department four days later with a HA, trigeminal neuralgia, and a new cranial nerve III palsy. After appropriate imaging, she was found to have a large PCOM aneurysm, which was treated with surgical clipping with significant improvement in patient’s symptoms.

  8. [Idiopathic sudden hearing loss: role of the posterior communicating cerebral arteries of the Willis' circle].

    Science.gov (United States)

    De Capua, B; De Felice, C; D'Onza, M; De Lauretis, A; Monaco, G; Cosentino, G; Tassi, R; Gistri, M; Passàli, D

    2001-06-01

    Sudden hearing loss (SHL) is a neurosensorial hearing loss of variable entity with an onset of less than three days. In most cases (85-90%) it is of unknown etiology (idiopathic sudden hearing loss--ISHL). The most accredited hypotheses for origin are: viral, immunitary and vascular. ISHL accounts for approximately 1% of all neurosensorial hearing loss; onset is most frequent in winter, i.e. January and February, and it most frequently affects women, particularly at 15 and between 40-50 years of age. In order to evaluate the role of vascular condition on the onset of ISHL, we focused our attention on the circle of Willis. The results confirm that, in the absence of cerebro-vascular pathology, posterior communicating arteries (PCAs) that cannot be activated--evaluated by transcranial Doppler (TCD)--are associated with ISHL. Moreover, hemodynamic alterations detected in the basilar artery in ISHL patients are correlated with the final prognosis for hearing. These observations highlight the importance of TCD in testing subjects at risk for idiopathic SHL and show that PCAs are essential in maintaining normal cochlear function.

  9. False aneurysm of the interosseous artery and anterior interosseous syndrome - an unusual complication of penetrating injury of the forearm: a case report

    Directory of Open Access Journals (Sweden)

    Garavaglia Guido

    2009-12-01

    Full Text Available Abstract Background Palsies involving the anterior interosseous nerve (AIN comprise less than 1% of all upper extremity nerve palsies. Objectives This case highlights the potential vascular and neurological hazards of minimal penetrating injury of the proximal forearm and emphasizes the phenomenon of delayed presentation of vascular injuries following seemingly obscure penetrating wounds. Case Report We report a case of a 22-year-old male admitted for a minimal penetrating trauma of the proximal forearm that, some days later, developed an anterior interosseous syndrome. A Duplex study performed immediately after the trauma was normal. Further radiologic investigations i.e. a computer-tomographic-angiography (CTA revealed a false aneurysm of the proximal portion of the interosseous artery (IA. Endovascular management was proposed but a spontaneous rupture dictated surgical revision with simple excision. Complete neurological recovery was documented at 4 months postoperatively. Conclusions/Summary After every penetrating injury of the proximal forearm we propose routinely a detailed neurological and vascular status and a CTA if Duplex evaluation is negative.

  10. First reported case of magnesium-made bioresorbable scaffold to treat spontaneous left anterior descending coronary artery dissection.

    Science.gov (United States)

    Quadri, Giorgio; Tomassini, Francesco; Cerrato, Enrico; Varbella, Ferdinando

    2017-11-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of Acute Coronary Syndrome. Although its treatment is still debated, use of Bioreasorbable Scaffold was recently advocated as an attractive option in this setting. We report the first case, to our knowledge, of a new magnesium-made Bioresorbable Scaffold implantation in a young woman presenting with Non-ST- Elevation Myocardial Infarction and a rapid worsening SCAD. © 2017 Wiley Periodicals, Inc.

  11. A Method for Passive Imaging of the Left Anterior Descending Coronary Artery in the Presence of Coherent Heart Wall Motion.

    Science.gov (United States)

    1998-04-03

    This occurs during the diastolic phase of the heart cycle, when the semilunar valves of the pulmonary artery and the aorta are closed and the tricuspid ...the tricuspid (right) valve into the corresponding ventricles. This produces forces against the inside of the heart wall that result in both... Disease ," principal investigators Andrew J. Hull (Code 2141) and Norman L. Owsley (Code 2123). The technical reviewer for this report was Ronald R

  12. Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study

    Directory of Open Access Journals (Sweden)

    Bernardo Cunha Araujo Filho

    2011-02-01

    Full Text Available Ligadura da artéria etmoidal anterior (AEA pode ser necessária em casos de epistaxe grave refratária ao tratamento tradicional. O uso da ligadura endoscópica endonasal da AEA ainda é bastante limitado. Existem poucos estudos na literatura sobre a técnica de abordagem endoscópica desta artéria. OBJETIVOS: Demonstrar a aplicabilidade técnica da ligadura periorbitária da AEA por via endoscópica transetmoidal. MATERIAL E MÉTODOS: Estudo prospectivo. 50 fossas nasais de cadáveres foram dissecadas. Após a realização de uma etmoidectomia anterior e remoção parcial da lâmina papirácea, a periórbita foi cuidadosamente dissecada até a identificação da AEA. Após sua identificação, a artéria foi exposta e ligada dentro da órbita. RESULTADOS: Todas as dificuldades inerentes ao procedimento, as complicações associadas, a curva de aprendizado e variações anatômicas foram coletados. CONCLUSÕES: A abordagem endoscópica da AEA na órbita de cadáveres mostrou-se factível. A identificação da artéria é fácil e a técnica evita incisões externas. Este acesso parece ser uma excelente alternativa para a abordagem da AEA. Estudos clínicos futuros são necessários para comprovar os benefícios desta técnica.Anterior ethmoidal artery (AEA ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties

  13. Ventricular Fibrillation-Induced Cardiac Arrest Results in Regional Cardiac Injury Preferentially in Left Anterior Descending Coronary Artery Territory in Piglet Model

    Directory of Open Access Journals (Sweden)

    Giridhar Kaliki Venkata

    2016-01-01

    Full Text Available Objective. Decreased cardiac function after resuscitation from cardiac arrest (CA results from global ischemia of the myocardium. In the evolution of postarrest myocardial dysfunction, preferential involvement of any coronary arterial territory is not known. We hypothesized that there is no preferential involvement of any coronary artery during electrical induced ventricular fibrillation (VF in piglet model. Design. Prospective, randomized controlled study. Methods. 12 piglets were randomized to baseline and electrical induced VF. After 5 min, the animals were resuscitated according to AHA PALS guidelines. After return of spontaneous circulation (ROSC, animals were observed for an additional 4 hours prior to cardiac MRI. Data (mean ± SD was analyzed using unpaired t-test; p value ≤ 0.05 was considered statistically significant. Results. Segmental wall motion (mm; baseline versus postarrest group in segment 7 (left anterior descending (LAD was 4.68±0.54 versus 3.31±0.64, p=0.0026. In segment 13, it was 3.82±0.96 versus 2.58±0.82, p=0.02. In segment 14, it was 2.42±0.44 versus 1.29±0.99, p=0.028. Conclusion. Postarrest myocardial dysfunction resulted in segmental wall motion defects in the LAD territory. There were no perfusion defects in the involved segments.

  14. Detection of severe left anterior descending coronary artery stenosis by transthoracic evaluation of resting coronary flow velocity dynamics

    Directory of Open Access Journals (Sweden)

    Edward G. Abinader

    2010-09-01

    Full Text Available In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made non-invasive sampling of velocities in the left an­terior descending coronary artery (LAD possible. The aim of our study was to evaluate feasi­bility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative cor­onary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with non-signifi­cant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005. Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013. LAD velocities had high sensitiv­ity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feas­ible and can predict the presence of severe LAD stenosis or occlusion.

  15. A comparative study of clinical signs, computed tomography, and electroencephalography after direct operation of ruptured anterior communicating aneurysms, 1

    International Nuclear Information System (INIS)

    Kitaoka, Kenichi; Abe, Hiroshi; Nakagawa, Yoku; Imai, Tomohiro; Satoh, Masaharu.

    1987-01-01

    Eight cases with ruptured anterior communicating aneurysms, who developed mental signs of mild degree lasting more than two weeks following direct operation, were subjected to our study. The following results were obtained. 1) The mental signs of mild degree in 8 cases consisted of memory and emotional disturbances. The main findings of CT scan was low density area in the subcortical and cortical areas of the frontal lobe. There was no close correlation on CT findings between memory and emotional disturbances. 2) Abnormal density areas were detected on CT scan, but EEG showed no localized abnormalities of slow waves. Abnormal density areas were not clearly shown on CT, but EEG showed localized abnormalities. Background activities on EEG were favorable despite lesions detected on CT. Either local or diffuse abnormalities were observed in EEG background activities while no abnormal mental signs were recognized. 3) In cases with no apparent abnormal findings on CT and with favorable background activities on EEG, EEG showed marked build up during hyperventilation. 4) As indicated by the above data, comparative studies of CT and EEG findings revealed differences in sites of abnormalities and degree of abnormalities. This is considered caused by a possible increase in cerebral blood flow and metabolism at initiation of chronic stage following subarachnoid hemorrhage-resulting in the disappearance of abnormalities on EEG. (author)

  16. Aneurysm of the anterior inferior cerebellar artery (AICA) associated with high-flow lesion: report of two cases and review of literature.

    Science.gov (United States)

    Menovsky, Tomas; André Grotenhuis, J; Bartels, Ronald H M A

    2002-03-01

    Although aneurysms of the anterior inferior cerebellar artery (AICA) are rare lesions, their occurrence in combination with high-flow lesions in the same arterial territory is even more striking. Two cases of an AICA aneurysm in combination with a high -flow lesion are described. In one case, a 52-year-old female presented with cerebellar syndrome as the result of a left-sided cerebellar tumor. Angiography revealed a highly vascularized tumor and a broad-based aneurysm at the offspring of the left AICA. In the second case, a 17-year-old female presented with a right-sided cerebellar hemorrhage. Angiography revealed a large peripheral AICA aneurysm and a distal arteriovenous malformation (AVM) fed by the AICA. In the first case, a left lateral suboccipital craniotomy was performed and a highly vascularized tumor was removed. The AICA aneurysm could not be adequately clipped and was subsequently wrapped with muscle and reinforced with fibrin glue. Pathological examination of the tumor revealed a hemangioblastoma. Five years after surgery, the patient experienced a subarachnoid hemorrhage. Subsequent vertebral angiography revealed local enlargement of the known AICA aneurysm just at the superior aspect, but the patient refused further treatment. In the second case, the patient sustained a novel cerebellar rebleed while awaiting surgery. A right-sided lateral retromastoid suboccipital craniotomy was performed and the AICA aneurysm could be successfully clipped. More peripherally, the AVM with two draining veins could be totally removed. Postoperative angiography revealed no residual aneurysm or AVM. Several aspects of these cases are discussed, such as the rare occurrence of AICA aneurysm and the contribution of high-flow lesions to the genesis of the AICA aneurysms. Copyright 2002, Elsevier Science Ltd. All rights reserved.

  17. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms.

    Science.gov (United States)

    Sirikci, Akif; Bayazit, Yildirim; Ozer, Enver; Ozkur, Ayhan; Adaletli, Ibrahim; Cüce, M Ali; Bayram, Metin

    2005-12-01

    In this study, we aimed to assess anatomical relationship between the anterior inferior cerebellar artery (AICA) and cochleovestibular nerve (CNV) in patients with non-specific cochleovestibular symptoms using magnetic resonance imaging (MRI). One-hundred and forty patients with non-specific neuro-otologic symptoms were assessed using cranial and temporal MRI. Classification was performed according to four different types of anatomical relationship observed between the AICA and CVN. In type 1 (point compression), the AICA compresses only a limited portion of the CVN. In type 2 (longitudinal compression), the AICA approaches the CVN as both traverse parallel to each other. In type 3 (loop compression), the vascular loop of the AICA encircles the CVN. In type 4 (indentation), the AICA compresses the CVN so as to make an indentation in the nerve. The anatomical relationship between the CVN and AICA was encountered in 19 out of 140 (13.6%) patients (20 ears). The VCC was unilateral in 18 patients (94.7%) and bilateral in one patient (5.3%). There was no other vascular structure causing VCC to the CVN except for vertebral artery that was seen in 2 out of 140 patients (1.4%). These were unilateral cases. There were tinnitus, vertigo or dizziness, hearing loss, and both hearing loss and vertigo in 5 (25%), 13 (65%), 1 (5%) and 1 (5%) ears of 20 patients, respectively. There was no relationship between the cochleovestibular symptoms and type of compression (p>0.05). Neurovascular relationship between the CVN and AICA can be imaged properly using MR and MR based classification may help reporting this relationship in a standard way. Although, MR images can show the anatomical relationship accurately, diagnosis of vascular conflict should not be based on imaging findings alone.

  18. Endoscopic endonasal anatomy and approaches to the anterior skull base: a neurosurgeon's viewpoint.

    Science.gov (United States)

    Abuzayed, Bashar; Tanriover, Necmettin; Gazioglu, Nurperi; Sanus, Galip Zihni; Ozlen, Fatma; Biceroglu, Huseyin; Kafadar, Ali Metin; Eraslan, Berna Senel; Akar, Ziya

    2010-03-01

    The objective of this study was to review the endoscopic anatomy of the anterior skull base, defining the pitfalls of endoscopic endonasal approaches to this region. Recently, these approaches are gaining popularity among neurosurgeons, and the details of the endoscopic anatomy and approaches are highlighted from the neurosurgeons' point of view, correlated with demonstrative cases. Twelve fresh adult cadavers were studied (n = 12). We used Karl Storz 0 and 30 degrees, 4 mm, 18- and 30-cm rod lens rigid endoscope in our dissections. After preparation of the cadaveric specimens, we approached the anterior skull base by the extended endoscopic endonasal approach. After resection of the superior portion of the nasal septum, bilateral middle and superior turbinates, and bilateral anterior and posterior ethmoidal cells, we could obtain full exposure of the anterior skull base. The distance between optic canal and the posterior ethmoidal artery ranged from 8 to 16 mm (mean, 11.08 mm), and the distance between posterior ethmoidal artery and the anterior ethmoidal artery ranged from 10 to 17 mm (mean, 13 mm). After resecting the anterior skull base bony structure and the dura between the 2 medial orbital walls, we could visualize the olfactory nerves, interhemispheric sulcus, and gyri recti. With dissecting the interhemispheric sulcus, we could expose the first (A1) and second (A2) segments of the anterior cerebral artery, anterior communicating artery, and Heubner arteries. This study showed that extended endoscopic endonasal approaches are sufficient in providing wide exposure of the bony structures, and the extradural and intradural components of the anterior skull base and the neighboring structures providing more controlled manipulation of pathologic lesions. These approaches need specific skill and learning curve to achieve more minimally invasive interventions and less postoperative complications.

  19. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

    Directory of Open Access Journals (Sweden)

    Nan Lv

    Full Text Available The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA aneurysms.In 129 PCoA aneurysms (85 ruptured, 44 unruptured, clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms.While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR, size ratio (SR, dome-to-neck ratio (DN, inflow angle (IA, normalized wall shear stress (NWSS and percentage of low wall shear stress area (LSA were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001 and LSA (OR = 1.393, p = 0.041.Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms.

  20. Aneurisma da artéria cerebelar ântero-inferior: relato de caso Aneurysm of the anterior inferior cerebellar artery: case report

    Directory of Open Access Journals (Sweden)

    Juan Oscar Alarcón Adorno

    2002-12-01

    Full Text Available Os aneurismas intracranianos do sistema vértebro-basilar representam cerca de 5 a 10% de todos os aneurismas cerebrais. Os aneurismas da artéria cerebelar ântero-inferior (AICA são considerados raros, podendo causar síndrome do ângulo ponto cerebelar, com ou sem hemorragia subaracnóidea. Desde 1948, foram descritos poucos casos na literatura. Apresentamos o caso de uma paciente, de 33 anos, na qual, após investigação de quadro de hemorragia subaracnóidea, diagnosticou-se aneurisma sacular da AICA esquerda. Foi submetida a clipagem do aneurisma, com ótimo resultado pós operatório.The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA are considered rare, can cause cerebello pontine angle (CPA syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  1. Development of delineation for the left anterior descending coronary artery region in left breast cancer radiotherapy: An optimized organ at risk.

    Science.gov (United States)

    Lee, Jie; Hua, Kai-Lung; Hsu, Shih-Ming; Lin, Jhen-Bin; Lee, Chou-Hsien; Lu, Kuo-Wei; Dai, Kun-Yao; Huang, Xu-Nian; Huang, Jun-Zhao; Wu, Meng-Hao; Chen, Yu-Jen

    2017-03-01

    The left anterior descending coronary artery (LAD) and diagonal branches (DBs) are blurred on computed tomography (CT). We aimed to define the LAD region (LADR) with adequate inclusion of the LAD and DBs and contouring consistency. The LADR was defined using coronary CT angiograms. The inclusion ratio was used to assess the LAD and DBs inclusion by the LADR. Four radiation oncologists delineated the LAD and LADR, using contrast-enhanced CT of 15 patients undergoing left breast radiotherapy. The Sørensen-Dice similarity index (DSI), Jaccard similarity index (JSI), and Hausdorff distance (HD) were calculated to assess similarity. The mean dose (D mean ) and maximum dose (D max ) to the LAD and LADR were calculated to compare consistency. Correlations were evaluated using Pearson's correlation coefficient. The inclusion ratio of the LAD by the LADR was 96%. The mean DSI, JSI, and HD values were respectively 27.9%, 16.7%, and 0.42mm for the LAD, and 83.1%, 73.0%, and 0.18mm for the LADR. The D mean between the LAD and LADR were strongly correlated (r=0.93). Delineation of the LADR significantly improved contouring similarity and consistency for dose reporting. This could optimize dose estimation for breast radiotherapy. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  2. Dynamic changes in the inner ear function and vestibular neural pathway related to the progression of labyrinthine infarction in patient with an anterior inferior cerebellar artery infarction.

    Science.gov (United States)

    Kim, Duk Rim; Lee, Hyo-Jeong; Kim, Hyung-Jong; Hong, Sung Kwang

    2011-12-01

    To describe changes in the inner ear function and the vestibular neural pathway according to the progression of a labyrinthine infarction in a patient with an anterior inferior cerebellar artery (AICA) infarction. A 58-year-old woman with hypertension who presented with isolated inner ear symptoms similar to those of endolymphatic hydrops but finally progressed to an AICA infarction. Serial neurotologic testing according to progression to an AICA infarction and antiplatelet therapy. Radiologic findings and neurotologic parameters, including pure tone audiogram thresholds, spontaneous nystagmus, summating potentials/action potentials on electrocochleography, interaural amplitude difference on the vestibular-evoked myogenic potential test, canal paresis and fixation index on the bithermal caloric test, and gain on oculomotor tests. Our patient initially presented with sudden hearing loss and was diagnosed with an acute AICA infarction on a follow up MRI. Dynamic change in neurotologic testing was observed during disease progression. The vertigo and motion intolerance improved gradually after antiplatelet therapy. Changes in the clinical profile, which were documented during a transition from isolated labyrinthine ischemia to an AICA infarction, suggest that sensitivity to an ischemic injury is variable in different components of the labyrinthine organs in addition to providing a new insight into the response of vestibular neural pathway to ischemic injury.

  3. Isolated anterior interosseous nerve deficit due to a false aneurysm of the humeral artery: an unusual complication of penetrating arm injury. Case report and literature review.

    Science.gov (United States)

    Dunet, B; Pallaro, J; Boullet, F; Tournier, C; Fabre, T

    2013-12-01

    Anterior interosseous nerve (AIN) injuries account for only 1% of all the nerve injuries at the upper limb. We report the case of a 22-year-old male who sustained a penetrating injury to the arm. No neurological deficit was found at the initial evaluation. However, 6 weeks later, he had a motor deficit confined to the territory of the AIN with weakness of the flexor pollicis longus and flexor digitorum longus to the index. He also reported paraesthesia. Tinel's test was positive over the pinpoint wound in the arm, where a painful swelling was felt. Electroneurophysiological testing indicated a deficit of the AIN. Surgical exploration identified a thrombosed false aneurysm of the humeral artery responsible for compression of the median nerve. One month later, the patient had achieved a full recovery. Immediate routine exploration of deep penetrating wounds, although mandatory, may fail to detect any lesions. Close monitoring must be provided subsequently, as gradual nerve compression can result in delayed neurological deficits. Copyright © 2013. Published by Elsevier Masson SAS.

  4. Avaliação da anastomose de artéria torácica interna esquerda com artéria interventricular anterior pela ecodopplercardiografia Evaluation of left internal thoracic artery anastomosis with left anterior descending coronary artery by Doppler echocardiography

    Directory of Open Access Journals (Sweden)

    Adelaide Arruda

    1997-12-01

    Full Text Available OBJETIVO: Avaliar o valor do ecocardiograma Doppler(ECO transtorácico na identificação de perviabilidade da anastomose entre artéria torácica interna esquerda (ATIE e interventricular anterior, realizada pela técnica de revascularização miocárdica pela minitoracotomia sem circulação extracorpórea. MÉTODOS: Estudaram-se os primeiros 12 pacientes, consecutivos, no período de pós-operatório intra-hospitalar pelo ECO, utilizando-se transdutores de 5MHz, pela via paraesternal esquerda, preferencialmente. Foram analisadas velocidades máximas e integrais de velocidade dos componentes sistólico e diastólico das curvas espectrais de fluxo Doppler. Todos pacientes foram submetidos à cinecoronariografia, enquanto hospitalizados. RESULTADOS: O ECO foi exeqüível em 93% dos pacientes. Nos com anastomose pérvia (6/7, observou-se ao estudo Doppler amplo componente diastólico (padrão A. Naqueles com anastomose obstruída (4/4 o padrão observado foi de predomínio sistólico (padrão B (p=0,003*. CONCLUSÃO: O ECO da ATIE anastomosada com a artéria interventricular anterior, após cirurgia de revascularização miocárdica pela técnica de minitoracotomia, permitiu caracterizar precocemente, com precisão, a perviabilidade da anastomose.PURPOSE: To study the value of Doppler echocardiography as a tool for the evaluation of left internal thoracic artery graft (LITAG patency in patients who underwent coronary revascularization using minimally invasive bypass surgery without extracorporeal circulation. METHODS: The first 12 consecutive patients were studied after coronary artery bypass surgery using a 5MHz Doppler transducer. Doppler signals for the systolic and diastolic flow velocities were preferably obtained in the second intercostal space. All patients underwent coronary angiography while hospitalized. RESULTS: The exam was feasible in 93% of patients. Doppler flow pattern was predominantly diastolic (pattern A in patients with patent

  5. A Challenging Case of Bifurcation Lesion in Left Anterior Descending Artery: Managed Successfully with Everolimus-Eluting Bioresorbable Vascular Scaffold and Kissing Balloon Technique under Optical Coherence Tomography Guidance

    OpenAIRE

    Sridhar Kasturi; Shivakumar Bandimida; Nirlep Gajiwala; Ashok Thakkar

    2015-01-01

    A 54-year-old Indian male patient was presented to our hospital with the complaints of chest pain since 1-day prior to admission. He was diagnosed, elsewhere, with anterior-wall myocardial infarction and was treated with tenecteplase. Subsequently, he was referred to us for the management of postinfarction angina. He was a known case of hypertension and had no family history of coronary artery disease. Echocardiogram demonstrated hypokinesia of anterolateral wall with normal left ventricular ...

  6. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

    Science.gov (United States)

    Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

    2016-08-01

    OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p < 0.05) among the 3 groups. Furthermore, multiple comparisons revealed that these parameters differed significantly between the ONP group and the asymptomatic unruptured group and between the ruptured group and the asymptomatic unruptured group, except for size, which differed significantly only between the ONP group and the asymptomatic unruptured group (p = 0.0005). No morphological or hemodynamic parameters differed between the ONP group and the ruptured group. CONCLUSIONS Unruptured PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.

  7. Accuracy of routine treatment planning 4-dimensional and deep-inspiration breath-hold computed tomography delineation of the left anterior descending artery in radiation therapy.

    Science.gov (United States)

    White, Benjamin M; Vennarini, Sabina; Lin, Lilie; Freedman, Gary; Santhanam, Anand; Low, Daniel A; Both, Stefan

    2015-03-15

    To assess the feasibility of radiation therapy treatment planning 4-dimensional computed tomography (4DCT) and deep-inspiration breath-hold (DIBH) CT to accurately contour the left anterior descending artery (LAD), a primary indicator of radiation-induced cardiac toxicity for patients undergoing radiation therapy. Ten subjects were prospectively imaged with a cardiac-gated MRI protocol to determine cardiac motion effects, including the displacement of a region of interest comprising the LAD. A series of planar views were obtained and resampled to create a 3-dimensional (3D) volume. A 3D optical flow deformable image registration algorithm determined tissue displacement during the cardiac cycle. The measured motion was then used as a spatial boundary to characterize motion blurring of the radiologist-delineated LAD structure for a cohort of 10 consecutive patients enrolled prospectively on a breast study including 4DCT and DIBH scans. Coronary motion-induced blurring artifacts were quantified by applying an unsharp filter to accentuate the LAD structure despite the presence of motion blurring. The 4DCT maximum inhalation and exhalation respiratory phases were coregistered to determine the LAD displacement during tidal respiration, as visualized in 4DCT. The average 90th percentile heart motion for the region of interest was 0.7 ± 0.1 mm (left-right [LR]), 1.3 ± 0.6 mm (superior-inferior [SI]), and 0.6 ± 0.2 mm (anterior-posterior [AP]) in the cardiac-gated MRI cohort. The average relative increase in the number of voxels comprising the LAD contour was 69.4% ± 4.5% for the DIBH. The LAD volume overestimation had the dosimetric impact of decreasing the reported mean LAD dose by 23% ± 9% on average in the DIBH. During tidal respiration the average relative LAD contour increase was 69.3% ± 5.9% and 67.9% ± 4.6% for inhalation and exhalation respiratory phases, respectively. The average 90th percentile LAD motion was 4.8 ± 1.1 mm (LR), 0.9 ± 0.4 mm (SI), and 1

  8. Supplementary motor complex and disturbed motor control – a retrospective clinical and lesion analysis of patients after anterior cerebral artery stroke

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    Florian eBrugger

    2015-10-01

    Full Text Available Background: Both the supplementary motor complex (SMC, consisting of the supplementary motor area (SMA-proper, the pre-SMA and the supplementary eye field, and the rostral cingulate cortex (ACC are supplied by the anterior cerebral artery (ACA and are involved in higher motor control. The Bereitschaftspotential (BP originates from the SMC and reflects cognitive preparation processes before volitional movements. ACA strokes may lead to impaired motor control in the absence of limb weakness and evoke an alien-hand syndrome (AHS in its extreme form.Aim: To characterize the clinical spectrum of disturbed motor control after ACA strokes including signs attributable to AHS and to identify the underlying neuroanatomical correlates.Methods: A clinical assessment focusing on signs of disturbed motor control including intermanual conflict (i.e. bilateral hand movements directed at opposite purposes, lack of self-initiated movements, exaggerated grasping, motor perseverations, mirror movements and gait apraxia was performed. Symptoms were grouped into A AHS specific and B non-AHS specific signs of upper limbs and C gait apraxia. Lesion summation mapping was applied to the patients’ MRI or CT scans to reveal associated lesion patterns. The BP was recorded in two patients.Results: Ten patients with ACA strokes (9 unilateral, 1 bilateral; mean age: 74.2 years; median NIH-SS at admission: 13.0 were included in this case series. In the acute stage, all cases had marked difficulties to perform volitional hand movements, while movements in response to external stimuli were preserved. In the chronic stage (median follow-up: 83.5 days initiation of voluntary movements improved, although all patients showed persistent signs of disturbed motor control. Impaired motor control is predominantly associated with damaged voxels within the SMC and the anterior and medial cingulate cortex, while lesions within the pre-SMA are specifically related to AHS. No BP was detected

  9. Cardiac counterclockwise rotation is a risk factor for high-dose irradiation to the left anterior descending coronary artery in patients with left-sided breast cancer who receiving adjuvant radiotherapy after breast-conserving surgery.

    Science.gov (United States)

    Tanaka, Hidekazu; Hayashi, Shinya; Hoshi, Hiroaki

    2014-08-01

    Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotate around longitudinal axis, showing either clockwise or counterclockwise rotation (CCWR). On electrocardiography, the transition zone (TZ) was judged in precordial leads. CCWR was considered to be present if TZ was at or to the right of V3. The prescribed dose was 50 Gy in 25 fractions. The maximum (Dmax) and mean (Dmean) doses to the LAD artery and the volumes of the LAD artery receiving at least 20 Gy, 30 Gy and 40 Gy (V20Gy, V30Gy and V40Gy, respectively) were significantly higher in CCWR than in the non-CCWR patients. On multivariate analysis, TZ was significantly associated with Dmax, Dmean, V20Gy, V30Gy, and V40Gy. CCWR is a risk factor for high-dose irradiation to the LAD artery. Electrocardiography is useful for evaluating the cardiovascular risk of high-dose irradiation to the LAD artery.

  10. Resultados del tratamiento quirúrgico de los aneurismas del complejo cerebral anterior-arteria comunicante anterior

    Directory of Open Access Journals (Sweden)

    Armando Alemán Rivera

    2001-06-01

    Full Text Available Se realiza un estudio de 30 pacientes con aneurismas localizados en el complejo de la arteria cerebral anterior-arteria comunicante anterior (ACoA, operados en el Servicio de Neurocirugía del Hospital Universitario "Arnaldo Milián Castro", durante un período de 7 años. Se analizan variables tales como edad, sexo, estado neurológico preoperatorio, momento quirúrgico, complicaciones y estado al egreso. La mortalidad general fue del 10 %The authors carried out a study in 30 patients with aneurysms located in the anterior communicating artery-anterior cerebral complex (ACA-ACC, that were operated on at the Neurosurgery Service of "Arnaldo Milián Castro" Teaching Hospital, during a period of 7 years. Variables such as age, sex, preoperative neurologic state, surgical moment, complications and status on discharge were analyzed. General mortality was 10 %

  11. Detection of severe stenosis and total occlusion in the left anterior descending coronary artery with transthoracic Doppler echocardiography in the emergency room.

    Science.gov (United States)

    Tani, Tomoko; Tanabe, Kazuaki; Kitai, Takeshi; Yamane, Takafumi; Kureha, Fumie; Katayama, Minako; Tamita, Koichi; Kaji, Shuichiro; Oda, Tomoyuki; Ehara, Natsuhiko; Kinoshita, Makoto; Yamamuro, Atsushi; Morioka, Shigefumi; Kihara, Yasuki

    2009-01-01

    The noninvasive measurement of coronary flow velocity in the left anterior descending artery (LAD) has recently been realized by using the transthoracic Doppler echocardiography (TTDE). A couple of investigations demonstrated that the diastolic-to-systolic peak velocity ratio (DSVR) by TTDE is a simple and noninvasive method for the detection of severe stenosis in the elective settings. However, the usefulness of DSVR by TTDE in the emergency settings has not been evaluated. The purpose of this study was to assess the clinical feasibility to document the LAD flow by TTDE in emergency patients who complained of chest pain. We studied 49 consecutive patients with acute coronary syndrome who were going to undergo emergency coronary angiography (CAG) for the anatomical diagnosis and the facilitated percutaneous coronary intervention (PCI). Prior to CAG, we recorded the LAD flow by TTDE and measured the diastolic peak velocity (DVp), systolic peak velocity (SVp), and their ratio, DSVR (DVp/SVp) of LAD flow. By CAG, the culprit lesions actually resided in the proximal LAD in 36 patients. Among the 36 patients, we detected the Doppler LAD flow in 29. Five out of 7 patients who were unable to detect the LAD flow revealed total occlusions by CAG. DSVR of the LAD is significantly lower in 17 patients who showed severe stenoses (>90%) than those in the rest of 12 patients who did not show such critical stenoses (1.44 +/- 0.16 vs 2.10 +/- 0.26, P < 0.0001). In the emergency settings, a noninvasive assessment of the LAD flow by TTDE accurately estimates the critical stenotic lesions of the LAD.

  12. Long-term clinical efficacy of cutting balloon angioplasty followed by bare metal stent implantation for treating ostial left anterior descending artery lesions.

    Science.gov (United States)

    Gao, Li-Jian; Chen, Ji-Lin; Chen, Jun; Yang, Yue-Jin; Gao, Run-Lin; Li, Jian-Jun; Qin, Xue-Wen; Qiao, Shu-Bin; Xu, Bo; Yao, Min; Liu, Hai-Bo; Wu, Yong-Jian; Yuan, Jin-Qing; Chen, Jue; You, Shi-Jie; Dai, Jun

    2009-08-01

    Drug-eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice. We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy. In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was > or =3.0 mm. We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6-8 months angiographic follow-up, but there were higher bleeding events in the DES group (p = 0.033). During a 2-year clinical follow-up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE-free survival rate was 90.2% versus 88 % (p = 0.723). The CBA + BMS combination has a good long-term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication, or in elderly patients.

  13. Underdiagnosis of posterior communicating artery aneurysm in non-invasive brain vascular studies

    Science.gov (United States)

    Elmalem, Valerie I.; Hudgins, Patricia A.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

    2013-01-01

    Introduction Expert interpretation of modern noninvasive neuroimaging such as CTA or MRA should detect nearly all aneurysms responsible for an isolated third nerve palsy. Whether a catheter angiogram should still be obtained in cases with negative CTA or MRA remains debated, and mostly relies on whether the noninvasive study was correctly performed and interpreted. The aim of our study was to review the diagnostic strategies used to evaluate patients with isolated aneurysmal third nerve palsy at a large academic center. Methods Retrospective review of all cases with posterior communicating artery (PCom A) aneurysmal third nerve palsies seen at our institution since 2001. Results We identified 417 cases with third nerve palsy, aneurysm, or subarachnoid hemorrhage, among which 17 presented with an acute isolated painful third nerve palsy related to an ipsilateral PCom A aneurysm (mean age 52; range 33–83 years). Patients were classified into 3 groups based on the results of the noninvasive imaging obtained at initial presentation. Group I included 4 cases with subarachnoid hemorrhage on initial non-contrast head CT initially obtained in an emergency department for evaluation of their isolated third nerve palsy. Group II included 5 cases with isolated third nerve palsy and normal non-contrast head CT at presentation, immediately correctly diagnosed with a PCom A aneurysm at the referring institution. Group III included the 8 remaining cases who all had aneurysms that were missed on noninvasive studies at outside institutions. Review of these outside studies at our institution showed a PCom A aneurysm, confirming misinterpretation of these tests by the outside radiologists, rather than inadequate technique. Absence of specific training in neuroradiology and inaccurate clinical information provided to the interpreting radiologist were associated with test misinterpretation at the outside institutions. The average size of PCom A aneurysms causing an isolated third

  14. Vertebral Artery Dissection Leading to Fornix Infarction: A Case Report.

    Science.gov (United States)

    Kurokawa, Takashi; Baba, Yasuhisa; Fujino, Kimihiro; Kuroiwa, Yoshiyuki; Tomita, Yusuke; Nakane, Makoto; Yamada, Shoko Merrit; Tanaka, Fumiaki

    2015-07-01

    The subcallosal artery is a proximal branch of the anterior communicating artery and has been recognized as the vessel responsible for fornix infarction. Fornix infarction caused by vascular damage to the posterior circulation has not been reported previously. A 26-year-old woman suffered from fornix infarction due to artery-to-artery embolism after vertebral artery dissection. Cerebral infarctions were also found in the left thalamus, body of the left caudate nucleus, and the left occipital lobe other than the fornix. Occlusion of the subcallosal artery results in cerebral infarction of fornix, anterior cingulate cortex, and genu of the corpus callosum. However, in our case, lesions were restricted to the territory of posterior circulation. In addition to subcallosal artery, lateral posterior choroidal artery, a perforating branch of the posterior cerebral artery, has been described to send branches to the fornix, so we speculated that the left lateral posterior choroidal artery was actually responsible for fornix infarction. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Internal carotid artery agenesis: A case report and review of literature

    Science.gov (United States)

    Hooda, Kusum; Gupta, Nishant; Kumar, Yogesh

    2017-01-01

    Congenital agenesis of the internal carotid artery is a very rare anomaly. Intracranial circulation in the involved internal carotid artery territory is maintained by collateral circulation from the contralateral internal carotid artery through the anterior communicating artery and from the vertebrobasilar system through the posterior communicating artery. Usually, patients with internal carotid artery agenesis are asymptomatic due to collateral circulation, but they may present with headache, seizures, or transient ischemic attack. Aneurysms have also been reported to be associated with this entity. Computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography are commonly used modalities to make the diagnosis. Unenhanced skull base computed tomography will show the absence of carotid canal, thus differentiating from carotid hypoplasia. We report on a case of right internal carotid artery agenesis with discussion of embryogenesis, clinical presentation, and imaging findings. PMID:28424012

  16. SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

    International Nuclear Information System (INIS)

    Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn; Crandley, Edwin; Read, Paul; Krishni, Wijesooriya

    2014-01-01

    Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed on 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude

  17. TU-F-BRF-07: Accuracy of Routine Treatment Planning 4D and DIBH CT Delineation of the Left Anterior Descending Artery in Radiotherapy

    International Nuclear Information System (INIS)

    White, B; Lin, L; Freedmen, G; Both, S; Vennarini, S

    2014-01-01

    Purpose: To assess the feasibility of routine treatment planning 4DCT and deep inspiration breath-hold (DIBH) to accurately contour the left anterior descending artery (LAD), a primary indicator of cardiac toxicity, for radiotherapy treatment planning of breast cancer. Methods: Ten subjects were imaged with a cardiac-gated MRI protocol to determine the displacement of a ROI that included the LAD. The subjects performed a series of breath-hold maneuvers to obtain short-axis and radial views, which were resampled to create a 3D-volume. Tissue motion was determined using a multi-resolution 3D optical flow deformable image registration algorithm. The ROI motion was then used as a spatial boundary to characterize the blurring motion of the LAD in ten patients during clinical 4DCT and DIBH protocols. A radiologist contoured the LAD. Coronary motion-induced blurring artifacts were quantified by applying an unsharp filter to accentuate the LAD despite motion-blurring. The 4DCT maximum inhalation and exhalation respiratory phases were co-registered to determine the LAD displacement during tidal respiration, as visualized in 4DCT. Results: The average 90 th percentile heart motion for the ROI was 0.7±0.1mm(LR), 1.3±0.6mm(SI), 0.6±0.2mm(AP) in the cardiac-gated MRI cohort. The average relative increase in the number of voxels comprising the LAD contour was 69.4±4.5% for the DIBH. During tidal respiration, the average relative increase in the LAD contour was 69.3±5.9% and 67.9±4.6% for inhalation and exhalation respiratory phases respectively. The average 90 th percentile LAD motion was 4.8±1.1mm(LR), 0.9±0.4mm(SI), 1.9±0.6mm(AP) for the 4DCT cohort, in the absence of cardiac-gating. Conclusion: Uncompensated coronary motion was the dominant form of motion blurring present in the CT images due to the high frequency of the cardiac cycle relative to the respiratory cycle. The 4D and DIBH CT contour delineation of the LAD was consistently overestimated without cardiac

  18. SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn; Crandley, Edwin; Read, Paul; Krishni, Wijesooriya [Radiation Oncology, University of Virginia Health System, Charlottesville, VA (United States)

    2014-06-15

    Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed on 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude.

  19. Importance of guiding catheter disengagement during measurement of fractional flow reserve in patients with an isolated proximal left anterior descending artery stenosis.

    Science.gov (United States)

    Aminian, Adel; Dolatabadi, Dariouch; Lefebvre, Pascal; Khalil, Georges; Zimmerman, Robert; Michalakis, Georges; Lalmand, Jacques

    2015-03-01

    To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis. Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa1 , Pd1 , FFReng ), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa2 , Pd2 , FFRdis ). The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFReng was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFRdis ) after 38 ± 6 sec of guiding catheter disengagement. The mean ΔFFR (FFReng  - FFRdis ) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pabaseline  - FFRdis vs. Pd/Pabaseline  - FFReng , 0.15 ± 0.05 vs. 0.10 ± 0.04, P guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy. During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy. © 2014 Wiley Periodicals, Inc.

  20. A comparison of survival between on-pump and off-pump left internal mammary artery bypass graft surgery for isolated left anterior descending coronary artery disease: an analysis of the UK National Adult Cardiac Surgery Audit Registry.

    Science.gov (United States)

    Hickey, Graeme L; Pullan, Mark; Oo, Aung; Mediratta, Neeraj; Chalmers, John; Bridgewater, Ben; Poullis, Michael

    2016-05-01

    To determine if the use of cardiopulmonary bypass is associated with all-cause in-hospital and mid-term survival for patients undergoing left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass grafting (CABG) for single coronary vessel disease. Data from the National Adult Cardiac Surgery Audit registry for all elective and urgent isolated CABG procedures performed between April 2003 and March 2013 in first-time cardiac surgery patients were extracted. Experienced surgeons (those with ≥300 records) were classified by their technique preference (as 'off-pump preference', 'mixed practice', 'on-pump preference') based on their entire isolated CABG data. In-hospital mortality and time to death were analysed using logistic and Cox proportional hazards regression models, respectively. From a total of 3402 records, 65.5% were performed off-pump. There were 16 (0.47%) in-hospital deaths: 6 (0.51%) in the on-pump group and 10 (0.45%) in the off-pump group. The risk-adjusted odds ratio of in-hospital mortality in the direction of on-pump was 1.09 [95% confidence interval (CI): 0.39-3.04; P = 0.86]. The overall 5-year survival in the on- and off-pump groups was 93.1 and 93.4%, respectively. The adjusted hazard ratio (HR) for mortality in the direction of on-pump CABG was 1.15 (95% CI: 0.89-1.49; P = 0.28). Comparing off-pump cases performed by experienced CABG surgeons with a preference for the off-pump technique with on-pump cases performed by surgeons with a preference for the on-pump technique indicated a significant difference (HR for on-pump = 1.72; 95% CI: 1.19-2.47; P = 0.004). Elective and urgent first-time CABG for isolated LAD disease is associated with excellent mid-term survival in the England and Wales population, conferring a 5-year survival rate of 93.1 and 93.4% in the on-pump and off-pump groups, respectively. There was no difference in risk-adjusted survival between the on-pump and off-pump techniques when analysing all

  1. A Challenging Case of Bifurcation Lesion in Left Anterior Descending Artery: Managed Successfully with Everolimus-Eluting Bioresorbable Vascular Scaffold and Kissing Balloon Technique under Optical Coherence Tomography Guidance

    Directory of Open Access Journals (Sweden)

    Sridhar Kasturi

    2015-01-01

    Full Text Available A 54-year-old Indian male patient was presented to our hospital with the complaints of chest pain since 1-day prior to admission. He was diagnosed, elsewhere, with anterior-wall myocardial infarction and was treated with tenecteplase. Subsequently, he was referred to us for the management of postinfarction angina. He was a known case of hypertension and had no family history of coronary artery disease. Echocardiogram demonstrated hypokinesia of anterolateral wall with normal left ventricular function. Angiography revealed a single vessel disease-99% stenosis in the mid-segment of left anterior descending (LAD coronary artery with significant narrowing at the proximal site of diagonal 1 (D1 branch. An optical coherence tomography-guided percutaneous coronary intervention to the LAD-D1 bifurcation lesion was performed successfully using ABSORB bioresorbable vascular scaffold (Abbott Vascular, USA and kissing balloon angioplasty. No postprocedural complication was observed and the patient was discharged the next day. Clinical evaluation at 1-year follow-up was satisfactory.

  2. Fluxometria da artéria torácica interna esquerda na revascularização da artéria descendente anterior com e sem circulação extracorpórea Flowmetry of left internal thoracic artery graft to left anterior descending artery: comparison between on-pump and off-pump surgery

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    Filinto Marques de Cerqueira Neto

    2012-06-01

    Full Text Available INTRODUÇÃO: A cirurgia de revascularização do miocárdio (RM sem circulação extracorpórea (CEC é uma técnica amplamente utilizada. A fluxometria coronariana é a técnica mais usada para avaliação dos enxertos, porém, poucos estudos comparam os dados fluxométricos na RM com e sem CEC. O objetivo deste estudo foi comparar as variáveis fluxométricas dos enxertos de artéria torácica interna esquerda para a artéria descendente anterior em pacientes submetidos à RM com e sem CEC. MÉTODOS: Entre março e setembro de 2010, foram analisados retrospectivamente 35 pacientes consecutivos, não randomizados, submetidos à RM. Foram alocados 10 pacientes no grupo A (com CEC e 25 no grupo B (sem CEC. O fluxo médio do enxerto (FME, o índice pulsátil (PI e a porcentagem de enchimento diastólico (ED foram obtidos por meio da fluxometria por tempo de trânsito. Foi utilizado o teste exato de Fisher e Mann-Whitney, sendo considerado estatisticamente significante PBACKGROUND: Off-pump coronary bypass grafting (OPCAB has become a widely used technique. Coronary flowmetry is the most common method employed to assess graft patency, nevertheless, few studies compare flow patterns between ONCAB and OPCAB surgery. The objective of this study was to compare flowmetry data in left internal mammary artery grafts bypasses to the left anterior descendent artery. METHODS: From March to September of 2010, thirtyfive consecutive, non-randomized patients underwent CABG and were retrospectively evaluated. Ten patients were located on group A (On Pump, and twenty-five on group B (Off Pump. The mean graft flow (MGF, pulsatile index (PI and diastolic filling (DF were obtained using Transit Time Flowmetry (TTFM. The Fisher exact test, and Mann Whitney test were used, and a P value of < 0.05 was considered to indicate statistical significance. RESULTS: There were no deaths, AMI, re-interventions or PTCA in a 30-day period. The number of bypasses performed per

  3. Colour Doppler ultrasonography for evaluation of anterior chest blood supply: the possible role of arterial blood supply to the costosternal junction in the aetiology of idiopathic scoliosis in female adolescents.

    Science.gov (United States)

    Korovessis, Panagiotis; Iliopoulos, Panagiotis; Misiris, Alexandros; Koureas, Georgios

    2004-02-01

    This prospective comparative study was carried out to investigate the blood supply to the anterior chest wall by measurement of several anatomical and haemodynamic flow parameters of the internal mammary artery, with the use of colour Doppler ultrasonography, in female scoliotics with idiopathic right convex scoliosis in adolescence. Previous investigations have postulated that asymmetry of the breasts in female adolescents may be linked with the development of right convex thoracic scoliosis. This breast asymmetry is supposed to be linked with anatomical and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomical and haemodynamic parameters of the internal mammary artery have been made to justify or reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Twenty female adolescents with right convex thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with roentgenograms (scoliotics only) to measure scoliosis curve, vertebral rotation and concave and convex rib-vertebra angle at three vertebrae (the apical, one level above and one below the apical vertebra). Doppler ultrasonography was used to measure, at the origin of the internal mammary artery, its lumen diameter, cross-sectional area, time average mean flow and flow volume per minute in scoliotics and controls, which were compared with each other. The roentgenographic parameters were compared with the ultrasonographic parameters in the scoliotics to disclose any relationship. The reliability of colour Doppler ultrasonography was high and the intra-observer variability low (ANOVA, P=0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. In scoliotics the right

  4. Study of the posterior communicating arteries of the circle of willis in idiopathic sudden sensorineural hearing loss.

    Science.gov (United States)

    Van Prooyen-Keyzer, Sandrine; Sadik, Jean-Claude; Ulanovski, David; Parmantier, Monique; Ayache, Denis

    2005-05-01

    To evaluate the incidence of non-functioning posterior communicating arteries (PCoA) of the circle of Willis in patients presenting with idiopathic sudden sensorineural hearing loss (SSHL). Pathogenesis of SSHL remains unclear despite several theories. A strong association between non-functioning PCoA of the circle of Willis and SSHL has been recently suggested, supporting the theory of vascular disorders. Tertiary referral center. Ultrasonographic Doppler flow measurements of the vertebrobasilar system were performed prospectively in 27 consecutive patients with idiopathic SSHL and in 27 healthy subjects. A non-functioning PCoA was found in 4 patients with idiopathic SSHL and in 4 cases in the control group. The results of our study did not show any association between non-functioning PCoA of the circle of Willis and idiopathic SSHL, contrasting with previous data. We do not recommend adding routine transcranial Doppler ultrasonography in the test-battery for SSHL.

  5. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

    2005-04-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

  6. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    International Nuclear Information System (INIS)

    Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

    2005-01-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

  7. Anterior spinal cord syndrome of unknown etiology

    OpenAIRE

    Klakeel, Merrine; Thompson, Justin; Srinivasan, Rajashree; McDonald, Frank

    2015-01-01

    A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome.

  8. Doppler findings in a rare Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Jorns Carl

    2007-03-01

    Full Text Available Abstract One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF. It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD artery to the left ventricular (LV apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm, a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life.

  9. SHORT COMMUNICATION ON THE INFLUENCE OF POSITION ON ANTERIOR CRUCIATE LIGAMENT INJURY AND RECONSTRUCTION IN RECREATIONAL RUGBY FOOTBALL UNION PARTICIPANTS

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    Helen Dawes

    2003-03-01

    Full Text Available The different player positions in rugby union may place varying demands on a reconstructed anterior cruciate ligament (ACL in regards to 'cutting manoeuvres', this in turn may effect performance. In order to investigate sporting performance post reconstruction, a questionnaire was sent to amateur rugby clubs affiliated to the Oxfordshire Rugby Football Union (R.F.U. From the returned questionnaires player positions were placed into categories based on similar 'cutting manoeuvre' demands. Seventy five percent of Individuals playing in the category 1 (low 'cutting manoeuvre' demands at slow running speeds could play a full game with a damaged ACL and post-reconstruction the majority returned to play at a higher level. Fifty percent of ACL injuries occurred on category 2 (high 'cutting manoeuvre' demands at medium running speeds suggesting they may be more prone to ACL injury than other positions. The majority of individuals playing in category 3 (high 'cutting manoeuvre' demands at fast speeds played at a lower level of rugby post reconstruction. Positional demands may influence ACL injury and post reconstruction sporting performance. However, more research is needed

  10. Retrograde pedal access with a 20-gauge intravenous cannula after failed antegrade recanalization of a tibialis anterior artery in a diabetic patient: a case report

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    Yucel Colkesen

    2015-08-01

    Full Text Available Retrograde tibiopedal approach is being used frequently in below-the-knee vascular interventions. In patients with diabetic foot pathology, complex anatomy often requires a retrograde technique when the distal vascular anatomy and puncture site is suitable. The dorsalis pedis and posterior tibial arteries can be punctured because of their relatively superficial position. We report a retrograde puncturing technique in patients with chronic total occlusions. After failed antegrade recanalization, puncturing and cannulation of a tiny dorsalis pedis artery with a narrow bore [20-gauge (0.8 mm] intravenous cannula is described.

  11. Superdominant Right Coronary Artery with Absence of Left Circumflex and Anomalous Origin of the Left Anterior Descending Coronary from the Right Sinus: An Unheard Coronary Anomaly Circulation

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    Marcos Danillo Peixoto Oliveira

    2015-01-01

    Full Text Available Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. We present herein the case of a 70-year-old man with symptomatic severe aortic valvar stenosis whose preoperative coronary angiogram revealed a so far unreported coronary anomaly circulation pattern.

  12. Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar artery.

    Science.gov (United States)

    Lee, Ji Yeoun; Kim, Seung-Ki; Cheon, Jung-Eun; Choi, Jung Won; Phi, Ji Hoon; Kim, In-One; Cho, Byung-Kyu; Wang, Kyu-Chang

    2013-12-01

    Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease, and progressive involvement of the posterior cerebral artery (PCA) has been reported. However, majority of MMD articles are presenting classic anterior circulation related issues. This study investigates the preoperative factors related to the long-term outcome of posterior circulation in MMD. Retrospective review of 88 MMD patients (166 PCAs in either hemisphere) without symptomatic disease involvement of PCA at initial diagnosis was done. Data at initial diagnosis regarding age, presence of infarction, status of the PCA, type of posterior communicating artery, and the angle between PCA and basilar artery were reviewed. Progressive stenosis of PCA was evaluated by symptom or radiological imaging during follow up. During an average follow up of 8.3 years, 29 out of 166 (18 %) evaluated PCAs showed progressive disease involvement. The average time of progression from the initial operation was 4.9 years, with the latest onset at 10.8 years. The patients who showed progressive stenosis of the PCA tended to be younger, present with infarction, have smaller angle between PCA and basilar artery, and have asymptomatic stenosis of the PCA at initial presentation. However, multivariate analysis confirmed only the presence of initial infarction and a smaller angle between PCA and basilar artery to be significantly associated with progressive stenosis of PCA. Involvement of PCA in MMD may occur in a delayed fashion, years after the completion of revascularization of anterior circulation. Persistent long-term follow-up regarding the posterior circulation is recommended.

  13. The association of right coronary artery conus branch size and course with ST segment elevation of right precordial leads and clinical outcome of acute anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Samad Ghaffari

    2017-03-01

    Methods: Seventy-four patients with acute anterior ST elevation myocardial infarction (Ant- STEMI presenting to the emergency room in the first 12 hours after the onset of symptoms were studied. Upon admission, a full 14-lead ECG (including leads V3R and V4R were performed. Angiographic and ECG findings, as well as clinical outcome were compared between two groups. The statistical tests including Chi-square and independent t-test were used for data analysis. Results: Small conus branch was seen in 52 (70.3% and large conus in 22 ( 29.7% patients. STE in right-sided leads and heart failure were significantly higher in small conus branch group versus large conus branch (88.6% vs 11.4%, P < 0.001 and 34.6% vs 9.1%, P = 0.02 respectively. There was no significant difference in mortality rate between the two groups (5.8% in small conous group vs 0% in large conus group, P = 0.55. There was a significant difference in major adverse cardiac events (MACE between the two groups (51.9% in small conous group vs 18.2% in large conus group, P = 0.01. Conclusion: In patients with anterior MI, small conus branch was associated with higher rate of major adverse cardiac events mostly because of increased rate of acute heart failure.

  14. Multisoliton solutions in terms of double Wronskian determinant for a generalized variable-coefficient nonlinear Schroedinger equation from plasma physics, arterial mechanics, fluid dynamics and optical communications

    International Nuclear Information System (INIS)

    Lue Xing; Zhu Hongwu; Yao Zhenzhi; Meng Xianghua; Zhang Cheng; Zhang Chunyi; Tian Bo

    2008-01-01

    In this paper, the multisoliton solutions in terms of double Wronskian determinant are presented for a generalized variable-coefficient nonlinear Schroedinger equation, which appears in space and laboratory plasmas, arterial mechanics, fluid dynamics, optical communications and so on. By means of the particularly nice properties of Wronskian determinant, the solutions are testified through direct substitution into the bilinear equations. Furthermore, it can be proved that the bilinear Baecklund transformation transforms between (N - 1)- and N-soliton solutions

  15. [Short-term outcome of single stenting technique for unruptured wide-necked tiny aneurysms of the anterior circulation].

    Science.gov (United States)

    Lu, Jun; Wang, Daming; Liu, Jiachun; Wang, Lijun; Qi, Peng

    2015-07-01

    To evaluate the short-term outcome of single stenting technique for unruptured, wide-necked, tiny aneurysms of the anterior circulation. Eleven unruptured, wide-necked, tiny aneurysms of the anterior circulation were treated by a single stent deployed in the parent artery between January 2008 and July 2013 in Department of Neurosurgery in Beijing Hospital. The maximum diameter of the aneurysms ranged from 2.0 to 3.0 mm, mean (2.4 ± 0.4) mm, and the dome-to-neck ratios were all ≤ 1.2. The locations were clinoid segment of internal carotid artery (n=2), posterior communicating artery origin (n=4), anterior choroidal artery origin (n=2) and middle cerebral artery bifurcation (n=3). All internal carotid aneurysms were located in the medial and/or ventral wall of the internal carotid artery. The rate of aneurysm obliteration and rupture during follow-up was obtained by repeat angiography and clinic or telephone interview respectively. Sole stent placement in the parent artery was intentionally performed for nine aneurysms, while attempt of coiling after stent deployment for the other two aneurysms failed due to unsuccessful microcatherization. Ten stents were successfully deployed, of which one was used to treat two tandem lesions simultaneously. Only one aneurysm became smaller immediately postprocedure. No perioperative complications occurred. Angiographic follow-up after a mean period of (13 ± 6) months (range 8-24 months) revealed that 8 aneurysms did no change in size, 2 became smaller and only one was totally occluded. Asymptomatic in-stent stenosis of the parent artery was found in all 3 shrinking or occluded aneurysms. No aneurysm rupture was observed in the clinical follow-up. For those unruptured, wide-necked, tiny aneurysms arising at branching sites in the anterior circulation, single stenting technique seems to be a safe alternative treatment, while the short-term rate of aneurysm occlusion is low.

  16. Anatomia microcirúgica da substâcia perfurada anterior basal humana Microsurgical anatomy of the human basal anterior perforated substance

    Directory of Open Access Journals (Sweden)

    Arlindo Alfredo Silveira D’Ávila

    2006-06-01

    Full Text Available A substância perfurada anterior constitui referencial na base do encéfalo. Localizada acima da bifurcação subaracnóidea da artéria carótida interna em sua porção basal e junto à artéria comunicante anterior na face inter-hemisférica, é transfixada por ramos perfurantes dirigidos aos núcleos telencefálicos corticais, cápsula interna e parte do tálamo. Por injeção intravascular de gelatina carminada, resina de Batson e látex, analisamos 50 hemisférios cerebrais humanos adultos de ambos os sexos, sob o microscópio cirúrgico. Objetivamos contribuir para a determinação da origem, número e topografia dos ramos destinados a essa região, seu curso, anastomoses e territórios de penetração. Propusemo-nos também a analisar a contribuição da artéria comunicante anterior à substância perfurada anterior. Foram encontradas variações anatômicas, incluindo anastomoses, envolvendo principalmente a artéria cerebral média e a artéria coróidea anterior. Estes conhecimentos são de interesse clínico-cirúrgico em razão da freqüência de patologias vasculares e tumorais a ela relacionadas.The anterior perforated substance (APS is a landmark in the basal forebrain. It has a basal face located above the carotid bifurcation in the subarachnoid space, and an interhemispheric one. It is the site of passage of the arteries to the caudate nucleus, putamen, internal capsule, adjacent areas of the globus pallidus and thalamus. Fifty hemispheres from twenty-five adult cadavers were obtained. The arteries were perfused with colored latex, Batson’s resin and gelatin colored with carmine. Using a surgical microscope we have determined the origin, local and number of origin from the parent vessel. The sites of penetration in the mediolateral and anteroposterior direction were also recorded. The anterior communicating artery contribution to the basal APS was reviewed. Significant vascular variations and anastomoses were encountered

  17. Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy: maximizing symptomatic resolution and minimizing surgical invasiveness.

    Science.gov (United States)

    Park, Jaechan; Kang, Dong-Hun; Chun, Bo-Young

    2011-10-01

    For oculomotor nerve palsy (ONP) induced by unruptured posterior communicating artery (PCoA) aneurysms, the authors performed surgical clipping via a superciliary keyhole approach as an optimal treatment modality with high efficiency and low invasiveness. In this study, they then evaluated the technical feasibility, safety, clinical outcomes, including recovery from ONP as well as cosmetic results, and durability of the procedure. Thirteen patients presenting with complete (7 patients) or incomplete (6 patients) ONP underwent surgery via a superciliary approach. The operative video record was used to evaluate the technical feasibility, neurological examinations and CT were performed to analyze the safety of the treatment, and neuroophthalmological examinations and 3D CT angiography were undertaken to determine the effectiveness and durability of the treatment. In all cases, the aneurysms were successfully clipped using a 3.5-cm eyebrow incision and supraorbital minicraniotomy. The mean operative time was 108 ± 24 minutes. Twelve (92.3%) of the 13 patients showed complete resolution of the ONP. All 6 patients (100%) with incomplete ONP recovered completely within 1-2 months after surgery, whereas 6 (85.7%) of the 7 patients with complete ONP recovered completely within 1-6 months after surgery. Cosmetic results for the operative wounds were excellent without frontalis palsy. The durability of the treatment was ascertained based on 3D CT angiograms obtained 1 year after surgery. Surgical clipping via a superciliary keyhole approach can be an optimal treatment modality for PCoA aneurysms inducing ONP because it is effective, safe, and durable.

  18. A median sacral artery anterior to the iliocaval junction: a case report-anatomical considerations and clinical relevance for spine surgery.

    Science.gov (United States)

    Chenin, Louis; Tandabany, Sharmila; Foulon, Pascal; Havet, Eric; Peltier, Johann

    2018-01-01

    The median sacral artery (MSA) is a relatively small vessel that always arises from the posterior, terminal part of the infrarenal aorta. In most cases, the MSA runs behind the iliocaval junction. Here, we describe a very rare case of an MSA running in front of this junction. During a human cadaveric dissection of the retroperitoneal area, we unexpectedly observed that the MSA passed in front of the left common iliac vein. The anatomy of the MSA has been extensively described and variations are quite rare. On the basis of this specific case, knowledge of the anatomic interactions between the MSA and other lumbar retroperitoneal vessels may help to avoid potential complications during surgery.

  19. 'Doctor' or 'darling'? Decoding the communication partner from ECoG of the anterior temporal lobe during non-experimental, real-life social interaction

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    Johanna eDerix

    2012-09-01

    Full Text Available Human brain processes underlying real-life social interaction in everyday situations have been difficult to study and have, until now, remained largely unknown. Here, we investigated whether electrocorticography (ECoG recorded for pre-neurosurgical diagnostics during the daily hospital life of epilepsy patients could provide a way to elucidate the neural correlates of non-experimental social interaction. We identified time periods in which patients were involved in conversations with either their respective life partners (Condition 1; C1 or attending physicians (Condition 2; C2. These two conditions can be expected to differentially involve subfunctions of social interaction which have been associated with activity in the anterior temporal lobe (ATL, including the temporal poles (TP. Therefore, we specifically focused on ECoG recordings from this brain region and investigated spectral power modulations in the alpha (8-12 Hz and theta (3-5 Hz frequency ranges, which have been previously assumed to play an important role in the processing of social interaction. We hypothesized that brain activity in this region might be sensitive to differences in the two interaction situations and tested whether these differences can be detected by single-trial decoding. Condition-specific effects in both theta and alpha bands were observed: the left and right TP exclusively showed increased power in C1 compared to C2, whereas more posterior parts of the ATL exhibited similar (C1 > C2 and also contrary (C2 > C1 effects. Single-trial decoding accuracies for classification of these effects were highly above chance. Our findings demonstrate that it is possible to study the neural correlates of human social interaction in non-experimental conditions. Decoding the identity of the communication partner and adjusting the speech output accordingly may be useful in the emerging field of brain- machine interfacing for restoration of expressive speech.

  20. Carotid artery sacrifice for unclippable and uncoilable aneurysms: endovascular occlusion vs common carotid artery ligation.

    Science.gov (United States)

    Elhammady, Mohamed Samy; Wolfe, Stacey Quintero; Farhat, Hamad; Ali Aziz-Sultan, Mohammad; Heros, Roberto C

    2010-11-01

    Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a

  1. Meta-Analysis of Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left Anterior Descending Coronary Disease.

    Science.gov (United States)

    Kinnaird, Tim; Kwok, Chun Shing; Narain, Aditya; Butler, Rob; Ossei-Gerning, Nicholas; Ludman, Peter; Moat, Neil; Anderson, Richard; Mamas, Mamas A

    2016-10-15

    We performed a meta-analysis of the studies comparing the efficacy and safety of coronary artery bypass surgery against percutaneous coronary intervention with drug-eluting stents (PCI-DES) in patients with isolated LAD disease. Because of the limited randomized trial data, the optimal revascularization strategy for patients with isolated LAD disease remains uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3 randomized trials and 8 cohort studies) including 5,044 participants were identified. No significant difference in mortality between PCI-DES and coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574 [4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to 1.69) was detected. For MACE, PCI-DES was associated with significant increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230 participants). There were no significant differences in the risk of myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36; 95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel revascularization (TVR) events among 2,237 participants in the PCI-DES group (10.7%) and 145 TVR events among 2,793 participants in the CABG group (5.2%) with a significant increased risk of TVR in the PCI group (RR 2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In conclusion, for patients with isolated disease of the LAD, meta-analysis of the available data suggests revascularization with a PCI-DES strategy offers similar mortality, MI, and stroke rates to CABG at the expense of increased TVR. Much of the data are derived from registries using first-generation DES, and further randomized trials with more contemporary platforms are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Development and application of the informational and communication technologies in quality standards of health care management for patients with arterial hypertension.

    Science.gov (United States)

    Smііanov, V; Smiianova, O; Tarasenko, S

    2014-01-01

    Mobile health technologies improve the quality of health care service. The information and communication technology is developed and applied to remind patients with arterial hypertension to follow medical recommendations. The feedback system from general practitioners was developed (the reminder system for patients sending the feedbacks). It helped to supervise follow-up patients online. Suggested system provides for forming the database for summarized analysis of online survey of the patients, who receive medical care at health care institution, to take managerial decisions concerning the improvements of medical services quality. Evaluation of efficiency of the applied technology assured that the number of patients, who checked regularly his/her arterial pressure, increased by 31.00%. The number of patients, who visited doctors for preventive purpose two or more times during given year, rose by 18.24%. The number of patients with target pressure grew by 24.51% and composed 38.55±4.26%.

  3. A rare case of Cystic artery arising from Gastroduodenal artery ...

    African Journals Online (AJOL)

    The tortuous cystic artery arose outside hepatobiliary triangle, crossed the common bile duct anteriorly and was lying anterior to the cystic duct hiding it from view. On reaching the neck of gall bladder, it again travelled for short distance before its termination. The non-peritonealised surface of the gall bladder was receiving ...

  4. Anomalous left-to-right shunting communication between the ascending aorta and right pulmonary artery in a dog.

    Science.gov (United States)

    Scollan, Katherine; Salinardi, Brenda; Bulmer, Barret J; Sisson, D David

    2011-06-01

    Anomalies of conotruncal septation are rare in dogs and uncommon in humans. Congenital conotruncal defects most commonly reported in veterinary medicine include aorto-pulmonary window and persistent truncus arteriosus. We report a case of an anomalous vessel connecting the ascending aorta to the right pulmonary artery causing left-to-right shunting, left-sided volume overload, and pulmonary overcirculation. Transesophageal echocardiography, cardiac catheterization, and contrast-enhanced computed tomography assisted in the diagnosis and facilitated the surgical correction of the anomalous vessel. The authors hypothesize this defect represents an unusual anomalous vessel connecting the ascending aorta to the right pulmonary artery. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Successful surgical repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery with prior reconstruction of the carotid artery

    International Nuclear Information System (INIS)

    Miyahara, Ken; Maeda, Masanobu; Sakai, Yoshimasa; Sakurai, Hajime; Murayama, Hiroomi; Hasegawa, Hiroki

    2003-01-01

    We report the successful repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery (BCA) in a 70-year-old man. He had undergone a mediastinal tumor resection through a median sternotomy in 1995. Pathological examination revealed non-Hodgkin's lymphoma. Two years later, he underwent radiation therapy of 65 Gray for metastasis to the supraclavicular lymph nodes. On January 18, 2000, plastic surgeons planned to perform a pectoralis major musculocutaneous flap to repair a radiation skin ulcer. During the operation, the BCA was lacerated, possibly in an area of radiation tissue damage. We performed a prosthetic graft (10-mm Gelseal) replacement of the BCA. The right subclavian artery had to be ligated. Postoperative digital subtraction angiography (DSA) showed excellent reconstruction of the artery. Magnetic resonance angiography of the brain showed a deficit in the anterior communicating artery and stenosis of the posterior communicating artery, which indicated that the reconstruction procedure was reasonable. Seven months later, on August 18, 2000, the patient was transferred to our hospital because of swelling of the right neck and oozing from the previous cutaneous wound. CT scan and DSA demonstrated the presence of a pseudoaneurysm of the proximal anastomosis site, which required emergency surgery. Before this third sternotomy, a saphenous vein graft was interposed between both external carotid arteries. Removal of the prosthetic graft and resection of the pseudoaneurysm were performed under mild hypothermia and cardiopulmonary bypass with left common carotid arterial perfusion. Then, the wound was closed completely using a left pectoralis major musculocutaneous flap. The postoperative course was uneventful and DSA showed good patency of the graft and intracranial arteries. The patient was discharged without neurological complications. We conclude that prior reconstruction of the carotid artery is a safe and effective procedure for patients with

  6. Successful surgical repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery with prior reconstruction of the carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Miyahara, Ken; Maeda, Masanobu; Sakai, Yoshimasa; Sakurai, Hajime; Murayama, Hiroomi; Hasegawa, Hiroki [Social Insurance Chukyo Hospital, Nagoya (Japan)

    2003-01-01

    We report the successful repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery (BCA) in a 70-year-old man. He had undergone a mediastinal tumor resection through a median sternotomy in 1995. Pathological examination revealed non-Hodgkin's lymphoma. Two years later, he underwent radiation therapy of 65 Gray for metastasis to the supraclavicular lymph nodes. On January 18, 2000, plastic surgeons planned to perform a pectoralis major musculocutaneous flap to repair a radiation skin ulcer. During the operation, the BCA was lacerated, possibly in an area of radiation tissue damage. We performed a prosthetic graft (10-mm Gelseal) replacement of the BCA. The right subclavian artery had to be ligated. Postoperative digital subtraction angiography (DSA) showed excellent reconstruction of the artery. Magnetic resonance angiography of the brain showed a deficit in the anterior communicating artery and stenosis of the posterior communicating artery, which indicated that the reconstruction procedure was reasonable. Seven months later, on August 18, 2000, the patient was transferred to our hospital because of swelling of the right neck and oozing from the previous cutaneous wound. CT scan and DSA demonstrated the presence of a pseudoaneurysm of the proximal anastomosis site, which required emergency surgery. Before this third sternotomy, a saphenous vein graft was interposed between both external carotid arteries. Removal of the prosthetic graft and resection of the pseudoaneurysm were performed under mild hypothermia and cardiopulmonary bypass with left common carotid arterial perfusion. Then, the wound was closed completely using a left pectoralis major musculocutaneous flap. The postoperative course was uneventful and DSA showed good patency of the graft and intracranial arteries. The patient was discharged without neurological complications. We conclude that prior reconstruction of the carotid artery is a safe and effective procedure for patients

  7. Multiple Coronary Artery Microfistulas Associated with Apical Hypertrophic Cardiomyopathy: Left and Right Coronary Artery to the Left Ventricle

    Directory of Open Access Journals (Sweden)

    Jeong-Woo Choi

    2015-01-01

    Full Text Available A 76-year-old woman underwent coronary angiography for chest pain. On the coronary angiogram, no significant coronary artery atherosclerotic stenosis was observed. Multiple coronary artery microfistulas, draining from the left anterior descending artery to the left ventricle and from the posterior descending artery of the right coronary artery to the left ventricle, were observed. Apical wall thickening and fistula flow from the left anterior descending artery were demonstrated by using transthoracic echocardiography. We describe a rare case of multiple coronary artery microfistulas from the left and right coronary artery to the left ventricle combined with apical hypertrophic cardiomyopathy.

  8. [Efficacy comparison between drug-eluting stents versus cutting balloon angioplasty followed by bare metal stents for the treatment of ostial lesions of the left anterior descending coronary artery].

    Science.gov (United States)

    Chen, Ji-lin; Gao, Li-jian; Gao, Run-lin; Yang, Yue-jin; Qin, Xue-wen; Qiao, Shu-bin; Xu, Bo; Yao, Min; Liu, Hai-bo; Wu, Yong-jian; Yuan, Jin-qing; Chen, Jue

    2008-08-01

    To compare the short and long-term clinical and angiographic outcomes of drug-eluting stents (DES) versus cutting balloon angioplasty followed by bare metal stents (CBA + BMS) for the treatment of ostial lesions of the left anterior descending coronary artery (LAD). A total of 51 consecutive patients with LAD ostial lesions were treated by DES and all patients had completed 2-year clinical follow-up, 50 consecutive patients with LAD ostial lesions treated by CBA + BMS and followed up for 2 years prior to the DES era (May 2000 to November 2003) served as control group. In DES group, one patient experienced acute myocardial infarction (AMI) during hospitalization, the in-hospital major adverse cardiac event (MACE) was 1.96% (1/51), angiography follow-up data at 6-8 months were available in 29 patients and the in-DES restenosis was 10.3% (3/29), at 2-year clinical follow-up, 1 patient died, 4 patients received target lesion revascularization. Total MACE rate was 9.8% (5/51). In CBA + BMS group, there was no in-hospital death and AMI. Angiographic follow-up at 6-8 months was completed in 28 cases and in-stent restenosis rate was 17.9% (5/28). During 2-year follow-up, there was no death and AMI and 6 patients underwent target lesion revascularization. MACE rate was 12% (6/50) in this group. This study showed that both clinical and angiographic outcomes were comparable between DES and CBA + BMS treated patients with LAD ostial lesions during the 2-year follow up period.

  9. Retrograde snare-assisted rescue via the anterior communicating artery for lost access during multiple overlapping pipeline embolization device placement: A technical case report.

    Science.gov (United States)

    Son, Wonsoo; Kang, Dong-Hun; Kim, Byung Moon; Park, Jaechan; Kim, Yong-Sun

    2018-03-07

    The pipeline embolization device (PED; ev3, Irvine, California, USA) has been used to divert flow away from an aneurysm sac. The risk of complications may increase for flow diversion with giant aneurysms, since these cases may require multiple overlapping PEDs, which makes the technique highly complex. We report a rescue technical strategy for lost access during multiple overlapping PED placement for a giant, fusiform cavernous aneurysm. By using the collateral circulation as an alternative rescue route, intraprocedural loss of distal access may be salvaged. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Communications

    OpenAIRE

    anonymous

    1982-01-01

    Communications are read for interest in issues that have importance for all who practice and use management science. They are not refereed for technical correctness, as are articles and Notes that appear in Management Science. The reader is therefore cautioned that the publication of any Communication implies neither scientific standing nor acceptance per se on the part of either Management Science or TIMS. Centers Within Universities: Management and Evaluation by James G. Taaffe, On a Common...

  11. [Arterial plasma histamine concentration for airway obstruction due to different areas of the bronchial system. IV. Communication (author's transl)].

    Science.gov (United States)

    Zimmermann, I; Ulmer, W T

    1980-01-01

    The separate inhalation of A.E. aerosol in the upper and the peripheral parts of the airways in allergic dogs is followed by an increase of the histamine concentration in the arterial plasma. The correlation between the plasma histamine concentration and dynamic elastance and the correlation between dynamic elastance and arterial oxygen pressure is very similar following the challenge of the upper and the peripheral parts of the airways. The results argue for reflex bronchoconstriction also by challenge of the more peripheral airways. The results are in accord with the idea that the answer of Edyn depends on a product of local histamine concentration and the area in which the histamine is released. The number of sensory receptors per surface area which is suspected to be greater in the upper part of the airways may also be important.

  12. The posterior communicating artery: morphometric study in 3D angio-computed tomography reconstruction. The proof of the mathematical definition of the hypoplasia.

    Science.gov (United States)

    Dzierżanowski, J; Szarmach, A; Słoniewski, P; Czapiewski, P; Piskunowicz, M; Bandurski, T; Szmuda, T

    2014-08-01

    The aim of this study was to investigate the morphometry of the posterior communicating artery (PCoA), on the basis of angio-computed tomography (CT), and to give proof of the mathematical definition of the term "hypopal sia of the PCoA". One hundred 3-dimensional (3D) angio-CT images, performed in adult patients with bilateral reconstruction of the PCoA (200 results) were used tocalculate the morphometry of the vessel. The average length of the vessel on the right side was 14.48 ± 3.47 mm, andon the left side 14.98 ± 4.77 mm (in women 14.75 mm, in men 14.70 mm). The mean of the diameter at the "proximal" point (the junction with P1) on the right side was 1.49 ± 0.51 mm, and on the left 1.46 ± 0.47 mm (in women 1.44 mm and in men 1.51 mm). The mean of the diameter in the "distal" part (the connection with ICA) on the right side was 1.4 ± 0.49 mm, and on the left 1.37 ± 0.41 mm (in women 1.38 mm, and in men 1.39 mm). No statistical correlation between the length and the diameter of the PCoA in relation to the sex and side was shown. On the basis of our measurements, we defined the hypoplasia of the artery as the estimated value less than the average diameter minus the standard deviation. The percentage distribution was as follows: the left artery 15.5%, the right artery 24%, women 11.5%, and the men 9%. Similarly to the above parameters, we have not found any statistical differences. The presence of the foetal origin was noted in 25% of the radiological examinations. The infundibular widening was visualised in 11.5% of cases of 3D reconstructions. The agenesis of PCoA was found in 9% (never bilaterally), and in 1 case the unilateral duplication of the artery was observed. No statistical differences between those parameters in relation to sex and the examined side were revealed. Morphological calculation of the PCoA on the basis of angio-CT from adult patients did not show any statistical differences depending on sex or the investigated side. The presented

  13. Coronary Artery Bypass

    Science.gov (United States)

    ... from the inside of your chest wall (the internal mammary artery) instead. Or the surgeon may use ... Library & Learning Resource Center Scientific Publications & Grants Visual Communications & Public Affairs For Medical Professionals Continuing Medical Education ...

  14. Unilateral arteria peronea magna associated with bilateral replaced dorsalis pedis arteries.

    Science.gov (United States)

    Jung, Wonsug; Oh, Chang-Seok; Won, Hyung-Sun; Chung, In-Hyuk

    2008-07-01

    During anatomic dissection, a 59-year-old man presented with an arteria peronea magna that replaced all the branches of the posterior tibial artery as well as the dorsalis pedis artery. Thus, the right popliteal artery terminated into the anterior tibial artery and the enlarged peroneal artery. The right anterior tibial artery ended before it reached the ankle. The right dorsalis pedis artery arose from the peroneal artery through its perforating branch. The left popliteal artery gave rise to a common stem that subdivided into two individual branches replacing the proximal part of the anterior tibial artery, and then divided into the posterior tibial artery and the peroneal artery. As on the right side, the left dorsalis pedis artery also arose from the peroneal artery through its perforating branch. A possible embryologic explanation of these variations is proposed.

  15. Ptosis as partial oculomotor nerve palsy due to compression by infundibular dilatation of posterior communicating artery, visualized with three-dimensional computer graphics: case report.

    Science.gov (United States)

    Fukushima, Yuta; Imai, Hideaki; Yoshino, Masanori; Kin, Taichi; Takasago, Megumi; Saito, Kuniaki; Nakatomi, Hirofumi; Saito, Nobuhito

    2014-01-01

    Oculomotor nerve palsy (ONP) due to internal carotid-posterior communicating artery (PcomA) aneurysm generally manifests as partial nerve palsy including pupillary dysfunction. In contrast, infundibular dilatation (ID) of the PcomA has no pathogenic significance, and mechanical compression of the cranial nerve is extremely rare. We describe a 60-year-old woman who presented with progressive ptosis due to mechanical compression of the oculomotor nerve by an ID of the PcomA. Three-dimensional computer graphics (3DCG) accurately visualized the mechanical compression by the ID, and her ptosis was improved after clipping of the ID. ID of the PcomA may cause ONP by mechanical compression and is treatable surgically. 3DCG are effective for the diagnosis and preoperative simulation.

  16. Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

    African Journals Online (AJOL)

    Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

  17. Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

    Directory of Open Access Journals (Sweden)

    Mehmet Osman Akçakaya

    2015-01-01

    Full Text Available Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm; optic chiasm as 76.2 ± 5.4 mm (67-86 mm; anterior communicating artery as 82.6 ± 6.1 mm (71-93 mm; internal carotid artery (ICA bifurcation as 74.7 ± 6.0 mm (66-84 mm and the basilar tip as 94.9 ± 7.0 mm (87-111 mm. The mean diameter of the optic canal was 7.4 ± 1.3 mm (6-11 mm, whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7-10 mm. Conclusions: The results of this study showed that the anterior anda medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.

  18. COMMUNICATIONS

    CERN Multimedia

    L. Taylor and D. Barney

    2010-01-01

    CMS Centres, Outreach and the 7 TeV Media Event The new CMS Communications group is now established and is addressing three areas that are critical to CMS as it enters the physics operations phase: - Communications Infrastructure, including almost 50 CMS Centres Worldwide, videoconferencing systems, and CERN meeting rooms - Information systems, including the internal and external Web sites as well as the document preparation and management systems - Outreach and Education activities, including working with print, radio and TV media, visits to CMS, and exhibitions. The group has been active in many areas, with the highest priority being accorded to needs of CMS operations and preparations for the major media event planned for 7 TeV collisions. Unfortunately the CMS Centre@CERN suffered a major setback when, on 21st December, a cooling water pipe froze and burst on the floor above the CMS Centre main room. Water poured through the ceiling, flooding the floor and soaking some of the consoles, before e...

  19. COMMUNICATIONS

    CERN Multimedia

    A. Petrilli

    2013-01-01

    The organisation of the Open Days at the end of September was the single biggest effort of the CMS Communications Group this year. We would like to thank all volunteers for their hard work to show our Point 5 facilities and explain science and technology to the general public. During two days more than 5,000 people visited the CMS detector underground and profited from the surface activities, which included an exhibition on CMS, a workshop on superconductivity, and an activity for our younger visitors involving wooden Kapla blocks. The Communications Group took advantage of the preparations to produce new CMS posters that can be reused at other venues. Event display images have been produced not just for this occasion but also for other exhibits, education purposes, publications etc. During the Open Days, Gilles Jobin, 2012 winner of CERN Collide@CERN prize, performed his Quantum show in Point 5, with the light installation of German artist Julius von Bismarck. Image 3: CERN Open Days at CMS wel...

  20. Histomorphological features of atherosclerosis in the left anterior ...

    African Journals Online (AJOL)

    The pattern of coronary artery atherosclerosis is valuable in informing mitigation strategies for coronary heart disease. Histomorphological data on this disease among Africans living in Sub Saharan Africa are, however, scarce. The left anterior descending is one of the most commonly afflicted arteries. This study, therefore ...

  1. The role of the circle of Willis in internal carotid artery stenosis and anatomical variations: a computational study based on a patient-specific three-dimensional model.

    Science.gov (United States)

    Zhu, Guangyu; Yuan, Qi; Yang, Jian; Yeo, Joon Hock

    2015-11-25

    The aim of this study is to provide better insights into the cerebral perfusion patterns and collateral mechanism of the circle of Willis (CoW) under anatomical and pathological variations. In the current study, a patient-specific three-dimensional computational model of the CoW was reconstructed based on the computed tomography (CT) images. The Carreau model was applied to simulate the non-Newtonian property of blood. Flow distributions in five common anatomical variations coexisting with different degrees of stenosis in the right internal carotid artery (RICA) were investigated to obtain detailed flow information. With the development of stenosis in unilateral internal carotid artery (ICA), the cerebral blood supply decreased when the degree of stenosis increased. The blood supply of the ipsilateral middle cerebral artery (MCA) was most affected by the stenosis of ICA. The anterior communicating artery (ACoA) and ipsilateral posterior communicating artery (PCoA) functioned as the important collateral circulation channels when unilateral stenosis occurred. The blood flow of the anterior circulation and the total cerebral blood flow (CBF) reached to the minimum in the configuration of the contralateral proximal anterior cerebral artery (A1) absence coexisting with unilateral ICA stenosis. Communicating arteries provided important collateral channels in the complete CoW when stenosis in unilateral ICA occurred. The cross-flow in the ACoA is a sensitive indicator of the morphological change of the ICA. The collateral function of the PCoA on the affected side will not be fully activated until a severe stenosis occurred in unilateral ICA. The absence of unilateral A1 coexisting with the stenosis in the contralateral ICA could be the most dangerous configuration in terms of the total cerebral blood supply. The findings of this study would enhance the understanding of the collateral mechanism of the CoW under different anatomical variations.

  2. Proposal of anatomical terminology to call the arteries of the base of the encephalon in the monkey (Cebus paella L., 1766 Nomenclatura proposta para denominar as artérias da base do encéfalo do macaco-prego (Cebus apella L., 1766

    Directory of Open Access Journals (Sweden)

    Jussara Rocha Ferreira

    2001-05-01

    Full Text Available Arteries of the encephalon basis of 30 monkeys (Cebus paella were studied. Arteries were injected with colored latex, fixed in formaldehyde solution at 10% and dissected under magnifying lenses. Since the animals died from natural causes they had been previously used in other experiments. Human and veterinary anatomical terminology and literature were used as a reference for the determination of vessels studied in the primates. Arteries of the encephalon base represent division branches of three vascular pedicules: the right and left internal carotid arteries and the basilar system. Vessels in the basilar system of the animal were called vertebral arteries; anterior spinal artery; anterior and posterior cerebelar arteries; pontine arteries; satellite cerebelar arteries; caudal and cranial cerebelar arteries. The basilar artery bifurcates into two posterior cerebral arteries (100%. The caudal area of the encephalon’s arterial circuit is thus constituted. Linking between the vertebro-basilar and the carotid segments is done by the posterior communicating artery, that caudally anastomizes (100% with the posterior cerebral artery. The internal carotid artery gives origin to the posterior communicating artery. The right and left internal carotid artery (intracranial portion compounds the carotid system. The following vessels were identified: middle cerebral artery; anterior cerebral artery; interhemispheric artery; olfactory arteries. Results report that Cebus paella presents an arterial pattern of relative morphological stabilityEstudaram-se as artérias da base do encéfalo do Cebus apella em 30 animais, vindos a óbito por morte natural no Zoológico de São Paulo e coletados durante 10 anos. O material recebeu injeção de látex corado, fixado em formol a 10%, e foi dissecado sob lupa. Encontramos dificuldade e denominar estes vasos. As terminologias anatômicas humana e veterinária e a recuperação da literatura nos serviram de base para

  3. Anterior Horn Cell Diseases

    Directory of Open Access Journals (Sweden)

    Merve Firinciogullari

    2016-09-01

    Full Text Available The anterior horn cells control all voluntary movement. Motor activity, respiratory, speech, and swallowing functions are dependent upon signals from the anterior horn cells. Diseases that damage the anterior horn cells, therefore, have a profound impact. Symptoms of anterior horn cell loss (weakness, falling, choking lead patients to seek medical attention. In this article, anterior horn diseases were reviewed, diagnostic criteria and management were discussed in detail. [Archives Medical Review Journal 2016; 25(3.000: 269-303

  4. The endothelial component of cannabinoid-induced relaxation in rabbit mesenteric artery depends on gap junctional communication

    Science.gov (United States)

    Chaytor, A T; Martin, P E M; Evans, W H; Randall, M D; Griffith, T M

    1999-01-01

    We have shown that the endocannabinoid anandamide and its stable analogue methanandamide relax rings of rabbit superior mesenteric artery through endothelium-dependent and -independent mechanisms that are unaffected by blockade of NO synthase and cyclooxygenase. The endothelium-dependent component of the responses was attenuated by the gap junction inhibitor 18α-glycyrrhetinic acid (18α-GA; 50 μm), and a synthetic connexin-mimetic peptide homologous to the extracellular Gap 27 sequence of connexin 43 (43Gap 27, SRPTEKTIFII; 300 μm). By contrast, the corresponding connexin 40 peptide (40Gap 27, SRPTEKNVFIV) was inactive. The cannabinoid CB1 receptor antagonist SR141716A (10 μm) also attenuated endothelium-dependent relaxations but this inhibition was not observed with the CB1 receptor antagonist LY320135 (10 μm). Furthermore, SR141716A mimicked the effects of 43Gap 27 peptide in blocking Lucifer Yellow dye transfer between coupled COS-7 cells (a monkey fibroblast cell line), whereas LY320135 was without effect, thus suggesting that the action of SR141716A was directly attributable to effects on gap junctions. The endothelium-dependent component of cannabinoid-induced relaxation was also attenuated by AM404 (10 μm), an inhibitor of the high-affinity anandamide transporter, which was without effect on dye transfer. Taken together, the findings suggest that cannabinoids derived from arachidonic acid gain access to the endothelial cytosol via a transporter mechanism and subsequently stimulate relaxation by promoting diffusion of an to adjacent smooth muscle cells via gap junctions. Relaxations of endothelium-denuded preparations to anandamide and methanandamide were unaffected by 43Gap 27 peptide, 18α-GA, SR141716A, AM404 and indomethacin and their genesis remains to be established. PMID:10523421

  5. Communicating with Professionals

    Medline Plus

    Full Text Available ... Make Changes That Matter Find HBP Tools & Resources Stroke Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals ...

  6. What is the origin of the labyrinthine artery among black Kenyans ...

    African Journals Online (AJOL)

    ... that majority of labyrinthine arteries arise from basilar artery, different from that in oriental, Indo-Asian and Caucasian populations, in which it arises from the anterior inferior cerebellar artery. Preoperative evaluation of basilar artery branching is recommended. Keywords: labyrinthine artery, origin, Kenyan, Basilar, AICA ...

  7. The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients.

    Science.gov (United States)

    Caplan, Justin M; Papadimitriou, Kyriakos; Yang, Wuyang; Colby, Geoffrey P; Coon, Alexander L; Olivi, Alessandro; Tamargo, Rafael J; Huang, Judy

    2014-06-01

    The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

  8. Dural AVM supplied by the ophthalmic artery.

    LENUS (Irish Health Repository)

    Flynn, T H

    2012-02-03

    Dural arteriovenous malformations in the anterior cranial fossa are rare and are especially prone to haemorrhage. These lesions are usually treated by surgical excision. We report the embolization of an anterior cranial fossa DAVM using an endovascular approach via the ophthalmic artery.

  9. Communicating with Professionals

    Medline Plus

    Full Text Available ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals Updated:Mar 8,2018 After a ... rushed than you (or your professionals) want. Simple communication skills can help you get what you need – ...

  10. Communicating with Professionals

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals Updated:Mar 8,2018 After a ... rushed than you (or your professionals) want. Simple communication skills can help you get what you need – ...

  11. Communicating with Healthcare Professionals

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals Updated:Mar 8,2018 After a ... rushed than you (or your professionals) want. Simple communication skills can help you get what you need – ...

  12. Celiac artery compression syndrome.

    Science.gov (United States)

    Kokotsakis, J N; Lambidis, C D; Lioulias, A G; Skouteli, E T; Bastounis, E A; Livesay, J J

    2000-04-01

    Celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. We report a case of a 65-year-old woman who presented with a three-month history of postprandial abdominal pain, nausea and some emesis, without weight loss. There was a bruit in the upper mid-epigastrium and the lateral aortic arteriography revealed a significant stenosis of the celiac artery. At operation, the celiac axis was found to be severely compressed anteriorly by fibers forming the inferior margin of the arcuate ligament of the diaphragm. The ligament was cut and a vein by-pass from the supraceliac aorta to the distal celiac artery was performed. The patient remains well and free of symptoms two and a half years since operation.In this report we discuss the indications and the therapeutic options of this syndrome as well as a review of the literature is being given.

  13. Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Hossein Doustkami

    2016-07-01

    Full Text Available Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic.

  14. Case of radiation induced aneurysm of extracranial carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Tashiro, Takashi; Ikota, Toshio; Yamashita, Kousuke; Kodama, Takao

    1988-08-01

    An unusual case of post-irradiation aneurysm of extracranial internal carotid artery is presented. A 70-year-old man, complaining of left cervical throbbing mass with focal pain, was admitted on February 8, 1985. It was noted, from his past history, that he had had surgery of the removal of cervical lymphnodes and that unknown dosage of irradiation had been added to the cervical region 30 years before. Left carotid angiography (on admission) demonstrated a giant aneurysm in the cervical portion of internal carotid artery. Right carotid angiography with compression of left carotid artery revealed good cross filling through anterior communicating artery. Computed tomography with contrast media showed a ring like enhanced mass, which was thought to suggest that a large part of the aneurysm was filled with intraluminal thrombosis. During 30 days of evaluation, the aneurysm grew larger and his cervical pain became untolerable. Operation, the resection of the aneurysm and the reconstruction (of circulation) with vein graft, was challenged on March 12. It was so difficult with meticulous work that the ligation of left common carotid artery was performed after all. Seven days after the operation, he suffered from the gastrointestinal bleeding, which was enough to lead him to hypovolemic shock. Thereafter, right hemiparesis and aphasia were brought about. Two months later, he died of pneumonia. On histological examination, it was demonstrated that the aneurysm communicated with the necrotic tissue and that the normal structure of the blood vessel was not observed in the aneurysmal wall and consisted of the collagenous fiber and granulated tissue. The aneurysm was interpreted as a false one.

  15. A case of radiation induced aneurysm of extracranial carotid artery

    International Nuclear Information System (INIS)

    Tashiro, Takashi; Ikota, Toshio; Yamashita, Kousuke; Kodama, Takao

    1988-01-01

    An unusual case of post-irradiation aneurysm of extracranial internal carotid artery is presented. A 70-year-old man, complaining of left cervical throbbing mass with focal pain, was admitted on February 8, 1985. It was noted, from his past history, that he had had surgery of the removal of cervical lymphnodes and that unknown dosage of irradiation had been added to the cervical region 30 years before. Left carotid angiography (on admission) demonstrated a giant aneurysm in the cervical portion of internal carotid artery. Right carotid angiography with compression of left carotid artery revealed good cross filling through anterior communicating artery. Computed tomography with contrast media showed a ring like enhanced mass, which was thought to suggest that a large part of the aneurysm was filled with intraluminal thrombosis. During 30 days of evaluation, the aneurysm grew larger and his cervical pain became untolerable. Operation, the resection of the aneurysm and the reconstruction (of circulation) with vein graft, was challenged on March 12. It was so difficult with meticulous work that the ligation of left common carotid artery was performed after all. Seven days after the operation, he suffered from the gastrointestinal bleeding, which was enough to lead him to hypovolemic shock. Thereafter, right hemiparesis and aphasia were brought about. Two months later, he died of pneumonia. On histological examination, it was demonstrated that the aneurysm communicated with the necrotic tissue and that the normal structure of the blood vessel was not observed in the aneurysmal wall and consisted of the collagenous fiber and granulated tissue. The aneurysm was interpreted as a false one. (author)

  16. Coronary artery fistulas

    Directory of Open Access Journals (Sweden)

    V. M. Subbotin

    2015-01-01

    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  17. Nitroglycerine-induced vasodilation in coronary and brachial arteries in patients with suspected coronary artery disease.

    Science.gov (United States)

    Maruhashi, Tatsuya; Kajikawa, Masato; Nakashima, Ayumu; Iwamoto, Yumiko; Iwamoto, Akimichi; Oda, Nozomu; Kishimoto, Shinji; Matsui, Shogo; Higaki, Tadanao; Shimonaga, Takashi; Watanabe, Noriaki; Ikenaga, Hiroki; Hidaka, Takayuki; Kihara, Yasuki; Chayama, Kazuaki; Goto, Chikara; Aibara, Yoshiki; Noma, Kensuke; Higashi, Yukihito

    2016-09-15

    Nitroglycerine-induced vasodilation, an index of endothelium-independent vasodilation, is measured for the assessment of vascular smooth muscle cell function or alterations of vascular structure. Both coronary and brachial artery responses to nitroglycerine have been demonstrated to be independent prognostic markers of cardiovascular events. The purpose of this study was to evaluate the nitroglycerine-induced vasodilation in coronary and brachial arteries in the same patients. We measured nitroglycerine-induced vasodilation in coronary and brachial arteries in 30 subjects with suspected coronary artery disease who underwent coronary angiography (19 men and 11 women; mean age, 69.0±8.8years; age range, 42-85years). The mean values of nitroglycerine-induced vasodilation in the brachial artery, left anterior descending coronary artery, and left circumflex coronary artery were 12.6±5.2%, 11.6±10.3%, and 11.9±11.0%, respectively. Nitroglycerine-induced vasodilation in the brachial artery correlated significantly with that in the left anterior descending coronary artery (r=0.43, P=0.02) and that in the left circumflex coronary artery (r=0.49, P=0.006). There was also a significant correlation between nitroglycerine-induced vasodilation in the left anterior descending coronary artery and that in the left circumflex coronary artery (r=0.72, Parteries and that in coronary arteries are simultaneously present. Nitroglycerine-induced vasodilation in the brachial artery could be used as a surrogate for that in a coronary artery and as a prognostic marker for cardiovascular events. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. CONGENITAL ANTERIOR TIBIOFEMURAL SUBLUXATION

    Directory of Open Access Journals (Sweden)

    A. Shahla

    2008-06-01

    Full Text Available Congenital anterior tibiofemoral subluxation is an extremely rare disorder. All reported cases accompanied by other abnormalities and syndromes. A 16-year-old high school girl referred to us with bilateral anterior tibiofemoral subluxation as the knees were extended and reduced at more than 30 degrees flexion. Deformities were due to tightness of the iliotibial band and biceps femuris muscles and corrected by surgical release. Associated disorders included bilateral anterior shoulders dislocation, short metacarpals and metatarsals, and right calcaneuvalgus deformity.

  19. Arterial management.

    Science.gov (United States)

    2004-04-01

    In many major metropolitan areas, the freeway system is : functioning at or beyond the capacity for which it was : designed. Many drivers are choosing to use arterial streets : instead. The resulting stress on the arterial systems creates : gridlock ...

  20. Anterior ankle impingement

    NARCIS (Netherlands)

    Tol, Johannes L.; van Dijk, C. Niek

    2006-01-01

    The anterior ankle impingement syndrome is a clinical pain syndrome that is characterized by anterior ankle pain on (hyper) dorsiflexion. The plain radiographs often are negative in patients who have anteromedial impingement. An oblique view is recommended in these patients. Arthroscopic excision of

  1. MDCTA diagnosis of cerebral vessel disease among patients with arterial hypertension

    International Nuclear Information System (INIS)

    Romanko-Hrushchak, Nataliya

    2013-01-01

    to study changes involving cerebral vessels in patients with hypertension and various levels of total cardiovascular risk. One hundred and thirty-four patients underwent CT-angiography of intracranial vessels. Ninety-eight of them were diagnosed with hypertension. Taking into consideration high blood pressure, presence of risk factors and target organ damage subjects were divided into 4 groups: with low, medium, high and very high total cardiovascular risk. Control group included 36 patients. They were not diagnosed with hypertension at the time of examination. One hundred and five patients were examined using a 4-slice CT scanner (Toshiba Asteion 4, Toshiba Medical System, Japan), and 29 patients were examined using a 128-slice scanner (Siemens Definition AS+, Siemens Healthcare, Germany) with an injection system. We used iodine-containing contrast agents such as iodixanol and iopromide for angiography. Anatomical and topographic changes of cerebral vessels were most frequently found in hypertensive patients with high and very high total cardiovascular risk. Narrowing of vertebral vessels was the most common change (27 patients (27.55%), 21 patients (21.43%) had narrowing of the right artery, and 6 (6.12%) subjects – of the left one). Tortuous course of internal carotid arteries at the neck level was visualized in 11 patients (11.22%). Narrowing of A1 segment of anterior cerebral artery was noted in 9 patients (9.18%), of the right one – in 8 patients (8.16%), of the left one – in 1 patient (1.02%). Aneurysmal dilation of intracranial vessels was visualized in 6 patients (6.12%). Saccular aneurysm of left internal carotid artery was diagnosed in 2 patients (2.04%), one patient (1.02%) had right internal carotid artery aneurysm and one patient (1.02%) had an aneurysm of the basilar artery. the most common changes of cerebral vessels diagnosed in MDCTA among patients with hypertension included various degrees of narrowing of vertebral vessels, anterior

  2. Woven coronary artery: differential diagnosis with diffuse intracoronary thrombosis.

    Science.gov (United States)

    Martuscelli, E; Romeo, F; Giovannini, M; Nigri, A

    2000-04-01

    Woven coronary malformation is characterized by the branching of a major epicardial coronary artery into thin channels which then merge again in a normal conduit. The angiogram can suggest a filling defect instead of a malformation and an undue coronary angioplasty could be performed determining some damage to the arterial wall. In this case report we describe a patient with a stenosis on the left anterior descending coronary artery and a woven coronary artery on the right coronary artery. In 1995 a coronary angioplasty was performed on the left anterior descending coronary artery. Four years later a coronary angiogram did not show any changes in the right coronary artery. In this patient the malformation did not induce any reduction in the coronary reserve as shown at cardiac scintigraphy. We need more information about the natural history of such a malformation.

  3. Acute internal carotid artery occlusion after carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Masatoshi Yunoki

    2016-09-01

    Full Text Available We report two cases of acute carotid artery (CA occlusion following carotid endarterectomy (CEA. Case 1: a 58-year-old man was admitted with transient right-sided hemiparesis. Magnetic resonance imaging (MRI and MR angiography (MRA revealed cerebral infarction in the left cerebral hemisphere and left CA stenosis. Ten days after admission, he underwent CEA. 24 h after surgery, he developed right hemiplegia. MRI and MRA demonstrated a slightly enlarged infarction and left internal carotid artery (ICA occlusion. Emergency reoperation was performed and complete recanalization achieved. The patient made a clinically significant recovery. Case 2: a 65 year-old man underwent a right-sided CEA for an asymptomatic 80% CA stenosis. 48 h after surgery, his family noticed he was slightly disorientated. MRI and MRA revealed multiple infarctions and right ICA occlusion. He was treated with antiplatelet therapy without reoperation because sufficient cross-flow from the left ICA through the anterior communicating artery was demonstrated by angiography, and his neurological symptoms were mild. His symptoms gradually alleviated and he was discharged 14 days after surgery. With ICA occlusion after CEA, immediate re-operation is mandatory with severe neurological symptoms, whereas individualized judgement is needed when the symptoms are mild.

  4. Congenital anterior urethral diverticulum

    International Nuclear Information System (INIS)

    Jung, Hyun Sub; Chung, Young Sun; Suh, Chee Jang; Won, Jong Jin

    1985-01-01

    Two cases of congenital anterior urethral diverticular which have occurred in a 4 year old and one month old boy are presented. Etiology, diagnostic procedures, and its clinical results are briefly reviewed

  5. Anterior knee pain

    Science.gov (United States)

    ... thighbone where the kneecap normally rests is too shallow. You have flat feet. Anterior knee pain is ... the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should ...

  6. Identifying anterior segment crystals.

    OpenAIRE

    Hurley, I W; Brooks, A M; Reinehr, D P; Grant, G B; Gillies, W E

    1991-01-01

    A series of 22 patients with crystals in the anterior segment of the eye was examined by specular microscopy. Of 10 patients with hypermature cataract and hyperrefringent bodies in the anterior chamber cholesterol crystals were identified in four patients and in six of the 10 in whom aspirate was obtained cholesterol crystals were demonstrated in three, two of these having shown crystals on specular microscopy. In 10 patients with intracorneal crystalline deposits, cholesterol crystals were f...

  7. Giant coronary artery aneurysm after Takeuchi repair for anomalous left coronary artery from the pulmonary artery.

    Science.gov (United States)

    Dunlay, Shannon M; Bonnichsen, Crystal R; Dearani, Joseph A; Warnes, Carole A

    2014-01-01

    A 33-year-old woman with an anomalous left coronary artery arising from the pulmonary artery who had undergone Takeuchi repair at age 7 years presented for evaluation. The Takeuchi procedure creates an aortopulmonary window and an intrapulmonary tunnel that baffles the left coronary artery to the aorta. A mediastinal mass was identified as a giant aneurysm of the left coronary artery resulting in compression of the pulmonary artery and left upper pulmonary vein. The patient underwent open repair with patch closure at the aortic entrance of the left coronary Takeuchi repair and resection and evacuation of the aneurysm. A saphenous vein graft to the left anterior descending artery was performed. Postoperative echocardiography demonstrated normal left ventricular function. This is the first reported case of giant aneurysm formation after Takeuchi repair. The reported complications have included the development of pulmonary artery stenosis at the intrapulmonary baffle, baffle leak, decreased left ventricular function, and mitral regurgitation. In conclusion, late complications of the Takeuchi procedure are common, underscoring the importance of lifelong follow-up at a center with experience in treating coronary anomalies. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Communicating with Professionals

    Medline Plus

    Full Text Available ... High Blood Pressure Know Your Numbers Understand Symptoms & Risks Learn How HBP Harms Your Health Make Changes That Matter Find HBP Tools & Resources Stroke Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals ...

  9. Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

    Directory of Open Access Journals (Sweden)

    Yoshiki Noda

    2010-01-01

    Full Text Available Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT and transthoracic echocardiography (TTE.

  10. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  11. [Mini-orbitozygomatic craniotomy in surgery for supratentorial aneurysms and tumors of the anterior and middle cranial fossae].

    Science.gov (United States)

    Dzhindzhikhadze, R S; Dreval', O N; Lazarev, V A; Kambiev, R L

    2016-01-01

    Progress in microneurosurgical techniques, neuroanesthesiology, and intraoperative imaging enables surgery using small incisions and craniotomy, in accordance with the keyhole surgery concept. Supraorbital craniotomy is the most widespread minimally invasive approach. There are a number of supraorbital craniotomy modifications, regarding different soft tissue incisions and the extent of craniotomy. We present the first results of using mini-orbitozygomatic craniotomy for aneurysms of the anterior circle of Willis and space-occupying lesions of the anterior and middle cranial fossae performed through an eyebrow incision. Forty five patients were operated on using mini-orbitozygomatic (MOZ) craniotomy in the period between March 2014 and December 2015. Fifteen supratentorial aneurysms were clipped, and 30 space-occupying lesions were resected. Most patients had unruptured aneurysms (10 patients). Five patients had a history of SAH. The aneurysm localization was as follows: 8 anterior communicating artery aneurysms, 4 aneurysms of the internal carotid artery in the area of the posterior communicating artery orifice, and 3 ophthalmic aneurysms. The Hunt-Hess scale was used to evaluate the patients' condition, and the Fisher scale was used to quantify SAH volume. Surgery was performed 14 days after SAH, on average. Contrast-enhanced MRI of the brain was the diagnostic method of choice in a group of patients with space-occupying lesions within the anterior and middle cranial fossae. In some cases, patients underwent CT with reconstruction for assessment of the skull base bone structures. The mean age of patients was 58.3 years. All aneurysms were completely excluded from the cerebral blood flow. No serious complications and deaths in a group of aneurysm patients occurred. Complete tumor removal was performed in 28 patients. Two patients having pituitary macroadenomas with supra- and parasellar spread underwent subtotal resection due to adenoma invasion into the cavernous

  12. Case report: Varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: Report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain

    Directory of Open Access Journals (Sweden)

    Sandeep G Jakhere

    2011-01-01

    Full Text Available A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during surgery or cause life-threatening retroperitoneal hemorrhage. Varicosity of this venous channel may be mistaken for paraaortic lymphadenopathy, adrenal pseudo-mass, or renal artery aneurysm. We report a case of a patient with varicosity of this communicating vein, which mimicked a left renal artery aneurysm. A novel hypothesis is also proposed to explain the relationship with abdominal pain.

  13. Value of the 12-lead electrocardiogram to define the level of obstruction in acute anterior wall myocardial infarction: correlation to coronary angiography and clinical outcome in the DANAMI-2 trial

    DEFF Research Database (Denmark)

    Eskola, Markku J; Nikus, Kjell C; Holmvang, Lene

    2008-01-01

    BACKGROUND: Acute anterior myocardial infarction (MI) caused by proximal occlusion of the left anterior descending coronary artery (LAD), is associated with unfavourable outcome and should be recognized by simple noninvasive methods like the 12-lead electrocardiogram (ECG). METHODS: In a prospect......BACKGROUND: Acute anterior myocardial infarction (MI) caused by proximal occlusion of the left anterior descending coronary artery (LAD), is associated with unfavourable outcome and should be recognized by simple noninvasive methods like the 12-lead electrocardiogram (ECG). METHODS...

  14. Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    2012-10-01

    Full Text Available OBJETIVO: Definir zona de segurança para evitar possíveis complicações vasculares e ligamentares durante a reconstrução do ligamento cruzado anterior. MÉTODOS: Reconstrução artroscópica com uso de técnica transportal e transtibial em joelhos de cadáver foi realizada seguida de dissecção e mensuração da distância entre o túnel femoral e a inserção proximal do ligamento colateral lateral e o túnel femoral e a artéria genicular lateral superior. RESULTADOS: A mensuração das distâncias analisadas mostra uma aproximação maior do principal ramo da artéria genicular lateral superior e da inserção proximal do ligamento colateral lateral com o túnel femoral, realizado com a técnica transportal. CONCLUSÃO: Percebemos que o uso da técnica transportal para reconstrução artroscópica do LCA apresenta maior probabilidade de lesão da artéria genicular lateral e da inserção do ligamento colateral lateral, favorecendo complicações pós-cirúrgicas como instabilidade do joelho, osteonecrose do côndilo femoral lateral e ligamentização do enxerto.OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and

  15. Successful Embolization of an Ovarian Artery Pseudoaneurysm Complicating Obstetric Hysterectomy

    International Nuclear Information System (INIS)

    Rathod, Krantikumar R; Deshmukh, Hemant L; Asrani, Ashwin; Salvi, Vinita S; Prabhu, Santoshi

    2005-01-01

    Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization

  16. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

  17. Doppler colour flow imaging of fetal intracerebral arteries relative to fetal behavioural states in normal pregnancy

    NARCIS (Netherlands)

    M.J. Noordam (Marja); F.M.E. Hoekstra (Franciska); W.C.J. Hop (Wim); J.W. Wladimiroff (Juriy)

    1994-01-01

    textabstractIn 14 normally developing term fetuses, the relationship between the blood flow velocity waveforms at cerebral arterial level (internal carotid artery, anterior, middle and posterior cerebral artery) and fetal behavioural states was studied using Doppler colour flow imaging. Behavioural

  18. Coronary reoperation via small laparotomy using right gastroepiploic artery without CPB

    NARCIS (Netherlands)

    Grandjean, JG; Mariani, MA; Ebels, T

    The elective use of the right gastroepiploic artery as an in situ graft has been well established in coronary surgery. We propose a surgical technique for patients undergoing coronary reoperations with a patent mammary graft to the left anterior descending artery. The gastroepiploic artery is used

  19. anterior hyaloidal fibrovascular proliferation

    African Journals Online (AJOL)

    Okonkwo

    It most commonly occurs after phakic vitrectomy and scleral buckling for diabetic traction retinal detachment. It usually manifests with haemorrhage into the vitreous cavity or anterior hyaloid 3 to 12 weeks after vitrectomy and is the result of fibrovascular proliferation from the peripheral retina extending toward the equator of ...

  20. Arterial stick

    Science.gov (United States)

    ... to breathing problems or problems with the body's metabolism . Sometimes arterial sticks are done to get blood ... and the A.D.A.M. Editorial team. Bacterial Infections Read more Blood Read more Blood Disorders ...

  1. Coronary artery fistulas as a cause of angina: How to manage these patients?

    Energy Technology Data Exchange (ETDEWEB)

    Buccheri, Dario; Dendramis, Gregory, E-mail: gregorydendramis@libero.it; Piraino, Davide; Chirco, Paola Rosa; Carità, Patrizia; Paleologo, Claudia; Andolina, Giuseppe; Assennato, Pasquale; Novo, Salvatore

    2015-07-15

    Coronary artery fistulas represent the most common hemodynamically significant congenital defect of the coronary arteries and the clinical presentation is mainly dependent on the severity of the left-to-right shunt. We describe a case of a 55-year-old man with history of chest pain and without history of previous significant chest wall trauma or any invasive cardiac procedures. A coronary multislice computed tomography showed two large coronary fistulas arising from the left anterior descending coronary artery and ending in an angiomatous plexus draining into the common pulmonary trunk. Coronary angiography confirmed the CT finding and showed a third fistulous communication arising from the sinus node artery. Although coronary fistulas are infrequent, they are becoming increasingly important because their management and treatment could prevent serious complications. The latest guidelines of the American College of Cardiology/American Heart Association indicate as Class I recommendation the percutaneous or surgical closure for large fistulas regardless of symptoms. In this manuscript, we provide a detailed review of the literature on this topic, focusing on the clinical management of these patients.

  2. Short communication: genetic ablation of L-type Ca2+ channels abolishes depolarization-induced Ca2+ release in arterial smooth muscle.

    Science.gov (United States)

    Fernández-Tenorio, Miguel; González-Rodríguez, Patricia; Porras, Cristina; Castellano, Antonio; Moosmang, Sven; Hofmann, Franz; Ureña, Juan; López-Barneo, José

    2010-04-16

    In arterial myocytes, membrane depolarization-induced Ca(2+) release (DICR) from the sarcoplasmic reticulum (SR) occurs through a metabotropic pathway that leads to inositol trisphosphate synthesis independently of extracellular Ca(2+) influx. Despite the fundamental functional relevance of DICR, its molecular bases are not well known. Biophysical and pharmacological data have suggested that L-type Ca(2+) channels could be the sensors coupling membrane depolarization to SR Ca(2+) release. This hypothesis was tested using smooth muscle-selective conditional Ca(v)1.2 knockout mice. In aortic myocytes, the decrease of Ca(2+) channel density was paralleled by the disappearance of SR Ca(2+) release induced by either depolarization or Ca(2+) channel agonists. Ca(v)1.2 channel deficiency resulted in almost abolition of arterial ring contraction evoked by DICR. Ca(2+) channel-null cells showed unaltered caffeine-induced Ca(2+) release and contraction. These data suggest that Ca(v)1.2 channels are indeed voltage sensors coupled to the metabolic cascade, leading to SR Ca(2+) release. These findings support a novel, ion-independent, functional role of L-type Ca(2+) channels linked to intracellular signaling pathways in vascular myocytes.

  3. Anatomic characterization of the radial and ulnar nutrient arteries in humans.

    Science.gov (United States)

    Kinose, Shota; Kanaya, Yosuke; Kawasaki, Yuto; Okamura, Taro; Kato, Kota; Sakai, Tatsuo; Ichimura, Koichiro

    2018-03-01

    The localization of nutrient foramens has been extensively studied in humans and other vertebrate animals. However, accurate information on the origin and extraosseous course of the nutrient arteries in some types of long tubular bones is lacking. Terminologia Anatomica, the international standard on human anatomic terminology, lists the radial nutrient artery (RNA) and the ulnar nutrient artery (UNA) as branches of the radial and ulnar arteries, respectively. Anatomy textbooks published in both German- and English-speaking countries regard both the RNA and UNA as branches of the anterior interosseous artery. To clarify the anatomic characteristics of the RNA and UNA in humans, we reexamined the origin and course of these arteries by cadaveric dissection. Almost all RNAs and UNAs branched from the ulnar artery or its tributaries. In typical cases, the RNA branched from the anterior interosseous artery and the UNA branched from the proximal part of the ulnar artery or the anterior interosseous artery. These findings are reasonable from the perspective of regional anatomy, since the ulnar artery passes more deeply than the radial artery in the proximal forearm and thus the proximal part of the ulnar artery and its major branches are situated more closely to the radial and ulnar nutrient foramens. Based on our findings, it is necessary to correct the position of the RNA and UNA in the arterial hierarchy of T. Anatomica for accurate morphological description. Copyright © 2017 Elsevier GmbH. All rights reserved.

  4. Acute subarachnoid haemorrhage: 3D time-of-flight MR angiography versus intra-arterial digital angiography

    Energy Technology Data Exchange (ETDEWEB)

    Anzalone, N. [Dept. of Neuroradiology, Scientific Inst. H. S. Raffaele, Milan (Italy); Triulzi, F. [Dept. of Neuroradiology, Scientific Inst. H. S. Raffaele, Milan (Italy); Scotti, G. [Dept. of Neuroradiology, Scientific Inst. H. S. Raffaele, Milan (Italy)

    1995-05-01

    To evaluate the efficacy and reliability of 3D time-of-flight MR angiography (TOF MRA) as a noninvasive procedure, 27 patients with acute subarachnoid haemorrhage (SAH) were studied with MRA immediately before or after intra-arterial digital subtraction angiography (DSA). 3DTOF MRA was performed with an axial slab of 60 mm centred on the circle of Willis and isotropic voxels. DSA showed 22 aneurysms and 1 dural arteriovenous fistula in 21 patients; the aneurysms ranged in size from 2 to 8 mm. MRA failed to show 2 small aneurysms, at the origin of the posterior and anterior communicating arteries. The 3D display of the intracranial vessels obtained with maximum intensity projection (MIP) or targetted MIP sometimes rendered the aneurysms better than DSA. However, due to its high spatial resolution, DSA more clearly defined the overall anatomy of the walls of the normal and abnormal vessels. (orig.)

  5. Diameter measurements of cerebral arteries on three-dimensional time-of-flight MR angiograms

    International Nuclear Information System (INIS)

    Zhang Yuzhong; Zhang Xuelin; Chang Renmin; Cang Peng; Liu Xingyuan; Xia Qiong

    2003-01-01

    Objective: To measure and establish the normal values of diameters of Chinese cerebral arteries on MRA. Methods: The diameters of the cerebral arteries in 100 persons with normal findings on 3D TOF MRA were measured with projector. There were 53 males and 47 females with the mean age of 45.8 years. 12 subjects were younger than 14 years and 88 were older than 14 years. The diameter differences between the left and the right, in gender and in ages were analyzed statistically. Results: The measurements of each arterial diameter were as follows: Ophthalmic artery: (0.8 ±0.2) mm in male, (0.9±0.2) mm in female. C2 segment of internal carotid artery (ICA-C2): (3.0±0.3) mm (≤14 years) and (3.5±0.6) mm (>14 years) in male, (2.8±0.6) mm (≤14 years) and (3.1±0.5) mm (>14 years) in female. ICA-C4: (4.3±0.6) mm in male, (3.9±0.6) mm in female. A1 segment of anterior cerebral artery (ACA-A1): (2.1±0.4) mm in male, (2.1±0.4) mm in female. Anterior communicating artery (ACoA) : (1.4±0.4) mm in male, (1.3±0.4) mm in female. M1 segment of middle cerebral artery (MCA-M1) : (2.7±0.4) mm in male, (2.6±0.4) mm in female. Basilar artery (BA) : (2.9±0.5) mm in male, (2.8±0.4) mm in female. P1 segment of posterior cerebral artery (PCA-P1) : (2.1±0.5) mm on the left and (2.0±0.5) mm on the right in male, (2.0±0.3) mm on the left and (1.9±0.3) mm on the right in female. PCA-P2: (1.8±0.4) mm in male, (1.7±0.3) mm in female. Posterior communicating artery (PCoA): (1.1±0.3) mm in male, (1.2±0.4) mm in female. Among various diameters, only PCA-P1 had significant difference between the left and the right ( P=0.003); only MCA-M1 (P =0.048), PCA-P1 (P=0.012), ICA-C2 (P=0.000) and C4 segments (P=0.000) had significant differences in gender, respectively; and only ICA-C2 had significant difference in age (P=0.001). Of these significantly different diameters, the diameters in male were larger than those in female. There were significant correlation between PCA-P1 and PCA

  6. Anterior cruciate ligament repair - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100230.htm Anterior cruciate ligament repair - Series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The anterior cruciate ligament (ACL) is a ligament in the center of ...

  7. Multidisciplinary management of anterior diastemata

    DEFF Research Database (Denmark)

    Furuse, Adilson Yoshio; Herkrath, Fernando José; Franco, Eduardo Jacomino

    2007-01-01

    Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance...

  8. Arteries and Veins of the Cerebellum.

    Science.gov (United States)

    Delion, Matthieu; Dinomais, Mickael; Mercier, Philippe

    2017-12-01

    Surgery of the posterior fossa represents a technical challenge because of the proximity of the vessels of the cerebellum. If the arterial vascularization of the cerebellum is well known, the main arterial variations and the whole venous vascularization are probably under recognized. We describe the vascular organization and the main variations through photographs of colored latex perfused brains, obtained with a surgical microscope. The arterial vascularization of the cerebellum is based on three arteries which all originate from the vertebrobasilar system: the superior cerebellar artery (SCA), the anterior and inferior cerebellar artery (AICA), and the posterior and inferior cerebellar artery (PICA). The main arterial variations involve essentially the origin of these vessels. Concerning the SCA, its origin depends on the embryology. The AICA can arise from a common trunk AICA-PICA. It can be sometimes doubled and rarely absent. The PICA also can arise from a common trunk AICA-PICA and sometimes from the extradural segment of the vertebral artery. Concerning the venous organization, we distinguish the superficial and deep veins. The superficial veins drain the cerebellar cortex and transit on the surface of the cerebellum. The deep veins refer to the veins transiting in the fissures between the cerebellum and the brainstem. All these veins terminate as bridging veins that we can divide in three groups: a superior group emptying into the great vein, a posterior group emptying into the transtentorial sinus, and a lateral group ending into the superior petrosal sinus. The surgical implications are discussed.

  9. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn

    2012-09-01

    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  10. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  11. Anterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Vidyadhar P. Mali

    2006-07-01

    Full Text Available We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU (in 2 or on cystoscopy (in 2. All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

  12. Detailed anatomy of a left accessory aberrant colic artery.

    Science.gov (United States)

    Rusu, M C; Vlad, M; Voinea, L M; Curcă, G C; Sişu, A M

    2008-10-01

    In an aged human female cadaver a left accessory aberrant colic artery (LAACA) was observed and studied. It originated from the superior mesenteric artery at 3 cm proximal to the middle colic artery, at the inferior border of pancreas, passing over Treitz's muscle and continued covered by the superior duodenal fold where it crossed the inferior mesenteric vein. Further, it continued with a satellite vein anterior to the left renal vein and the anterior branch of the renal artery. The LAACA divided into an ascending branch and a descending one, anastomosed with the middle colic and proper left colic arteries; between its two primary branches and the splenic flexure of colon, a hypovascular area was observed. The surgical relevance of the LAACA detailed anatomy mainly relates to specific procedures performed in left colectomies and nephrectomies.

  13. Collateral circulation via the circle of Willis in patients with carotid artery steno-occlusive disease: evaluation on 3-T 4D MRA using arterial spin labelling

    International Nuclear Information System (INIS)

    Iryo, Yasuhiko; Hirai, Toshinori; Nakamura, Masanobu; Inoue, Yasuteru; Watanabe, Masaki; Ando, Yukio; Azuma, Minako; Nishimura, Shinichiro; Shigematsu, Yoshinori; Kitajima, Mika; Yamashita, Yasuyuki

    2015-01-01

    Aim: To evaluate whether 3-T four-dimensional (4D) arterial spin-labelling (ASL) -based magnetic resonance angiography (MRA) is useful for assessing the collateral circulation via the circle of Willis in patients with carotid artery steno-occlusive disease. Materials and methods: Institutional review board approval and prior written informed consent from all patients were obtained. The inclusion criteria were fulfilled by 13 patients with carotid artery steno-occlusive disease. All underwent 4D-ASL MRA at 3 T and digital subtraction angiography (DSA). The flow-sensitive alternating inversion recovery (FAIR) preparation scheme with look-locker sampling was used for spin labeling. At 300-ms intervals seven dynamic scans were obtained with a spatial resolution of 0.5×0.5×0.6 mm 3 . The collateral flow via the circle of Willis was read on 4D-ASL MRA and DSA images by two sets of two independent readers each. κ statistics were used to assess interobserver and intermodality agreement. Results: On DSA, collateral flow via the anterior communicating artery (AcomA) was observed in six patients, via the posterior communicating artery (PcomA) in four patients, and via both the AcomA and PcomA in three patients. With respect to the qualitative evaluation of 4D-ASL MRA images, interobserver agreement was excellent for all items (κ=1). 4D-ASL MRA and DSA consensus readings agreed on the type of collateral flow pattern in 10 of the 13 patients (77%). Intermodality agreement was good (κ=0.606; 95% confidence interval (CI): 0.215–0.997). Conclusion: 3 T 4D-ASL MRA may be a useful tool for the evaluation of the collateral circulation in patients with carotid artery steno-occlusive disease. -- Highlights: •3-T 4D-ASL MRA has high spatial and temporal resolution. •There is no need for the use of contrast agents in this technique. •4D-ASL MRA is useful for assessing the collateral flow associated with carotid artery stenosis. •Intermodality agreement between 4D

  14. Agenesis of the internal carotid artery with a large hemangioma of the tongue

    International Nuclear Information System (INIS)

    Murotani, K.; Hiramoto, M.

    1985-01-01

    Total developmental absence of the internal carotid artery is relatively rare, with only 54 cases previously reported. Most, being without neurological symptoms, were found by chance. For this patient with cavernous hemangiomas in the facial, oral and cervical regions, conventional treatment would be embolization of the feeding vessels, combined with ligation of the external carotid artery. Angiography, however, revealed agenesis of the left internal carotid artery, abnormal origin of the aortic arch and azygos anterior cerebral artery. (orig./MG)

  15. Perawatan Ortodontik Gigitan Terbuka Anterior

    Directory of Open Access Journals (Sweden)

    Yuniar Zen

    2014-06-01

    Full Text Available Perawatan gigitan terbuka anterior telah lama dianggap sebagai tantangan bagi ortodontis. Prevalensi gigitan terbuka anterior antara 3,5% hingga 11% terdapat pada berbagai usia dan kelompok etnis, serta ada sekitar 17% pasien ortodonti memiliki gigitan terbuka. Stabilitas hasil perawatan gigitan terbuka anterior sangat sulit, karena adanya kombinasi diskrepansi anteroposterior dengan gigitan terbuka skeletal sehingga dibutuhkan tingkat keterampilan diagnosis dan klinis yang tinggi. Etiologi gigitan terbuka anterior sangat kompleks karena dapat melibatkan skeletal, dental, dan faktor-faktor habitual. Eliminasi faktor etiologi merupakan hal yang penting dalam perawatan gigitan terbuka anterior. Berbagai cara perawatan untuk koreksi gigitan terbuka anterior diantaranya bedah ortognatik dan perawatan ortodontik kamuflase, seperti high-pull headgear, chincup, bite blocks, alatfungsional, pencabutan gigi, multi-loop edgewise archwires dan mini implan. Stabilitas hasil perawatan adalah kriteria yang paling penting dalam menentukan cara perawatan gigitan terbuka anterior. Orthodontic Treatment of Anterior Open Bite. An anterior open bite therapy has long been considered a challenge to orthodontist. The prevalence of anterior openbite range from 3,5 % to 11% among various age and ethnic groups and it has been shown that approximately 17% of orthodontic patients have open bite. Stability of treatment result of anterior open bite with well-maintained results is difficult, because the combination of anteroposteriorly discrepancy with skeletal open bite requires the highest degree of diagnostic and clinical skill. The etiology is complex, potentially involving skeletal, dental and habitual factors. The importance of an anterior open bite therapy is to eliminate the cause of the open bite. Various treatment modalities for the correction of an anterior open bite have been proposed, orthognatic surgery and orthodontic camouflage treatment such as high

  16. Clinically relevant anatomy of high anterior cervical approach.

    Science.gov (United States)

    Haller, Justin M; Iwanik, Michael; Shen, Francis H

    2011-12-01

    An anatomic study of anterior cervical dissection of 11 embalmed cadavers and measurement of structures relative to cervical spine. To determine the anatomic relationship of the hypoglossal nerve (HN), internal and external superior laryngeal nerves (ESLNs), superior thyroid artery (STA), and superior laryngeal artery (SLA) to cervical spine and demonstrate any vulnerability. The anterior approach is a common approach to the cervical spine. Much of the operative morbidity in high cervical region is related to neurovascular injury leading to dysphagia, dysphonia, impaired high-pitch phonation, and impaired cough reflex. Eleven adult cadavers (5 male/6 female) were dissected bilaterally to expose structures of the high anterior cervical region. The HN consistently traveled toward the midline at C2-3 and was safe caudal to C3-4. In 95% of dissections, the internal superior laryngeal nerve (ISLN) was exposed within 1 cm of C3-4. The path of the ESLN was variable, but it was safe above C3-4 and below C6-7. The ESLN was deep to the STA, and it was less bulky and tauter than the ISLN in all dissections. The origin of the STA was quite variable along the carotid artery, but it was most commonly located at C4. Two anatomic variants of the SLA were observed. In 15 dissections, the SLA branched off the superior thyroid. In six dissections, the SLA branched directly from external carotid artery. There was no appreciable side-to-side variation in the neurovascular structures studied. On the basis this study, spine surgeons can have enhanced knowledge of high anterior cervical anatomy. The neurovascular structures in this study did not demonstrate side-to-side anatomic variation; therefore, patient pathology and surgeon preference should dictate the operative side.

  17. The intramyocardial left anterior descending artery: Prevalence and ...

    African Journals Online (AJOL)

    by muscle fibres. The deep variation had larger muscle bundles than the superficial one and was situated deep within the inter ventricular septum. Geiringer[3] and Polacek[21] reported fewer ... A retrospective analysis of 1 349 surgical reports of consecutive CABGs performed over a period of 23 years was conducted.

  18. Circumflex coronary artery with aberrant origin and atherosclerosis

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Celik, T.; Tasar, M.

    2012-01-01

    Full text: Introduction: Circumflex (Cx) coronary artery congenital anomaly is reported to be less than 1% incidence. Coronary arteries with aberrant origin are more likely to have atherosclerosis according to some published literatures. Objectives and tasks: In this study we aim to present computed tomography (CT) angiography findings of a patient, who has Cx artery with aberrant origin and atherosclerotic. Materials and methods: 57-year-old woman without any symptoms who has risk factors to atherosclerosis was referred to our clinic for coronary CT angiography. Results: In CT angiography; we detected Cx coronary artery with aberrant origin (right sinus of valsalva) and retroaortic course. Also we saw intimal irregularities and calcified plaque causing severe narrowing in the proximal segment of artery. Right coronary and left anterior descendant arteries had mild atherosclerosis. Conclusion: Coroner CT angiography, which allows multiplanar imaging with high resolution, is an effective diagnostic tool for coronary artery disease, like not only congenital anomalies but also acquired atherosclerotic disease

  19. Anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    LLopis, Eva [Hospital de la Ribera, Alzira, Valencia (Spain) and Carretera de Corbera km 1, 46600 Alzira Valencia (Spain)]. E-mail: ellopis@hospital-ribera.com; Padron, Mario [Clinica Cemtro, Ventisquero de la Condesa no. 42, 28035 Madrid (Spain)]. E-mail: mario.padron@clinicacemtro.com

    2007-04-15

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  20. Evaluating anterior knee pain.

    Science.gov (United States)

    Hong, Engene; Kraft, Michael C

    2014-07-01

    Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. The anterior cingulate cortex

    Directory of Open Access Journals (Sweden)

    Pavlović D.M.

    2009-01-01

    Full Text Available The anterior cingulate cortex (ACC has a role in attention, analysis of sensory information, error recognition, problem solving, detection of novelty, behavior, emotions, social relations, cognitive control, and regulation of visceral functions. This area is active whenever the individual feels some emotions, solves a problem, or analyzes the pros and cons of an action (if it is a right decision. Analogous areas are also found in higher mammals, especially whales, and they contain spindle neurons that enable complex social interactions. Disturbance of ACC activity is found in dementias, schizophrenia, depression, the obsessive-compulsive syndrome, and other neuropsychiatric diseases.

  2. Pathologic features of lower extremity arterial lesions in diabetes mellitus:an analysis of 162 patients

    International Nuclear Information System (INIS)

    Guo Xiangjiang; Zhang Jiwei

    2010-01-01

    Objective: To investigate the angiographic manifestations of lower extremity atherosclerotic occlusion in patients with diabetes mellitus. Methods: The angiographic findings of lower extremity in 162 patients with diabetes mellitus were retrospectively analyzed. (1) The arteries of lower extremity were divided into the following four segments: iliac, femoral, popliteal and crural artery. The involvements of these arteries were documented. (2) Based on the lesion's number, location, nature (stricture or occlusion) and length ( 5 cm), the diabetic arterial diseases were categorized. Results: (1) Of 162 diabetic lower limbs, multiple segmental lesions were seen in 131, superficial femoral arterial lesions in 130, and crural arterial lesions in 139, of which 130 arterial lesions had at least two below-the-knee arteries being involved. (2) Based on segmental angiographic classification, a total of 660 vascular lesions were detected, including stricture lesions (33.8%) and occlusive lesions (66.2%). Of the 437 occlusions, 70.5% were located in below-the-knee arteries, and most of which were longer than 10 cm and located in anterior and posterior tibial arteries, while only a few peroneal arteries were involved (P < 0.0001). One hundred and fifty-two lesions were detected in superficial femoral arteries, of which 49 (31.2%) were located at the origin of the superficial femoral artery and 56 (35.7) were in the adductor canal hiatus. Conclusion: The main feature of peripheral arterial disease of lower extremity caused by diabetes mellitus is multi-level atherosclerotic occlusion, the superficial femoral and the crural arteries are most likely to be involved. The lesions of superficial femoral artery are often located at the arterial origin and in the adductor canal hiatus, while the deep femoral artery and the femoral artery are less involved. Long occlusive lesions are more prevalent in crural arteries, especially in anterior and posterior tibial arteries. (J Intervent

  3. Morphologic expression of the left coronary artery in pigs. An approach in relation to human heart

    Directory of Open Access Journals (Sweden)

    Fabian Alejandro Gómez

    2014-04-01

    Full Text Available Introduction: In spite of its importance as an experimental model, the information on the left coronary artery in pigs is sparse. Objective: To determine the morphologic features of the left coronary artery in pigs. Methods: We evaluated 158 pig hearts. The left coronary artery was perfused with synthetic resin after their ostia had been catheterized. Diameters and courses of the vascular beds were measured with an electronic caliper (Mitutoyo(r. Results: The diameter of left coronary artery was 6.98 ± 1.56 mm and its length was 3.51±0.99 mm. It was found to end up by bifurcating itself into the anterior interventricular artery and the circumflex artery in 79% of the cases, and by trifurcating in 21% of the cases, with the presence of the diagonal artery. The anterior interventricular artery ended up at the apex in 79.7% of the cases, and the circumflex artery at the posterior aspect of the left ventricle in 64% of the case, this artery never reached the posterior interventricular sulcus. An anastomosis between the terminal branches of the anterior interventricular artery and the posterior interventricular artery was found in 7.6% of the specimens. The antero-superior branch of the anterior interventricular artery occurred in 89.9% of the hearts. A left marginal branch was observed in 87.9% of the cases with a diameter of 2.25±0.55 mm. Conclusion: Compared with humans, pigs have shorter left coronary artery trunks and branches; even the circumflex artery never reaches the posterior interventricular sulcus. Our findings are useful for the design of experimental hemodynamic and procedural models.

  4. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

    International Nuclear Information System (INIS)

    Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

    1981-01-01

    To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease

  5. [Anterior guidance in complete dentures].

    Science.gov (United States)

    Dubreuil, J; Trevelo, A

    1990-01-01

    Although the anterior guidance in complete dentures is not really a guide, the arrangement of the anterior maxillary and mandibular prosthetic teeth, defines a propulsive line called the virtual anterior guidance, a part from the cinematic criterias. The influence of this guide on cuspal movement is superior, in all mandibular points, to the influence of the condylar pathway. If this line is not respected, the practitioner may have to do excessive grindings during occlusal adjustments.

  6. Multidisciplinary management of anterior diastemata

    DEFF Research Database (Denmark)

    Furuse, Adilson Yoshio; Herkrath, Fernando José; Franco, Eduardo Jacomino

    2007-01-01

    Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance...... the aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology...

  7. Bioengineered anterior cruciate ligament

    Science.gov (United States)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  8. Subacute anterior spinal cord ischemia with lower limb monoplegia: a clinical dilemma and challenging scenario.

    LENUS (Irish Health Repository)

    Waters, Peadar S

    2012-12-01

    A 70-year-old woman presented with crescendo right lower limb monoplegia. Magnetic resonance imaging depicted anterior spinal artery syndrome with an 8.5 cm Crawford type II thoracoabdominal aortic aneurysm (TAAA). A staged hybrid procedure was performed, following which she had total exclusion of her TAAA and full resolution of her monoplegia. Clinical presentations of TAAAs can be diverse and require detailed clinical knowledge and lateral thinking to unearth unorthodox presentations. This erratic presentation of a TAAA with anterior spinal artery syndrome outlines particular challenges with management and portrays the need for tailored utilization of contemporary techniques to deal with the growing complexity of TAAAs.

  9. Types of the cerebral arterial circle (circle of Willis in a Sri Lankan Population

    Directory of Open Access Journals (Sweden)

    Gunasekera WSL

    2011-01-01

    Full Text Available Abstract Background The variations of the circle of Willis (CW are clinically important as patients with effective collateral circulations have a lower risk of transient ischemic attack and stroke than those with ineffective collaterals. The aim of the present cadaveric study was to investigate the anatomical variations of the CW and to compare the frequency of prevalence of the different variations with previous autopsy studies as variations in the anatomy of the CW as a whole have not been studied in the Indian subcontinent. Methods The external diameter of all the arteries forming the CW in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid to determine the prevalence in the variation in CW. Chisquared tests and a correspondence analysis were performed to compare the relative frequencies of prevalence of anatomical variations in the CW across 6 studies of diverse ethnic populations. Results We report 15 types of variations of CW out of 22 types previously described and one additional type: hypoplastic precommunicating part of the anterior cerebral arteries (A1 and contralateral posterior communicating arteries (PcoA 5(2%. Statistically significant differences (p Conclusion The present study reveals that there are significant variations in the CW among intra and inter ethnic groups (Caucasian, African and Asian: Iran and Sri Lanka dominant populations, and warrants further studies keeping the methods of measurements, data assessment, and the definitions of hypoplasia the same.

  10. High anterior cervical approach to the clivus and foramen magnum: a microsurgical anatomy study.

    Science.gov (United States)

    Russo, Vittorio M; Graziano, Francesca; Russo, Antonino; Albanese, Erminia; Ulm, Arthur J

    2011-09-01

    Surgical exposure of lesions located along the ventral foramen magnum (FM) and clivus poses a unique set of challenges to neurosurgeons. Several approaches have been developed to access these regions with varying degrees of exposure and approach-related morbidity. To describe the microsurgical anatomy of the high anterior cervical approach to the clivus and foramen magnum, and describe novel skull base extensions of the approach. Eight adult cadaveric specimens were included in this study. The high anterior cervical approach includes a minimal anterior clivectomy and its lateral skull base extensions: the extended anterior far-lateral clivectomy and the inferior petrosectomy. The microsurgical anatomy and exposure of the various extensions of the approach were analyzed. In addition, the capability of complementary endoscopy was evaluated. With proper positioning, the minimal anterior clivectomy exposed the vertebrobasilar junction, proximal basilar artery, anteroinferior cerebellar arteries, and 6th cranial nerve. The lateral skull base extensions provided access to the anterior FM, mid-lower clivus, and petroclival region, up to the Meckel cave, contralateral to the side of the surgical approach. The high anterior cervical approach with skull base extensions is an alternative to the classic approaches to the ventral FM and mid-lower clivus. A minimal anterior clivectomy provides access to the midline mid-lower clivus. The addition of an extended anterior far-lateral clivectomy and an inferior petrosectomy extends the exposure to the anterior FM and cerebellopontine angle lying anterior to the cranial nerves. The approach is also ideally suited for endoscopic-assisted techniques.

  11. Aorto-Right Ventricular Tunnel in Transposition of the Great Arteries

    Directory of Open Access Journals (Sweden)

    Antonio F. Corno

    2018-02-01

    Full Text Available Aorto-ventricular tunnel is an extremely rare congenital heart defect, consisting of failure of attachment of an aortic leaflet along the semilunar hinge. In all published reports the leaflet involved was either the right coronary leaflet, most frequently, or the left coronary leaflet, in most of the cases opening toward the left ventricle, with only one-eighth of the reported cases communicating with the right ventricle. Treatment of the aorto-ventricular tunnel has been anecdotally reported by interventional closure with a device and more frequently with surgical approach, either as an isolated malformation or as associated lesions. To the best of our knowledge, the presence of an aorto-ventricular tunnel of the non-adjacent aortic leaflet in transposition of the great arteries has never been reported. We have observed an aorto-ventricular tunnel involving the non-adjacent leaflet of the aortic root, which after arterial switch became the pulmonary root. The patient presented 18 years after the arterial switch with progressive dilatation of the right ventricle due to severe degree of pulmonary valve regurgitation, confirmed by echocardiography and cardiac MRI. Indication for surgery was given with the plan for a pulmonary valve implantation. Because of the intra-operative finding of disconnection of the anterior leaflet of the pulmonary valve (former aortic valve along the semilunar hinge, the surgical plan was modified and the anterior leaflet was attached to the valve annulus, with subsequent plasty in correspondence with the right and left commissurae to reduce the size of the dilated annulus to normal diameter. The post-operative course was uneventful, with extubation after few hours and discharge 4 days after surgery, with echocardiography showing trivial degree of pulmonary valve regurgitation. The patient remains in good conditions 6 months after surgery.

  12. Anterior Interhemispheric Approach for Olfactory Groove Meningioma

    Directory of Open Access Journals (Sweden)

    Imam Hidayat

    2016-09-01

    Full Text Available Objective: To evaluate the surgical technique with bifrontal interhemispheric approach for total removal of tumor in olfactory groove meningioma (OGM. Methods: This study described a case of a 38-year-old woman with bilateral blindness, anosmia, and behaviour changes. Imaging studies show a tumor mass in midfrontal base. Surgery using a bifrontal interhemispheric approach was performed and total removal was achieved and postoperative computed tomography (CT scan was performed to confirm the result. Histopathological findings established a diagnosis of meningioma. Results: A coronal skin incision behind the hairline was utilized. The scalp was elevated, taking care to reserve the vascularized pericranium medial to the linea temporalis of each side, and preserving the 2 supraorbital nerves. Eight burr holes were used, with the two initial holes made on each side of the orbitotemporal region, and the other four holes at the midline. A bifrontal craniotomy was performed. The tumor was first detached from its attachment with bipolar cautery and debulked. During this step, the main tumor feeder arteries from the anterior and posterior ethmoidal artery were interrupted, and the tumor devascularized. Total tumor removal through surgical intervention was achieved and confirmed by head CT-scan postoperatively. Conclusions: This case report supports the suitability of the bifrontal interhemispheric approach for OGM resection with additional radiation therapy.

  13. Double profunda brachii artery

    Directory of Open Access Journals (Sweden)

    Gavishiddappa A Hadimani

    2016-01-01

    Full Text Available Brachial artery (BA is a continuation of the axillary artery at the lower border of teres major. In the cubital fossa, BA divides into radial artery and ulnar artery as terminal branches. Large branch given from the BA in the upper part is profunda brachii artery. In the present case, we noticed double profunda brachii that arises from the BA. They are profunda brachii artery 1 and profunda brachii artery 2. Profunda brachii artery 1 arises in the proximal part of the BA and profunda brachii artery 2 arises distal to the profunda brachii artery 1. Both the arteries run inferolaterally in the spiral groove along with radial nerve. Variations of profunda brachii artery are important during harvesting of the lateral arm flaps and may lead to inadvertent injury during percutaneous arterial catheterization or injection of drugs.

  14. Localization of coronary artery disease with exercise electrocardiography: correlation with thallium-201 myocardial perfusion scanning

    International Nuclear Information System (INIS)

    Dunn, R.F.; Freedman, B.; Bailey, I.K.; Uren, R.F.; Kelly, D.T.

    1981-01-01

    In 61 patients with single vessel coronary artery disease (70 percent or greater obstruction of luminal diameter in only one vessel) and no previous myocardial infarction, the sites of ischemic changes on 12 lead exercise electrocardiography and on thallium-201 myocardial perfusion scanning were related to the obstructed coronary artery. The site of exercise-induced S-T segment depression did not identify which coronary artery was obstructed. In the 37 patients with left anterior descending coronary artery disease S-T depression was most often seen in the inferior leads and leads V4 to V6, and in the 18 patients with right coronary artery disease and in the 6 patients with left circumflex artery disease S-T depression was most often seen in leads V5 and V6. Although S-T segment elevation was uncommon in most leads, it occurred in lead V1 or a VL, or both, in 51 percent of the patients with left anterior descending coronary artery disease. A reversible anterior defect on exercise thallium scanning correlated with left anterior descending coronary artery disease (probability [p] less than 0.0001) and a reversible inferior thallium defect correlated with right coronary or left circumflex artery disease (p less than 0.0001). In patients with single vessel disease, the site of S-T segment depression does not identify the obstructed coronary artery; S-T segment elevation in lead V1 or aVL, or both, identifies left anterior descending coronary artery disease; and the site of reversible perfusion defect on thallium scanning identifies the site of myocardial ischemia and the obstructed coronary artery

  15. Post-irradiation vasculopathy of intracranial major arteries in children

    International Nuclear Information System (INIS)

    Nishizawa, Shigeru; Ryu, Hiroshi; Yokoyama, Tetsuo; Ninchoji, Toshiaki; Shimoyama, Ichiro; Yamamoto, Seiji; Uemura, Kenichi

    1991-01-01

    We report two rare cases of post-irradiation vasculopathy of intracranial major arteries in children. A 13-year-old girl suffered from transient right hemiparesis 1 year after irradiation for suprasellar germinoma. Left carotid angiograms revealed marked stenoses of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries, which were previously normal, and moyamoya vessels. A 2.5-year-old girl underwent internal irradiation with 198 Au colloid for cystic craniopharyngioma. At the age of 10 years, she suddenly became unconscious after vomiting. Computed tomographic scans showed a right frontal intracerebral hematoma. Right carotid angiograms disclosed complete obstruction of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries and moyamoya vessels, previously not present. The danger of radiation therapy causing occlusive vasculopathy in small and major cerebral arteries in children is emphasized. To prevent permanent ischemic neurological deficits, vasculopathy should be treated either medically or surgically as early as possible. (author)

  16. Left coronary arterial blood flow: Noninvasive detection by Doppler US

    International Nuclear Information System (INIS)

    Gramiak, R.; Holen, J.; Moss, A.J.; Gutierrez, O.H.; Picone, A.L.; Roe, S.A.

    1986-01-01

    Continuous wave (CW) and pulsed Doppler ultrasound studies with spectral analysis were used to detect the left coronary arterial blood flow in patients who were undergoing routine echocardiography. The pulmonary artery is a stable ultrasonic landmark from which detection of the blood flow can be effected. The left coronary artery can be distinguished by its blood flow toward the cardiac apex and by specific, functional flow features. Flow patterns vary among the left main, circumflex, and anterior descending arteries; patterns also vary with respiration cycles. In the present study, coronary arterial blood flow was detected in 58 of 70 patients (83%). Findings were validated by selectively injecting an agitated saline contrast medium into the left coronary artery and, in another study, by comparing human Doppler phasic flow waveforms with electromagnetic flowmeter recordings obtained in dogs

  17. Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft

    Science.gov (United States)

    Al-Sabti, Hilal Ali; Al Kindi, Adil; Al-Rasadi, Khalid; Banerjee, Yajnavalka; Al-Hashmi, Khamis; Al-Hinai, Ali

    2013-01-01

    Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency. PMID:24198449

  18. Inestabilidad Anterior de Hombro

    Directory of Open Access Journals (Sweden)

    Pablo David Flint Kuran

    2013-11-01

    Full Text Available In­tro­duc­ción La luxación recidivante de hombro es una patología frecuente en pacientes jóvenes, laboralmente activos. Existen numerosas técnicas quirúrgicas para la inestabilidad glenohumeral. La técnica de Bristow, discutida por no ser anatómica y por sus complicaciones, continúa vigente debido al bajo índice de reluxaciones. Los objetivos fueron determinar el índice de recidiva, alteraciones funcionales e índice de consolidación del injerto. Materiales­ y­ Métodos Se evaluaron 24 pacientes del sexo masculino, de entre 19 y 40 años, operados por luxación anterior recidivante de hombro según la técnica de Bristow, entre enero de 2003 y agosto de 2011. Se evaluó la tasa de reluxación, la función articular según el puntaje de Constant y el posicionamiento del injerto con respecto a la superficie articular con tomografía y radiografías para evaluar la consolidación del injerto. Se registraron las complicaciones quirúrgicas. Resultados ­Todos los pacientes eran hombres, con rango de edad de 19 a 40 años. La causa fue traumática en 24 pacientes. Dieciséis pacientes presentaron más de 3 episodios de luxación prequirúrgicos. Según la escala de Constant, 21 obtuvieron entre 96 y 100 puntos, y los restantes, entre 90 y 95 puntos. No hubo nuevos episodios de luxaciones. La tomografía mostró la consolidación en todos los casos. Un paciente tuvo una imagen osteolítica alrededor del tornillo, sin compromiso funcional del hombro. Conclusión La técnica de Bristow para tratar la luxación anterior recidivante de hombro provocó un bajo índice de complicaciones, con resultados funcionales entre excelentes y buenos. No hubo episodios de reluxación y se logró la consolidación del injerto óseo en todos los casos.

  19. Cortical branches of the middle cerebral artery in silver fox (Vulpes vulpes

    Directory of Open Access Journals (Sweden)

    Benedykt Skoczylas

    Full Text Available ABSTRACT: The study of the vascularization of the cerebrum in silver fox was performed on 80 cerebral hemispheres. It was found that the middle cerebral artery is the strongest vessel supplying blood to the cerebrum. The artery gets divided into ten permanent branches. Two olfactory arteries supply the region of the cerebrum located on the border between the old and the new cortex. The other eight supply the region of the new cortex. The frontal, parietal and temporal branches descended independently from the main trunk of the middle cerebral artery or formed a common trunk. Common trunks for respective groups of branches have been described as the anterior, superior and posterior middle cerebral artery. The alterior olfactory artery in 5% of cases and posterior olfactory artery in 2.5% of cases were independent branches of the middle cerebral artery extending from the rostral cerebral artery.

  20. Anterior ankle arthrodesis

    Science.gov (United States)

    Slater, Gordon L; Sayres, Stephanie C; O’Malley, Martin J

    2014-01-01

    Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes TomoFix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients (92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased (P plate offers added compression and provides a rigid fixation for arthrodesis stabilization. PMID:24649408

  1. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  2. Carotid Artery Disease

    Science.gov (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  3. Anterior Circulation Steal Syndrome

    Directory of Open Access Journals (Sweden)

    Motahareh Afrakhteh

    2017-02-01

    pattern and we can see the Flap flow in pseudolumen but in Carotid jugular fistula there is bidirectional and low resistance flow in proximal ICA. Meanwhile jugular vein have pulsatile flow due to direct carotid arterial flow.we presented a case of carotid-jugular fistula following cervical trauma.we are implicating on the role of carotid duplex for evaluation of cervical trauma. Duplex could efficiently differentiate between the two major  complication of trauma that is cervical arteries dissection and carotid-jugular fistula.

  4. Peripheral artery disease - legs

    Science.gov (United States)

    Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of ...

  5. Anterior segment indocyanine green angiography in anterior scleritis and episcleritis.

    Science.gov (United States)

    Guex-Crosier, Yan; Durig, Jacques

    2003-09-01

    To evaluate the pattern of anterior segment indocyanine green (ICG) angiography in episcleritis and scleritis. Prospective comparative (paired-eye) observational case series. Twenty subjects presenting clinical diseases compatible with episcleritis or scleritis. Anterior segment ICG angiography was performed according to a standard protocol in subjects presenting either episcleritis or scleritis. Photographs of the anterior segment were taken in the early phase (up to 3 minutes after dye injection), intermediate phase (10-12 minutes) and late phase (30-45 minutes). The inflamed zones were compared with the same regions of the controlateral eye. The amount of protein ICG exudation was scored by a masked observer as follows: zero for no exudation, one for slight exudation, two for moderate exudation, and three for severe exudation. Evaluation of dye leakage, which reflects protein exudation, with anterior segment ICG angiography in episcleritis and scleritis. Twenty subjects with a mean age of 43 +/- 15 years (7 male, 13 female) were enrolled in the study. Thirteen subjects had anterior scleritis (7 nodular, 5 diffuse, and 1 scleromalacia perforans), and 7 subjects had episcleritis. Only 1 out of 7 subjects with episcleritis showed a slight ICG leakage (a score of one), whereas all subjects with scleritis had ICG leakage scores of one or more (P = 0.0005, Fisher exact test). ICG angiography of the anterior segment of the eye is a good clinical test to differentiate episcleritis from scleritis.

  6. Communicating with Professionals

    Medline Plus

    Full Text Available ... Search By Zipcode Search by State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) ... HBP Tools & Resources Stroke Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Communicating with Professionals ...

  7. The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma

    DEFF Research Database (Denmark)

    Willer, Hanne; Aabakke, Anna J M; Krebs, Lone

    2014-01-01

    delivery of either the anterior or posterior shoulder. The primary outcome is any perineal trauma. Additional outcomes are the perineal injury subtypes, postpartum bleeding, umbilical artery pH, Apgar score at 5 minutes and any neonatal birth trauma. Perineal trauma is assessed by a midwife or doctor...

  8. Arterial tree anomalies in patients with clubfoot: an investigation carried out at Soba University Hospital.

    Science.gov (United States)

    Shaheen, Samir; Bahar, Mustafa E H; Mohammed, Almigdad H A; Elbadri, Sara F A; Johari, Ashok

    2018-01-01

    Vascular deficiencies and reduced perfusion of the anterior tibial artery and the dorsalis pedis artery were suggested as causes of congenital talipes equino varus (CTEV). In this study, we assessed the prevalence of arterial abnormalities in patients with CTEV (50 patients; 74 feet) compared with a normal control group (16 patients; 32 feet) by Doppler ultrasound and Ankle Brachial Index. The flow was normal in the control group and was deficient in 39.19% of clubfoot patients. In severe clubfoot cases, the deficiency was found to an extent of 76.67%. In conclusion, the anterior tibial artery and dorsalis pedis artery are deficient in CTEV patients; to avoid postoperative skin sloughing, arterial supply must be protected using a judicious incision.

  9. Analysis of Arterial Mechanics During Head-Down-Tilt Bed Rest

    Science.gov (United States)

    Elliott, Morgan B.; Martin, David S.; Westby, Christian M.; Stenger, Michael B.; Platts, Steven H.

    2014-01-01

    Carotid, brachial, and tibial arteries reacted differently to HDTBR. Previous studies have not analyzed the mechanical properties of the human brachial or anterior tibial arteries. After slight variations during bed-rest, arterial mechanical properties and IMT returned to pre-bed rest values, with the exception of tibial stiffness and PSE, which continued to be reduced post-bed rest while the DC remained elevated. The tibial artery remodeling was probably due to decreased pressure and volume. Resulting implications for longer duration spaceflight are unclear. Arterial health may be affected by microgravity, as shown by increased thoracic aorta stiffness in other ground based simulations (Aubert).

  10. Anterior Knee Pain (Chondromalacia Patellae).

    Science.gov (United States)

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  11. Anterior approach for knee arthrography

    International Nuclear Information System (INIS)

    Zurlo, J.V.; Towers, J.D.; Golla, S.

    2001-01-01

    Objective. To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy.Design. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected.Results and conclusion. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort. (orig.)

  12. A Case of Double Right Coronary Artery with Separate Ostium

    Directory of Open Access Journals (Sweden)

    Jalal Kheirkhah

    2015-10-01

    Full Text Available Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, and biphasic T wave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs.

  13. Estimation of labeling efficiency in pseudocontinuous arterial spin labeling.

    Science.gov (United States)

    Aslan, Sina; Xu, Feng; Wang, Peiying L; Uh, Jinsoo; Yezhuvath, Uma S; van Osch, Matthias; Lu, Hanzhang

    2010-03-01

    Pseudocontinuous arterial spin labeling MRI is a new arterial spin labeling technique that has the potential of combining advantages of continuous arterial spin labeling and pulsed arterial spin labeling. However, unlike continuous arterial spin labeling, the labeling process of pseudocontinuous arterial spin labeling is not strictly an adiabatic inversion and the efficiency of labeling may be subject specific. Here, three experiments were performed to study the labeling efficiency in pseudocontinuous arterial spin labeling MRI. First, the optimal labeling position was determined empirically to be approximately 84 mm below the anterior commissure-posterior commissure line in order to achieve the highest sensitivity. Second, an experimental method was developed to utilize phase-contrast velocity MRI as a normalization factor and to estimate the labeling efficiency in vivo, which was founded to be 0.86 +/- 0.06 (n = 10, mean +/- standard deviation). Third, we compared the labeling efficiency of pseudocontinuous arterial spin labeling MRI under normocapnic and hypercapnic (inhalation of 5% CO(2)) conditions and showed that a higher flow velocity in the feeding arteries resulted in a reduction in the labeling efficiency. In summary, our results suggest that labeling efficiency is a critical parameter in pseudocontinuous arterial spin labeling MRI not only in terms of achieving highest sensitivity but also in quantification of absolute cerebral blood flow in milliliters per minute per 100 g. We propose that the labeling efficiency should be estimated using phase-contrast velocity MRI on a subject-specific basis. (c) 2010 Wiley-Liss, Inc.

  14. Expression of melatonin receptors in arteries involved in thermoregulation

    International Nuclear Information System (INIS)

    Viswanathan, M.; Laitinen, J.T.; Saavedra, J.M.

    1990-01-01

    Melatonin binding sites were localized and characterized in the vasculature of the rat by using the melatonin analogue 2-[125I]iodomelatonin (125I-melatonin) and quantitative in vitro autoradiography. The expression of these sites was restricted to the caudal artery and to the arteries that form the circle of Willis at the base of the brain. The arterial 125I-melatonin binding was stable, saturable, and reversible. Saturation studies revealed that the binding represented a single class of high-affinity binding sites with a dissociation constant (Kd) of 3.4 x 10(-11) M in the anterior cerebral artery and 1.05 x 10(-10) M in the caudal artery. The binding capacities (Bmax) in these arteries were 19 and 15 fmol/mg of protein, respectively. The relative order of potency of indoles for inhibition of 125I-melatonin binding at these sites was typical of a melatonin receptor: 2-iodomelatonin greater than melatonin greater than N-acetylserotonin much much greater than 5-hydroxytryptamine. Norepinephrine-induced contraction of the caudal artery in vitro was significantly prolonged and potentiated by melatonin in a concentration-dependent manner, suggesting that these arterial binding sites are functional melatonin receptors. Neither primary steps in smooth muscle contraction (inositol phospholipid hydrolysis) nor relaxation (adenylate cyclase activation) were affected by melatonin. Melatonin, through its action on the tone of these arteries, may cause circulatory adjustments in these arteries, which are believed to be involved in thermoregulation

  15. Dynamic exercise enhances regional cerebral artery mean flow velocity

    DEFF Research Database (Denmark)

    Linkis, P; Jørgensen, L G; Olesen, H L

    1995-01-01

    Dynamic exercise enhances regional cerebral artery mean flow velocity. J. Appl. Physiol. 78(1): 12-16, 1995.--Anterior (ACA) and middle (MCA) cerebral artery mean flow velocities (Vmean) and pulsatility indexes were determined using transcranial Doppler in 14 subjects during dynamic exercise after...... a focal response but depended did not demonstrate a focal response but depended on the muscle mass involved during exercise. The data demonstrate a significant increase in Vmean for the artery supplying the cortical projection of the exercising limb. Insignificant and marginally significant increases...

  16. Isolated Unilateral Absent Branch Pulmonary Artery with Peripheral Pulmonary Stenosis and Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Sunil Abhishek B

    2017-09-01

    Full Text Available Isolated Unilateral Absent Pulmonary Artery (UAPA is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD artery that was totally cut off at the mid segment. The Left Circumflex (LCx artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.

  17. Ophthalmic artery occlusion following neuro-embolization of the external carotid artery, a case report.

    Science.gov (United States)

    Loon, Ng Wei; Gendeh, Balwant Singh; Zakaria, Rozman; Hamzah, Jemaima Che; Din, Norshamsiah Md

    2017-06-15

    Embozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery occlusion after Embozene® embolization of the external carotid artery (ECA). A 22-year-old African gentleman presented with left nasal obstruction and epistaxis for 2 years and was diagnosed with nasopharyngeal carcinoma. He subsequently underwent embolization of the maxillary branch of the left ECA using Embozene® Microspheres - 250 μm in size before endoscopic tumour excision to reduce intra-operative bleeding. He complained of sudden painless profound visual loss in the left eye (LE) two hours after embolization. Visual acuity in LE was no light perception. Fundus examination showed pale retina with no cherry red spot. Arterial narrowing and segmentation were seen in all quadrants. A diagnosis of left ophthalmic artery occlusion was made. Despite immediate management including ocular massage and lowering of intraocular pressure, the visual loss remained. Retrospective review of digital subtraction angiogram showed an anastomosis between the left ophthalmic artery and anterior deep temporal artery as a potential route for microspheres migration. Pre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. The use of newer agents for embolotherapy may cause migration of embolic material from the external to the internal carotid system leading to ophthalmic artery occlusion and blindness.

  18. An Incidental Finding of the Thyroidea Ima Artery:-A Case Report Study

    Directory of Open Access Journals (Sweden)

    Lalit C. Ratanpara

    2015-12-01

    Full Text Available We are here reporting a case of an incidental finding of the thyroidea ima artery emerging from the brachiocephalic trunk with a typical inferior thyroid vessels on both sides emerging from the thyrocervical trunk. The thyroidea ima artery entered the thyroid gland near to anterior surface of right lobe of thyroid gland. It arose from the brachiocephalic artery proximal to its bifurcation.

  19. Subarachnoid hemorrhage-induced upregulation of the 5-HT1B receptor in cerebral arteries in rats

    DEFF Research Database (Denmark)

    Hansen-Schwartz, Jacob; Hoel, Natalie Løvland; Xu, Cang-Bao

    2003-01-01

    experimental SAH. METHODS: Experimental SAH was induced in rats by using an autologous prechiasmatic injection of arterial blood. Two days later, the middle cerebral artery (MCA), posterior communicating artery (PCoA), and basilar artery (BA) were harvested and examined functionally with the aid of a sensitive...

  20. Extrinsic stretching narrowing and anterior indentation of the rectosigmoid junction

    International Nuclear Information System (INIS)

    Schulman, A.; Fataar, S.

    1979-01-01

    Thirty-five cases of extrinsic narrowing or anterior indentation of the rectosigmoid junction (RSJ) have been studied. The RSJ lies directly behind the pouch of Douglas which is a favoured site for peritoneal metastasis, abscess and endometriosis. Any space-occupying lesion of sufficient size at this site will indent the anterior aspects of the RSJ. Causes include distension or tumour of the ileum or sigmoid colon, gross ascites (when the patient is erect), and tumours below the pelvic peritonium, such as gynaecological neoplasm and internal iliac artery aneurysm. When a desmoplastic metastasis in the pouch of Douglas infiltrates the outer layers of the RSJ, the fibrosis produces an eccentric shortening on its anterior aspect, which in turn causes a pleating of the mucosa with the folds radiating towards the shortened area. This is also seen with primary pelvic carcinomas directly adherent to the rectum, endometriosis with repeated bleeding and increasing eccentric, submucosal fibrosis, and chronic abscess in the pouch of Douglas. Not all extrinsic narrowing of the RSJ are pathological. One case of anterior indentation followed operation for rectal prolapse. Ten additional cases showed narrowing due to a technical artefact air-distended colon rising into the upper abdomen to cause stretching at the RSJ. As with ascites, this narrowing due to 'high-rise sigmoid' disappeared when the patients became recumbent and the colonic air redistributed. (author)

  1. Spontaneous coronary artery dissection: complete angiographic resolution without stenting

    Directory of Open Access Journals (Sweden)

    Alexandre Abizaid

    2007-09-01

    Full Text Available A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.

  2. Notes upon the intercostal arteries in some snakes

    NARCIS (Netherlands)

    Brongersma, L.D.

    1961-01-01

    From its origin, the right aortic arch passes anteriorly, and obliquely to the right; in this part of its course it gives off the two carotid arteries, or as the case may be (e.g., in Uropeltis melanogaster (GRAY)) the common carotid trunk. It then curves dorsally, medially, and caudally. At the end

  3. Acute Simultaneous Thrombotic Occlusion of Multiple Coronary Arteries in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Daei

    2017-05-01

    Full Text Available Introduction Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI, and has a high mortality rate. Case Presentation We report a case of myocardial infarction with cardiogenic shock, left bundle branch block, and multiple ST segment elevation on the electrocardiogram and thrombotic occlusion of the left circumflex, optus marginal, and left anterior descending arteries on emergency coronary angiography. Thrombus aspiration was performed at left circumflex, optus marginal, and left anterior descending arteries. Conclusions In patients with STEMI, multiple coronary thrombosis is unusual and associated with high patient mortality.

  4. Reconstruction of Anterior Neck Scar Contracture Using A Perforator-Supercharged Transposition Flap

    Directory of Open Access Journals (Sweden)

    Yoshihiro Noda, MD

    2018-02-01

    Full Text Available Summary:. Reconstruction of the anterior neck requires attention to both aesthetic and functional outcomes. In general, skin grafts are not suitable for anterior neck reconstruction in Asian patients, even when artificial dermis is used before skin grafting. Therefore, we have employed various types of thin flaps for anterior neck reconstruction, including the cervico-pectoral flap. However, we have realized that, to fully release neck contractures and therefore achieve the full range of neck extension, the skin pedicle must be sufficiently wide. Therefore, we have started reconstructing anterior neck scar contractures using wide, thin, and long flaps that are harvested from the anterior chest wall. In this article, we describe the case of a 71-year-old man who presented with a neck contracture and tracheal fistula after receiving extensive burns. A transposition flap bearing the internal mammary artery perforator was harvested from the anterior chest wall to repair the neck wounds that were left after removing the scar. At the same time, the tracheal fistula was covered by the flap. The aesthetic and functional results were acceptable. The effectiveness of supercharged transposition flaps from the anterior chest wall for reconstructing anterior neck scar contraction is discussed.

  5. Vertebral Artery Stump Syndrome.

    Science.gov (United States)

    Suzuki, Masato; Dembo, Tomohisa; Hara, Wataru; Tajima, Takashi; Yamashita, Minako; Oji, Satoru; Nomura, Kyoichi

    2018-03-01

    Carotid stump syndrome is a well-documented embolic source for ischemic stroke. However, few cases have been reported of a similar condition - termed vertebral artery stump syndrome - which affects the posterior circulation after vertebral artery origin occlusion. We herein report a case of infarction of the right superior cerebellar artery and left posterior inferior cerebellar artery territories due to vertebral artery stump syndrome. In this interesting case, a turbulent flow at the distal side of the vertebral artery occlusion was captured on ultrasonography, and was identified as the probable mechanism of vertebral artery stump syndrome.

  6. Toxic anterior segment syndrome following deep anterior lamellar keratoplasty

    Directory of Open Access Journals (Sweden)

    Neslihan Sevimli

    Full Text Available ABSTRACT We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS that developed after undergoing deep anterior lamellar keratoplasty (DALK. She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber.

  7. Anterior ankle arthroscopy, distraction or dorsiflexion?

    NARCIS (Netherlands)

    de Leeuw, P.A.J.; Golanó, P.; Clavero, J.A.; van Dijk, C.N.

    2010-01-01

    Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly

  8. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa

    NARCIS (Netherlands)

    Broekman, Evelien A.; Versteeg, Henneke; Vos, Louwerens D.; Dijksterhuis, Marja G.; Papatsonis, Dimitri N.

    2015-01-01

    Objective To evaluate the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage during cesarean delivery among patients with anterior placenta previa. Methods In a retrospective cohort study conducted at Amphia

  9. A Rare Differential Diagnosis of a Solitary Anterior Neck Mass

    Directory of Open Access Journals (Sweden)

    Jeyasakthy Saniasiaya

    2016-09-01

    Full Text Available Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.

  10. The venous anatomy of the abdominal wall for Deep Inferior Epigastric Artery (DIEP) flaps in breast reconstruction

    Science.gov (United States)

    Ashton, Mark W

    2012-01-01

    Background Despite improving outcomes, venous problems in the harvest of deep inferior epigastric artery perforator (DIEP) flaps remain the more common vascular complications. However, it is apparent that the venous anatomy of the anterior abdominal wall has not been described to the same extent as the arterial anatomy. Cadaveric dissection studies of venous anatomy frequently lack the detail of their arterial counterparts. Venous valves complicate retrograde injection, resulting in poor quality studies with limited anatomical information. Methods The current manuscript comprises a review of the literature, highlighting key features of the anatomy of the venous drainage of the abdominal wall integument, with particular pertinence to DIEP flaps. Both cadaveric and clinical studies are included in this review. Our own cadaveric and in-vivo studies were undertaken and included in detail in this manuscript, with the cadaveric component utilizing direct catheter venography and the in-vivo studies were undertaken using preoperative computed tomographic angiography (CTA), mapping in-vivo venous flow. Results Several key features of the venous anatomy of the abdominal wall render it different to other regions, and are of particular importance to DIEP flap transfer. Conclusions The cause of venous compromise is multi-factorial, with perforator diameter, midline crossover, and deep-superficial venous communications all important. Venous cadaveric studies as well as clinical CTA preoperatively can identify these anomalies. PMID:25083432

  11. Arterial blood supply to midbrain, thalamus and internal capsule on CT, 3

    International Nuclear Information System (INIS)

    Takeshita, Gen; Ottomo, Michinori; Sasaki, Taisuke; Fukuda, Eiko.

    1984-01-01

    The selective injection of dye into the anterior choroidal artery (blue), the medial posterior choroidal artery (green), and the lateral posterior choroidal artery (red), using seven post-mortem brains, was performed. After fixation, sections parallel with the orbito-meatal line were obtained. The distribution of the anterior choroidal artery was visualized in the uncal region of the temporal lobe and the cerebral peduncle below the slice of the third ventricle. On the slice of the third ventricle, the lateral part of the geniculate region, the globus pallidus, and the posterior limb of the internal capsule were supplied by the anterior choroidal artery. The blood supply of the posterior limb of the internal capsule was also demonstrated on the slice of the anterior horn and on the body of the lateral ventricle. The distribution of the medial posterior choroidal artery was visualized in the tegmentum of the midbrain below the slice of the third ventricle, and on the slice of the anterior horn, the pineal body and the posterior part of the thalamus were also supplied. The distribution of the lateral posterior choroidal artery was visualized in the lateral part of the midbrain, around the red nucleus, below the slice of the third ventricle, and on the slice of the third ventricle, the upper part of the cerebral peduncle, the posterior part of the hypothalamus, and the medial part of the geniculate region were also supplied. Also, distribution to the medial and posterior parts of the thalamus was noted on the slice of the anterior horn. It was quite useful to identify the distribution of each choroidal artery on CT sections for the CT diagnosis of cerebrovascular disorders. (author)

  12. Surgical revascularization of posterior coronary arteries without cardiopulomonary bypass

    Directory of Open Access Journals (Sweden)

    Lobo Filho J. Glauco

    1999-01-01

    Full Text Available OBJECTIVE: To assess the results observed during the early postoperative period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB, in regard to the following parameters: age, sex,bypass grafts types, morbidity and mortality. METHODS: From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR. Of this total, 607 (90.20% MR procedures were performed without CPB. The posterior coronary arteries (PCA were revascularized in 298 (44.27% patients, 280 (93.95% without CPB. The age of the patients ranged from 37 to 88 years (mean, 61 years. The male gender predominated, with 198 men (70.7%. The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10%; marginal branches of the circumflex artery (243 patients, 78.7%; posterior ventricular artery (4 patients, 1.3%; and posterior descending artery (31 patients, 10%. RESULTS: Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5%. There were 11 deaths in the early postoperative period (mortality of 3.9%. CONCLUSION: Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.

  13. Technical strategy in a patient with symptomatic thoracic aneurysm near the origin of the left subclavian artery and left internal thoracic artery coronary graft.

    Science.gov (United States)

    Babic, Srdjan D; Radak, Djordje J; Sotirovic, Vuk A; Unic-Stojanovic, Dragana R; Babic, Dusan S; Popov, Petar Z; Sagic, Dragan Z

    2012-11-01

    Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico-axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)-left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. © 2012 Wiley Periodicals, Inc.

  14. Anterior retroperitoneal rami: until now unnamed direct branches of the abdominal aorta.

    Science.gov (United States)

    Turyna, R; Kachlik, D; Feyreisl, J; Stingl, J; Baca, V

    2014-09-01

    The aim of the study was to gain a thorough knowledge of the topography and distribution of until now officially unnamed minute direct branches from abdominal aorta, stemming from its ventral and lateral aspects, supplying surrounding tissue, and to comprise it to the existing studies. The study was performed in fixed cadaverous material collected from India ink injections of abdominal aorta samples with large surrounding retroperitoneal tissue. The 25 samples were dissected under magnifying binocular glass, followed by graphic reconstruction; statistical analysis, and the study was preceded with detailed review of branches from abdominal aorta. For systematization of the segmental anatomy of the abdominal aorta and infrarenal segment of inferior vena cava, we defined three levels in this area. The retroperitoneal branches were most frequently situated simultaneously within all three predefined levels according to renal and inferior mesenteric arteries origin. There were 18% of retroperitoneal branches within Level 1, 39% within Level 2 and 43% within Level 3. They were branches not only from the abdominal aorta, but also from the testicular/ovarian artery, common iliac artery and in one case from the right accessory renal artery. Paired arrangement was recorded mainly cranially to the origin of inferior mesenteric artery, unpaired branches were more frequently found caudally. In conclusion, due to the terminological disunity of these arteries in the clinical literature and total absence in the anatomical literature, we propose to denominate them as anterior retroperitoneal branches of abdominal aorta (rami retroperitoneales anteriores aortae abdominalis). © 2014 Wiley Periodicals, Inc.

  15. Anterior ethmoid anatomy facilitates dacryocystorhinostomy.

    Science.gov (United States)

    Blaylock, W K; Moore, C A; Linberg, J V

    1990-12-01

    The ethmoid air cell labyrinth lies adjacent to the medial orbital wall, extending even beyond the sutures of the ethmoid bone. Its anatomic relationship to the lacrimal sac fossa is important in lacrimal surgery. We evaluated computed tomographic scans of 190 orbits with normal ethmoid anatomy to define the anatomic relationship of anterior ethmoid air cells to the lacrimal sac fossa. In 93% of the orbits, the cells extended anterior to the posterior lacrimal crest, with 40% entering the frontal process of the maxilla. This anatomic relationship may be used to facilitate the osteotomy during dacryocystorhinostomy. During a 10-year period (310 cases), one of us routinely entered the anterior ethmoid air cells to initiate the osteotomy during dacryocystorhinostomy. This technique has helped to avoid lacerations of the nasal mucosa.

  16. Endovascular Management of Central Retinal Arterial Occlusion.

    Science.gov (United States)

    Agarwal, Nitin; Gala, Nihar B; Baumrind, Benjamin; Hansberry, David R; Thabet, Ahmad M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-11-01

    Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.

  17. Imaging of Dual Ophthalmic Arteries: Identification of the Central Retinal Artery

    Directory of Open Access Journals (Sweden)

    Louise Louw

    2014-01-01

    Full Text Available Identification of the origin of the central retinal artery (CRA is imperative in tailoring angiographic studies to resolve a given clinical problem. A case with dual ophthalmic arteries (OAs, characterized by different origins and distinct branching patterns, is documented for training purposes. Pre-clinical diagnosis of a 9-year-old child who presented with a sharp wire in the left-side eyeball was primarily corneal laceration. For imaging, a selected six-vessel angiographic study with the transfemoral approach was performed. Embolization was not required and the wire could be successfully removed. Right-side OA anatomy was normal, while left-side dual OAs with external carotid artery (ECA and internal carotid artery (ICA origins were seen. The case presented with a left-side meningo-ophthalmic artery (M-OA anomaly via the ECA, marked by a middle meningeal artery (MMA (origin: Maxillary artery; course: Through foramen spinosum with normal branches (i.e. anterior and posterior branches, and an OA variant (course: Through superior orbital fissure with a distinct orbital branching pattern. A smaller OA (origin: ICA; course: Through optic foramen with a distinct ocular branching pattern presented with the central retinal artery (CRA. The presence of the dual OAs and the M-OA anomaly can be explained by disturbed evolutionary changes of the primitive OA and stapedial artery during development. The surgical interventionist must be aware of dual OAs and M-OA anomalies with branching pattern variations on retinal supply, because of dangerous extracranial-intracranial anastomotic connections. It is of clinical significance that the origin of the CRA from the ICA or ECA must be determined to avoid complications to the vision.

  18. Anatomic anterior cruciate ligament reconstruction: reducing anterior tibial subluxation

    NARCIS (Netherlands)

    Muller, Bart; Duerr, Eric R. H.; van Dijk, C. Niek; Fu, Freddie H.

    2016-01-01

    To measure and compare the amount of anterior tibial subluxation (ATS) after anatomic ACL reconstruction for both acute and chronic ACL-deficient patients. Fifty-two patients were clinically and radiographically evaluated after primary, unilateral, anatomic ACL reconstruction. Post-operative true

  19. Radiometric analysis of paraclinoid carotid artery aneurysms.

    Science.gov (United States)

    Tanaka, Yuichiro; Hongo, Kazuhiro; Tada, Tsuyoshi; Nagashima, Hisashi; Horiuchi, Tetsuyoshi; Goto, Tetsuya; Koyama, Jun-ichi; Kobayashi, Shigeaki

    2002-04-01

    Classification of paraclinoid carotid artery (CA) aneurysms based on their associated branching arteries has been confusing because superior hypophyseal arteries (SHAs) are too fine to appear opacified on cerebral angiograms. The authors performed a retrospective radiometric analysis of surgically treated paraclinoid aneurysms to elucidate their angiographic and anatomical characteristics. A retrospective analysis was made of 85 intradural paraclinoid aneurysms in which the presence or absence of branching arteries had been determined at the time of surgical clipping. The lesions were classified as supraclinoid, clinoid, and infraclinoid aneurysms based on their relation to the anterior clinoid process on lateral angiograms of the CA. The direction of the aneurysms were measured according to angles formed between the medial portion of the horizontal line crossing the aneurysm sac and the center of the aneurysm neck on anteroposterior angiograms. Branching arteries were associated with 68 aneurysms, of which 28 were ophthalmic artery (OphA) lesions (32.9%) and 40 were SHA ones (47.1%); associated branching arteries were absent in 17 aneurysms (20%). Twenty-five aneurysms (29.4%) were located at the supraclinoidal level, 46 (54.1%) at the clinoidal, and 14 (16.5%) at the infraclinoidal. The majority of aneurysms identified at the supraclinoidal level were OphA lesions (44%) or those unassociated with branching arteries (48%), with mean directions of 57 degrees or 67 degrees, respectively. At the clinoidal level, the mean directions of aneurysms were 76 degrees in six lesions unassociated with branching arteries (13%), 43 degrees in 16 OphA lesions (35%), and -11 degrees in 24 SHA ones (52%). All aneurysms at the infraclinoidal level arose at the origin of the SHAs, with a mean direction of -29 degrees, and most of these were embedded in the carotid cave. Aneurysms arising from the SHA can be distinguished from those not located at an arterial division by cerebral

  20. Optimal Entry Point and Trajectory for Anterior C1 Lateral Mass Screw.

    Science.gov (United States)

    Hu, Yong; Dong, Wei-Xin; Spiker, William Ryan; Yuan, Zhen-Shan; Sun, Xiao-Yang; Zhang, Jiao; Xie, Hui; Albert, Todd J

    2017-06-01

    A radiographic analysis of the anatomy of the C1 lateral mass using computed tomography (CT) scans and Mimics software. To define the anatomy of the C1 lateral mass and make recommendations for optimal entry point and trajectory for anterior C1 lateral mass screws. Although various posterior insertion angles and entry points for screw insertion have been proposed for posterior C1 lateral mass screws, no large series have been performed to assess the ideal entry point and optimal trajectory for anterior C1 lateral mass screw placement. The C1 lateral mass was evaluated using CT scans and a 3-dimensional imaging application (Mimics software). Measuring the space available for the anterior C1 lateral mass screw (SAS) at different camber angles from 0 to 30 degrees (5-degree intervals) was performed to identify the ideal camber angle of insertion. Measuring the range of sagittal angles was performed to calculate the ideal sagittal angle. Other measurements involving the height of the C1 lateral mass were also made. The optimal screw entry point was found to be located on the anterior surface of the atlas 12.88 mm (±1.10 mm) lateral to the center of the anterior tubercle. This optimal entry point was found to be 6.81 mm (±0.59 mm) superior to the anterior edge of the atlas inferior articulating process. The mean ideal camber angle was 20.92 degrees laterally and the mean ideal sagittal angle was 5.80 degrees downward. These measurements define the optimal entry point and trajectory for anterior C1 lateral mass screws and facilitate anterior C1 lateral mass screw placement. A thorough understanding of the local anatomy may decrease the risk of injury to the spinal cord, vertebral artery, and internal carotid artery. Delineating the anatomy in each case with preoperative 3D CT evaluation is recommended.

  1. Spontaneous healing of spontaneous coronary artery dissection.

    Science.gov (United States)

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  2. Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.

    Science.gov (United States)

    Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, João Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Júlia; Pinto, Paula

    2013-06-01

    Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  4. Bilateral Anterior Opercular Syndrome With Partial Kluver?Bucy Syndrome in a Stroke Patient: A Case Report

    OpenAIRE

    Cho, Ah-Ra; Lim, Young-Ho; Chung, Sae-Hoon; Choi, Eun-Hi; Lim, Jong Youb

    2016-01-01

    Bilateral anterior opercular syndrome and partial Kluver?Bucy syndrome are associated with bilateral middle cerebral artery lesions. The combination of these two syndromes has only been reported in a child with limbic encephalitis. In this case, a 44-year-old woman with bilateral middle cerebral artery infarction, which occurred 2 years prior, could walk independently. However, she showed automatic-voluntary dissociation and anarthria with preserved writing skills. She also presented hypersex...

  5. Thyrocervical artery - jugular fistula following internal jugular venous catheterization

    Directory of Open Access Journals (Sweden)

    P P Zachariah

    2014-01-01

    Full Text Available Arteriovenous fistula (AVF is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far.

  6. Fracture of the anterior colliculus.

    Science.gov (United States)

    Skie, M C; Ebraheim, N A; Woldenberg, L; Randall, K

    1995-04-01

    The authors retrospectively reviewed 33 cases of fracture involving the anterior colliculus of the medial malleolus to examine clinical results of operative treatment for these fractures. Although this injury appears innocuous, it can be difficult to obtain stable fixation of the fragment intraoperatively, and painful nonunion can result. A simple reduction maneuver and method of tension band fixation are described.

  7. Direct type gerbode defect with cleft in anterior mitral leaflet: A rarest of rare combination

    Directory of Open Access Journals (Sweden)

    Rakesh Jain

    2016-01-01

    Full Text Available A 15-year-old boy was evaluated for the new onset of dyspnea. He had no significant medical or surgical history. On echocardiography, he was found to have a direct communication between the left ventricle and the right atrium through the atrioventricular (AV septum (a rare type of Gerbode defect with an associated cleft in the anterior mitral leaflet. The combination of direct type Gerbode defect with the cleft of the anterior mitral leaflet is extremely rare.

  8. Carotid artery disease

    Science.gov (United States)

    ... a blocked artery and places a tiny wire mesh (stent) in the artery to keep it open. ... Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical ...

  9. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features ... Overview The arteries which supply blood to the leg originate from the aorta and iliac vessels. Review ...

  10. Hepatic artery aneurysms (HAAs)

    International Nuclear Information System (INIS)

    Nosratini, H.

    2004-01-01

    The hepatic artery aneurysms are rare, especially in interahepatic branches, The frequency consists of 75-80% extrahepatic and 20-25% intrahepatic. Catheterization is achieved usually from common femoral artery, other methods implemented in the case of unsuccessful catheterization from femoral artery, are translumbar and brachial catheterization. The study consist of 565 patients that were referred to the angiography ward, During seven years of assessment, five cases of hepatic artery aneurysm were found; this is a rare condition reported in the English literature. In the literature as well as in this case report the hepatic artery aneurysms are rare. In reported series the extrahepatic artery aneurysms are found more often than in the intrahepatic artery aneurysm but in this case report intrahepatic artery aneurysms are more than extrahepatic one. (author)

  11. Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

    Science.gov (United States)

    Yanase, Yohsuke; Muraki, Satoshi; Koyanagi, Tetsuya; Watanabe, Noriyasu; Kurimoto, Yoshihiko

    2011-01-01

    Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB).

  12. Válvula de uretra anterior Anterior urethral valves

    Directory of Open Access Journals (Sweden)

    Silvio Tucci Jr.

    2003-02-01

    Full Text Available Objetivo: apresentar os aspectos clínicos, diagnósticos e terapêuticos de pacientes portadores de válvula da uretra anterior. Descrição: em dois neonatos, o diagnóstico presuntivo de patologia obstrutiva do trato urinário foi sugerido pela ultra-sonografia realizada no período pré-natal, confirmando-se o diagnóstico de válvula de uretra anterior pela avaliação pós-natal. Os pacientes foram submetidos a tratamento cirúrgico paliativo, com vesicostomia temporária e, posteriormente, definitivo, pela fulguração endoscópica das válvulas. Ambos evoluíram com função renal normal. Comentários: a válvula da uretra anterior é anomalia rara que deve ser considerada em meninos com quadro radiológico pré-natal sugestivo de obstrução infravesical, secundariamente à hipótese mais comum de válvula da uretra posterior. Ressaltamos a utilização da vesicostomia como derivação urinária temporária nestes casos, prevenindo potenciais complicações pela manipulação da uretra do recém-nascido.Objective: to discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. Description: signs of urinary tract obstruction were identified on pre-natal ultrasound in two male fetuses and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in both patients. Later, the valves were fulgurated using an endoscopic procedure. During the follow-up period both patients presented normal renal function. Comments: anterior urethral valves are a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra.

  13. Whole Cerebral Blood Flow Originating From Vertebral Arteries After Bilateral Internal Carotid Arteries Occlusion: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmad Pour Rashidi

    2018-01-01

    Full Text Available Bilateral occlusion of internal carotid arteries is a rare condition usually associated with severe neurological symptoms. It is very uncommon finding among patients with ischemic stroke. In this article, we report a rare case of bilateral occlusion of internal carotid artery who presented with mild reversible neurological symptoms. Angiographic evaluation of her cerebral vasculature revealed no flow across the both cervical internal carotid arteries, but a run off through both posterior communicating arteries from the vertebrobasilar system. We performed a review of the pertinent literature and discussed different management option in these patients.

  14. Coronary artery rupture in blunt thoracic trauma: a case report and review of literature.

    Science.gov (United States)

    Abu-Hmeidan, Jareer Heider; Arrowaili, Arief Ismael; Yousef, Raid Said; Alasmari, Sami; Kassim, Yasser M; Aldakhil Allah, Hamad Hamad; Aljenaidel, Abdullah Mohammed; Alabdulqader, Abdullah Abdulmohsen; Alrashed, Muath Hamad; Alkhinjar, Mulfi Ibrahim; Al-Shammari, Nawwaf Rahi

    2016-08-02

    Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient. In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.

  15. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    Science.gov (United States)

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease.

  16. Coronary artery angiographic changes in veterans poisoned by mustard gas.

    Science.gov (United States)

    Shabestari, Mahmoud M; Jabbari, Farahzad; Gohari, Behnaz; Moazen, Nasrin; Azizi, Hoda; Moghiman, Toktam; Ibrahimzadeh, Saeed; Amirabadi, Amir

    2011-01-01

    We aimed to identify coronary artery involvement in mustard gas-poisoned patients. We conducted a case-control study on 40 mustard gas-poisoned patients who underwent coronary artery angiography due to cardiac pain. The study was performed during a 3-year interval on patients who were referred to three main hospitals of Mashhad, Iran. The nonexposed control group consisted of 40 normal individuals who had undergone angiography for the same reasons. The primary outcome measurement was coronary artery involvement and its location. Data were collected through studying the angiography films. Among the 40 poisoned patients studied, 15 (37.5%) had coronary artery ectasia, mainly in the left anterior descending artery, but 25 (62.5%) did not. The same values were 2 (5%) and 38 (95%) in the nonexposed group, respectively, which was significantly different compared to the exposed group (p = 0.001). The odds ratio was 11.40. The prevalence of coronary artery ectasia in mustard gas-poisoned patients was 7.5 times more than in nonexposed controls. Considering the proposed odds ratio, the occurrence of coronary artery ectasia is around 11.4 times greater in mustard gas-poisoned veterans. This is the first study to suggest a strong correlation between mustard gas poisoning and coronary artery ectasia. Copyright © 2011 S. Karger AG, Basel.

  17. Multiple Spontaneous Intracranial-Extracranial Arterial Dissections in a Patient with Osteogenesis Imperfecta

    Directory of Open Access Journals (Sweden)

    Mehmet Kolukısa

    2017-01-01

    Full Text Available A 40-year-old male with osteogenesis imperfecta (OI was admitted to the hospital with an acute right monoparesis. Diffusion-weighted MRI showed infarction in the territory of the left anterior cerebral artery (ACA and in the left posterior cerebral artery (PCA. In his vascular imaging, occlusion of the left vertebral artery (VA starting from V2 segment was consistent with dissection and pseudoaneurysm in the right ACA. We presented this case because of the presence of spontaneous and simultaneous occurrence of both intracranial and extracranial arterial dissections in OI.

  18. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

  19. Transcatheter Arterial Embolization of Concurrent Spontaneous Hematomas of the Rectus Sheath and Psoas Muscle in Patients Undergoing Anticoagulation

    International Nuclear Information System (INIS)

    Basile, Antonio; Medina, Jose Garcia; Mundo, Elena; Medina, Vicente Garcia; Leal, Rafael

    2004-01-01

    We report a case of concurrent rectus sheath and psoas hematomas in a patient undergoing anticoagulant therapy, treated by transcatheter arterial embolization (TAE) of inferior epigastric and lumbar arteries. Computed tomography (CT) demonstrated signs of active bleeding in two hematomas of the anterior and posterior abdominal walls. Transfemoral arteriogram confirmed the extravasation of contrast from the right inferior epigastric artery (RIEA). Indirect signs of bleeding were also found in a right lumbar artery (RLA). We successfully performed TAE of the feeding arteries. There have been few reports in the literature of such spontaneous hemorrhages in patients undergoing anticoagulation, successfully treated by TAE

  20. Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

    Energy Technology Data Exchange (ETDEWEB)

    Selcuk, Hakan, E-mail: hakanselcuk73@yahoo.com; Soylu, Nur; Albayram, Sait; Selcuk, Dogan; Ozer, Harun; Kocer, Naci; Islak, Civan [Cerrahpasa Medical School, Istanbul University, Department of Radiology, Division of Neuroradiology (Turkey)

    2005-04-15

    We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.

  1. Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

    International Nuclear Information System (INIS)

    Selcuk, Hakan; Soylu, Nur; Albayram, Sait; Selcuk, Dogan; Ozer, Harun; Kocer, Naci; Islak, Civan

    2005-01-01

    We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection

  2. Anterior cruciate ligament (ACL) injury -- aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000681.htm Anterior cruciate ligament (ACL) injury - aftercare To use the sharing features ... that connects a bone to another bone. The anterior cruciate ligament (ACL) is located inside your knee joint and ...

  3. Myocardial Infarction as a Complication of Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Labbé, Hugo, E-mail: hugo.labbe.1@ulaval.ca [Université Laval, Department of Medicine (Canada); Bordeleau, Simon [Université Laval, Department of Emergency Medicine (Canada); Drouin, Christine [Université Laval, Department of Anesthesiology and Critical Care Medicine (Canada); Archambault, Patrick [Université Laval, Department of Emergency Medicine (Canada)

    2017-03-15

    Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

  4. Combined antegrade femoral artery and retrograde popliteal artery recanalization for chronic occlusions of the superficial femoral artery.

    Science.gov (United States)

    Shi, Weihao; Yao, Ye; Wang, Wei; Yu, Bo; Wang, Song; Que, Huafa; Xiang, Huanyu; Li, Qiong; Zhao, Qiufeng; Zhang, Zhen; Xu, Jienan; Liu, Xiaodong; Shen, Liang; Xing, Jie; Wang, Yunfei; Shan, Wei; Zhou, Jie

    2014-09-01

    To evaluate the efficacy and safety of a dual femoral-popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA). From May 2011 to October 2012, 21 patients underwent dual femoral-popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery. A technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively. A dual femoral-popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  5. Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results.

    Science.gov (United States)

    Kim, Hyungtae; Sung, Si Chan; Kim, Si-Ho; Chang, Yun Hee; Ahn, Hyo Yeong; Lee, Hyoung Doo

    2011-04-01

    The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was 13.4±10.2 days (4 to 39 days) and mean body weight was 3.48±0.33 kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration

  6. Unilateral and bilateral internal carotid artery stenosis or occlusion: a study of the secondary collateral circulation

    International Nuclear Information System (INIS)

    Zhao Yunhui; Ma Zhubin; Zhuang Lei; Liu Jianjun; Zang Jianhua

    2006-01-01

    Objective: It's a study of the collateral circulation secondary to unilateral and bilateral internal carotid artery (ICA) severe stenosis or occlusion using digital subtract angiography (DSA) and magnetic resonance angiography (MRA). Methods: Ninty-five patients with ICA stenosis or occlusion were diagnosed by DSA or MRA. Forty-four patients were assessed by DSA, and fifty-one patients were evaluated by MRA, who were divided into two groups of the unilateral and bilateral involvement. DSA, MRA findings were analyzed, by which the patterns of the collateral circulation were comparatively studied. Results: The presence rate of anterior communicating artery (AcoA) in the unilateral group on DSA and MRA was significantly higher than that in the bilateral group (P 0.05). On DSA, the presence rate of ophthalmic artery (OphA) in the unilateral and bilateral groups had no significant difference between the two groups. The augmentation rate of the OphA in the bilateral group was significantly higher than that in the unilateral group (P<0.05). The presence rate of leptomeningeal anastomosis in the bilateral group was significantly higher than that in the unilateral group on DSA and MRA (P<0.01). Conclusion: In patients with the unilateral and bilateral ICA stenosis or occlusion, the collateral circulation formats in different patterns. The major collateral pathways secondary to the unilateral ICA stenosis or occlusion are AcoA and ispilateral PCoA, while to the bilateral ICA stenosis or' occlusion are PCoA, OPhA, and leptomeningeal anastomosis. (authors)

  7. 38 CFR 3.379 - Anterior poliomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

  8. Epidermoid cyst in Anterior, Middle

    Directory of Open Access Journals (Sweden)

    Kankane Vivek Kumar

    2016-09-01

    Full Text Available Epidermoid cysts are benign slow growing more often extra-axial tumors that insinuate between brain structures, we present the clinical, imaging, and pathological findings in 35 years old female patients with atypical epidermoid cysts which was situated anterior, middle & posterior cranial fossa. NCCT head revealed hypodense lesion over right temporal and perisylvian region with extension in prepontine cistern with mass effect & midline shift and MRI findings revealed a non-enhancing heterogeneous signal intensity cystic lesion in right frontal & temporal region extending into prepontine cistern with restricted diffusion. Patient was detoriated in night of same day of admission, emergency Fronto-temporal craniotomy with anterior peterousectomy and subtotal resection was done. The histological examination confirms the epidermoid cyst. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts.

  9. [Anterior chest wall examination reviewed].

    Science.gov (United States)

    Lo Monaco, A; Santilli, D; Trotta, F

    2002-01-01

    Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondyloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the "activity" of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  10. Chronic Anterior Uveitis in Children.

    Science.gov (United States)

    Couto, Cristóbal; Frick, Mercedes M; LaMattina, Kara; Schlaen, Ariel; Khoury, Marina; Lopez, Matilde María; Hurtado, Erika; Espada, Graciela

    2016-08-01

    To describe the visual prognosis and remission rate of chronic anterior uveitis in pediatric patients. A retrospective case series of children with chronic anterior uveitis treated in the University of Buenos Aires. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Uveitis remission was defined according to SUN criteria. There were 35 pediatric patients (61 eyes), mean age of uveitis onset was 7.69 ± 3 years, 60% were females and 74% had bilateral disease, median follow-up was 60 months (range: 12-192 months). JIA was more frequent in females (80.95 vs 21.43; pgood Received 30 August 2015; revised 6 March 2016; accepted 14 March 2016; published online 18 May 2016.

  11. Anterior cingulotomy for intractable pain

    Directory of Open Access Journals (Sweden)

    Nitin Agarwal, MD

    2016-12-01

    Full Text Available Conservative therapy is often the first-line treatment for many symptoms of various disease processes, including pain. Nevertheless, if pharmacological or medical management fails for those patients with severe and chronic pain, a surgical strategy may be a reasonable option. First performed for psychiatric disorders, cingulotomy now has been recognized as a viable option for the management of pain. The authors review the literature on anterior cingulotomy for intractable pain to provide guidelines for management and expected outcomes.

  12. Anterior shoulder dislocations in sports.

    Science.gov (United States)

    Aronen, J G

    1986-01-01

    Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate

  13. Anterior chest wall examination reviewed

    OpenAIRE

    F. Trotta; D. Santilli; A. Lo Monaco

    2011-01-01

    Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as er...

  14. Relationship of uterine artery with ureter.

    Science.gov (United States)

    Ara, Z G; Khalil, M; Rahman, M H; Mannan, S; Sultana, S Z; Rahman, M M; Ahmed, M S; Zaman, K S; Islam, M S

    2008-07-01

    The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

  15. EXERCISE-INDUCED ARTERIAL ADAPTATIONS IN ELITE JUDO ATHLETES

    Directory of Open Access Journals (Sweden)

    Panagiotis Karagounis

    2009-09-01

    Full Text Available The purpose of this study was to examine exercise-induced arterial adaptations in elite Judo male and female athletes. 27 male Judo athletes (age 24.06 ± 2 years, 11 female Judoka (age 24.27 ± 1 years, 27 sedentary healthy men (age 24.01 ± 2 years and 11 women (age 24.21 ± 1 years participated in the current study. The examined vessels included brachial, radial, ulnar, popliteal, anterior and posterior tibial arteries. The experimental parameters were recorded with the use of Duplex ultrasound at rest. Diastolic diameter and blood mean flow velocity of the examined arteries in Judo athletes were found to be both significantly increased (p < 0.05 compared to the findings of the control groups. In male Judo athletes the brachial (p < 0.001, radial (p < 0.001, and anterior tibial artery (p < 0.001 presented the highest difference on the diastolic diameter, compared with the control male group. In female Judo athletes, ulnar (p < 0.001, radial (p < 0.001, and brachial (p < 0.001 arteries illustrated the highest diastolic diameter. The highest blood mean flow velocity was recorded in ulnar (p < 0.001 and popliteal arteries (p < 0.001 of the Judo athletes groups. Recording differences between the two genders, male participants presented larger arteries than females. Conclusively, Judo has been found to be a highly demanding physical sport, involving upper and lower limbs leading to significant arterial adaptations. Obtaining vascular parameters provide a useful tool to the medical team, not only in the direction of enhancement of the efficacy of physical training, but in unknown so far parameters that may influence athletic performance of both male and female elite Judokas

  16. Relation of Coronary Artery Diameters With Cardiorespiratory Fitness.

    Science.gov (United States)

    Ho, John S; Cannaday, John J; FitzGerald, Shannon J; Leonard, David; Finley, Carrie E; Wade, Wendy A; Reinhardt, Dale B; Ellis, Joe R; Barlow, Carolyn E; Haskell, William L; Defina, Laura F; Gibbons, Larry W; Cooper, Kenneth H

    2018-02-06

    Cardiorespiratory fitness is associated with reduced cardiovascular morbidity and mortality when adjusted for traditional risk factors. Mechanisms by which fitness reduces risk have been studied but remain incompletely understood. We hypothesize that higher fitness is associated with larger coronary artery diameters independent of its effect on traditional risk factors. Two independent measurements of the proximal diameters of the left main, left anterior descending, left circumflex, and right coronary arteries were obtained from gated multidetector computed tomography scans in 500 men from the Cooper Center Longitudinal Study (CCLS). Men with coronary artery calcium scores ≥10 were excluded. Fitness was measured with a maximal exercise treadmill test and reported by quintiles and as a function of METs. We then evaluated the relation between coronary artery diameters and fitness using mixed effect regression models. Higher fitness was associated with larger coronary artery diameters after adjustment for body surface area, smoking status, low-density lipoprotein and high-density lipoprotein cholesterol, resting systolic blood pressure, and serum glucose. When examined continuously, each MET increase in fitness was associated with a mean 0.03 ± 0.01 mm larger diameter of the left main, a 0.04 ± 0.01 mm larger diameter of the left anterior descending, a 0.05 ± 0.01 mm larger diameter of the left circumflex, and a 0.07 ± 0.01 mm larger diameter of the right coronary artery (p = 0.002). This correlation between fitness and coronary artery diameters was most prominent for fitness levels above 10 METs. In conclusion, higher fitness is associated with larger coronary artery diameters. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Recurrent post-partum coronary artery dissection

    Directory of Open Access Journals (Sweden)

    Resnic Frederic S

    2010-10-01

    Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  18. Superselective pseudo-continuous arterial spin labeling angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jensen-Kondering, Ulf [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Lindner, Thomas, E-mail: thomas.lindner@uksh.de [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Osch, Matthias J.P. van [C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden (Netherlands); Rohr, Axel; Jansen, Olav [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Helle, Michael [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Now with Philips GmbH Innovative Technologies, Research Laboratories, Hamburg (Germany)

    2015-09-15

    Highlights: • Superselective arterial spin labeling was capable of acquiring angiograms of individually selected arteries. • Image quality was similar compared with a routinely used time-of-flight angiography. • Superselective arterial spin labeling was utilized in patients with arterio-venous malformations and made it possible to visualize individual feeding vessels in a complete non-invasive way - Abstract: Purpose: To evaluate the utility of a novel non-contrast enhanced, vessel-selective magnetic resonance angiography (MRA) approach based on superselective pseudo-continuous arterial spin labeling (ASL) for the morphologic assessment of intracranial arteries when compared to a clinically used time-of-flight (TOF) MRA. Materials and methods: Three sets of selective ASL angiographies (right and left internal carotid artery, basilar artery) as well as one TOF data set were obtained from each of the five volunteers included in this study on a clinical 1.5T system. The depiction of arterial segments as well as their delineation was evaluated and independently analyzed by two radiologists. Additionally, the ASL angiography approach was performed in two patients suffering from arterio-venous malformations (AVM) in order to illustrate potential applications in a clinical setting. Results: In both angiography techniques, intracranial arteries and their segments (distal branches up to A5 segments of the anterior cerebral arteries, M8 segments of the middle cerebral arteries, and P5 segments of the posterior cerebral arteries) were continuously depicted with excellent inter-reader agreement (κ > 0.81). In AVM patients, reconstructed images of the TOF angiography presented similar information about the size and shape of the AVM as did superselective ASL angiography. In addition, the acquired ASL angiograms of selected vessels allowed assessing the blood supply of individually labeled arteries to the AVM which could also be confirmed by digital subtraction angiography

  19. Superselective pseudo-continuous arterial spin labeling angiography

    International Nuclear Information System (INIS)

    Jensen-Kondering, Ulf; Lindner, Thomas; Osch, Matthias J.P. van; Rohr, Axel; Jansen, Olav; Helle, Michael

    2015-01-01

    Highlights: • Superselective arterial spin labeling was capable of acquiring angiograms of individually selected arteries. • Image quality was similar compared with a routinely used time-of-flight angiography. • Superselective arterial spin labeling was utilized in patients with arterio-venous malformations and made it possible to visualize individual feeding vessels in a complete non-invasive way - Abstract: Purpose: To evaluate the utility of a novel non-contrast enhanced, vessel-selective magnetic resonance angiography (MRA) approach based on superselective pseudo-continuous arterial spin labeling (ASL) for the morphologic assessment of intracranial arteries when compared to a clinically used time-of-flight (TOF) MRA. Materials and methods: Three sets of selective ASL angiographies (right and left internal carotid artery, basilar artery) as well as one TOF data set were obtained from each of the five volunteers included in this study on a clinical 1.5T system. The depiction of arterial segments as well as their delineation was evaluated and independently analyzed by two radiologists. Additionally, the ASL angiography approach was performed in two patients suffering from arterio-venous malformations (AVM) in order to illustrate potential applications in a clinical setting. Results: In both angiography techniques, intracranial arteries and their segments (distal branches up to A5 segments of the anterior cerebral arteries, M8 segments of the middle cerebral arteries, and P5 segments of the posterior cerebral arteries) were continuously depicted with excellent inter-reader agreement (κ > 0.81). In AVM patients, reconstructed images of the TOF angiography presented similar information about the size and shape of the AVM as did superselective ASL angiography. In addition, the acquired ASL angiograms of selected vessels allowed assessing the blood supply of individually labeled arteries to the AVM which could also be confirmed by digital subtraction angiography

  20. The management of concomitant renal oncocytoma and giant coronary and bilateral common iliac artery aneurysms.

    Science.gov (United States)

    Clarke, Jonathan; Choong, Andrew; Raja, Shahzad; Amrani, Mohamed; Hellawell, Giles; Hussain, Tahir

    2014-05-01

    We present the rare case of a 66-year-old Caucasian male patient presenting with intermittent left-side abdominal pain. He underwent a kidneys, ureters, and bladder computed tomography scan on which an incidental 45-mm giant aneurysm of the left anterior descending coronary artery was discovered along with 55-mm right-sided and 62-mm left-sided common iliac artery aneurysms and a 100-mm benign renal oncocytoma. He underwent on-pump coronary artery bypass grafting of the left anterior descending, left circumflex and right coronary arteries using internal mammary artery and saphenous vein grafts. He subsequently underwent simultaneous open left nephrectomy and bilateral common iliac aneurysm repair using a bifurcated tube graft. He made a full recovery postoperatively. Giant coronary artery aneurysms are rare. In the pediatric population, they are predominantly secondary to Kawasaki disease. In adults, atheromatous disease is the leading cause. The coexistence of giant coronary artery aneurysms with extracoronary artery aneurysms is extremely unusual. We propose that the identification of giant coronary artery aneurysms necessitates further imaging investigations to identify the presence of extracoronary aneurysms. To our knowledge, this is the first description of such a case in the literature. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. REMODELING OF THE ARTERIAL COLLATERAL NETWORK AFTER EXPERIMENTAL SEGMENTAL ARTERY SACRIFICE

    Science.gov (United States)

    Etz, Christian D; Kari, Fabian A.; Mueller, Christoph S; Brenner, Robert; Lin, Hung-Mo; Griepp, Randall B

    2011-01-01

    Background A comprehensive strategy to prevent paraplegia after open surgical or endovascular repair of thoracoabdominal aortic aneurysms (TAAA) requires a thorough understanding of the response of the collateral network (CN) to extensive segmental artery (SA) sacrifice. Methods 10 Yorkshire pigs underwent perfusion with a low-viscosity acrylic resin. Using cardiopulmonary bypass, two animals each were perfused in the native state, immediately, six hours, 24h and five days (5d) after sacrifice of all SAs (T4-L5). After digestion of surrounding tissue, the vascular cast of the CN underwent analysis of arterial and arteriolar diameters and the density and spatial orientation of the vasculature, using light and scanning electron microscopy. Results Within 24 hours, the diameter of the anterior spinal artery (ASA) had increased significantly, and within 5 days the ASA and the epidural arterial network had enlarged in diameter by 80-100% (p <.0001). Also by 5 days, the density of the intramuscular paraspinous vessels had increased (p<.0001), a shift of size distribution from small to larger arterioles was seen (p=.0002), and a significant realignment of arterioles parallel to the spinal cord had occurred (p=.0005). Conclusions Within 5d after SA occlusion, profound anatomical alterations in the intraspinal and paraspinous arteries and arterioles occur, providing the anatomical substrate for preservation of spinal cord blood flow via collateral pathways. PMID:21419904

  2. Internal carotid artery stenosis or occlusion: study of collateral circulation pathways on DSA and MRA

    International Nuclear Information System (INIS)

    Zhao Yunhui; Ma Zhubin; Xu Yikai

    2004-01-01

    Objectives: To evaluate the collateral pathways of internal carotid artery (ICA) stenosis or occlusion on digital subtraction angiography (DSA) and magnetic resonance angiography (MRA), and to compare these two methods in the study for collateral pathways. Methods: Seventy-four patients with ICA stenosis or occlusion were included as the study group. Sixty persons with normal findings on DSA or MRA each served as the control group. DSA, MRA, MRI, CT findings, and clinicall materials were analyzed in the two groups. Results: Stenosis or occlusion over ICA bifurcation was showed clearly in all patients on DSA or MRA. On DSA, the presence rate of ipsilateral posterior communicating artery (PCoA) in the study group (82.5%) was lower significantly than that of the control group (94.2%) (P=0.025). On MRA (3D-TOF), the rate in the study group (59.3%) was higher significantly than that of the controls (30.0%) (P=0.000). On DSA and MRA, the diameter of ipsilateral PCoA in the study group was larger than that of the control group (P=0.000). On DSA, the presence rate of OPhA in the study group was significantly different from that of the control group, and its diameter was larger than that of the control group (P=0.003). On MRA, its presence rate was lower than that of the control group. The presence rate of anterior communicating artery (ACoA) in the study group showed no statistical difference between DSA and MRA. In the study group, the presence rate of PCoA on DSA was significantly higher than that on MRA (P 0.05). The diameters of the three arteries showed no significant differences between DSA and MRA (P>0.05). Conclusion: DSA is highly valuable for the evaluation of collateral pathways of ICA stenosis or occlusion, and it is necessary for preoperative examination. MRA is a non-invasive angiographic method and can evaluate collateral circulation in both morphology and function, and can be the preferred method for the disease. (authors)

  3. Anterior tracheal suspension for tracheobronchomalacia in infants and children.

    Science.gov (United States)

    Mitchell, Michael E; Rumman, Nisreen; Chun, Robert H; Rao, Aparna; Martin, Timothy; Beste, David J; Berens, Richard J; Parakininkas, Daiva E; Ghanayem, Nancy S; Hubert, Mary J; Uhing, Michael; Simpson, Pippa; Sato, Thomas T; Tweddell, James S; Kerschner, Joseph E

    2014-10-01

    Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS). Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months). There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p < 0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings. Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Feasibility of internal mammary vessel use in breast reconstruction versus coronary artery bypass surgery: an anatomic, cadaveric evaluation.

    Science.gov (United States)

    Greer-Bayramoglu, Rebecca J; Chu, Michael W A; Fortin, Amanda J

    2011-05-01

    Autologous free flap breast reconstruction using the internal mammary artery is common; however, its use may compromise treatment of occult coronary artery disease. The authors investigated whether internal mammary artery harvest for breast reconstruction is compatible with future use for coronary bypass. An anatomic analysis of 10 preserved female cadavers was performed. Internal mammary artery measurements, including the length from its origin to the third, fourth, and fifth intercostal spaces, were taken, and the minimum length required to reach the left anterior descending coronary artery was determined. The left internal mammary artery reached the left anterior descending target at a mean length of 10.0 cm. The mean lengths to the left third, fourth, and fifth intercostal spaces were 8.2 cm, 11.3 cm, and 13.7 cm, respectively, on the left, and 7.6 cm, 10.7 cm, and 13.2 cm, respectively, on the right. The right internal mammary artery reached the left anterior descending target at a mean of 12.0 cm. The left internal mammary artery was found to reach the estimated coronary target by the level of the fourth intercostal space consistently, while the right was more variable and required a greater length. If the fourth intercostal space was used to harvest the internal mammary artery, the length necessary for in situ coronary bypass surgery is preserved on the left, and may still be used as a free graft on the right.

  5. Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification

    Energy Technology Data Exchange (ETDEWEB)

    Assis, André Moreira de, E-mail: andre.maa@gmail.com; Moreira, Airton Mota, E-mail: motamoreira@gmail.com; Paula Rodrigues, Vanessa Cristina de, E-mail: vanessapaular@yahoo.com.br [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil); Harward, Sardis Honoria, E-mail: sardis.harward@merit.com [The Dartmouth Center for Health Care Delivery Science (United States); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@usp.br [University of Sao Paulo Medical School, Urology Department (Brazil); Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil)

    2015-08-15

    PurposeTo describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure.MethodsAngiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage.ResultsTwo hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3 %) were classified into I–IV types. Among them, the most common origin was type IV (n = 89, 31.1 %), followed by type I (n = 82, 28.7 %), type III (n = 54, 18.9 %), and type II (n = 42, 14.7 %). Type V anatomy was seen in 16 cases (5.6 %). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0 %).ConclusionsDespite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95 % of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.

  6. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  7. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  8. Anatomical Classifications of the Coronary Arteries in Complete Transposition of the Great Arteries and Double Outlet Right Ventricle with Subpulmonary Ventricular Septal Defect.

    Science.gov (United States)

    Wang, Cuijin; Chen, Shubao; Zhang, Haibo; Liu, Jinfen; Xu, Zhiwei; Zheng, Jinhao; Yan, Qin; Huang, Huimin; Huang, Meirong

    2017-01-01

    Objective  To discuss the anatomical morphologies of the coronary arteries and frequencies of unusual coronary arteries in complete transposition of the great arteries and double outlet right ventricle (DORV) associated with a subpulmonic ventricular septal defect (VSD). Methods  Between March 1999 and August 2012, 1,078 patients with complete transposition of the great arteries or DORV with subpulmonary VSD underwent arterial switch operations (ASOs) and were visually evaluated to classify their coronary artery morphology during open heart surgery. Results  The coronary arteries could be classified into five patterns with several subtypes. Unusual coronary arteries were observed in 248 of the 1,078 cases, providing a frequency of 23.01%. The frequencies of the patients with transposition of the great arteries with intact ventricular septum (TGA/IVS), TGA/VSD, and DORV with subpulmonary VSD were 17.65, 23.28, and 31.84%, respectively. The most common morphologies were the right coronary artery (RCA) originating from sinus 1 and circumflex (CX) originating from sinus 2 (1R, AD; 2CX; 26.50%); the CX originating from sinus 2 (1AD; 2R, CX; 21.36%); the RCA, left anterior descending artery, and CX originating from single sinus 2 (2R, AD, CX; 13.24%). The in-hospital mortalities of the patients with or without unusual coronary arteries after ASO were 14.1 and 6.02%, respectively. Conclusion  Patients with complete transposition of the great arteries or DORV with subpulmonary VSD have a high frequency of unusual coronary arteries, which might greatly impact on the mortality for ASO. Improving the preoperative diagnostic criteria for coronary artery morphology may significantly increase the success rate for ASOs. Georg Thieme Verlag KG Stuttgart · New York.

  9. Uncontrolled Epistaxis Secondary to Traumatic Pseudoaneurysm of the Maxillary Artery

    Directory of Open Access Journals (Sweden)

    Eelam Adil

    2011-01-01

    Full Text Available We describe a rare case of traumatic pseudoaneurysm of the maxillary artery following a fall. The patient presented with epistaxis that could not be controlled with anterior and posterior nasal packing. She was urgently taken to the angiography suite for evaluation and ultimately underwent embolization of a left maxillary artery pseudoaneurysm with 500–700 micron Contour PVA followed by coiling with two 3 mm Tornado coils. Bleeding subsided after embolization, and the patient suffered no neurologic sequelae.

  10. Fractional Flow Reserve Assessment of a Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Joseph Petit

    2015-01-01

    Full Text Available A 63 y/o male with a past medical history of hypertension, chronic obstructive pulmonary disease, and obesity was admitted to an outside hospital for an abdominal incisional hernia repair and cholecystectomy. Post-operatively he developed shortness of breath (SOB and multiple runs of paroxysmal atrial fibrillation. A CT scan was negative for pulmonary embolism, but showed a left anterior descending (LAD coronary artery to main pulmonary artery (MPA fistula. He was transferred to our facility for further management.

  11. Clarifying the anatomy of the fifth arch artery

    Directory of Open Access Journals (Sweden)

    Saurabh Kumar Gupta

    2016-01-01

    Full Text Available The artery allegedly forming in the fifth pharyngeal arch has increasingly been implicated as responsible for various vascular malformations in patients with congenitally malformed hearts. Observations from studies on developing embryos, however, have failed to provide support to substantiate several of these inferences such that the very existence of the fifth arch artery remains debatable. To the best of our knowledge, in only a solitary human embryo has a vascular channel been found that truly resembled the artery of the fifth arch. Despite the meager evidence to support its existence, the fifth arch artery has been invoked to explain the morphogenesis of double-barreled aorta, some unusual forms of aortopulmonary communications, and abnormalities of the brachiocephalic arteries. In most of these instances, the interpretations have proved fallible when examined in the light of existing knowledge of cardiac development. In our opinion, there are more plausible alternative explanations for the majority of these descriptions. Double-barreled aorta is more likely to result from retention of the recently identified dorsal collateral channels while abnormalities of brachiocephalic arteries are better explained on the basis of extensive remodeling of aortic arches during fetal development. Some examples of aortopulmonary communications, nonetheless, may well represent persistence of the developing artery of the fifth pharyngeal arch. We here present one such case - a patient with tetralogy of Fallot and pulmonary atresia, in whom the fifth arch artery provided a necessary communication between the ascending aorta and the pulmonary arteries. In this light, we discuss the features we consider to be essential before attaching the tag of "fifth arch artery" to a candidate vascular channel.

  12. Clinical anatomy study of autonomic nerve with respective to the anterior approach lumbar surgery.

    Science.gov (United States)

    Lu, Sheng; Xu, Yong-qing; Chang, Shan; Zhang, Yuan-zhi; Shi, Ji-hong; Ding, Zi-hai; Li, Zhong-hua; Zhong, Shi-zhen

    2009-07-01

    Male genital dysfunction was recognized as a complication following anterior approach lumbar surgery. Disruption of efferent sympathetic pathways such as the abdominal aortic plexus (AAP) and superior hypogastric plexus (SHP) which lied pre-abdominal aorta and iliac artery had been thought as the main reason. Though there were some clinical reports of retrograde ejaculation, the applied anatomic study of the autonomic nerve anterior to the lumbar was little. The purpose was to find out a lumbar surgery approach which was ejaculation preservation through the detailed study of the anatomy and histology observation of the autonomic nerve anterior to the lumbar vertebrae. The lumbar region of ten male cadavers was dissected and analyzed. We investigated the relationship between the peritoneum and abdominal aorta, iliac artery and sacral promontory fascia, as well as the trend and distribution of the autonomic nerve and SHP anterior to the L5-S1. We also observed the distribution of autonomic nerve at retroperitoneum through hematoxylin and eosin (HE)-stained tissues pre-aorta, para-aorta, and pre-vertebrae sacrales. Superior hypogastric plexus, which deviated to left, located in a triangle formed by the common iliac arteries and its bilateral branches, its truck sited anterior to the lumbarsacral space in seven cases (70%), and anterior to sacrum in three cases (30%); at the aortic bifurcation, SHP strided over left iliac artery from left-hand side, then located in front of sacrum in four cases (40%), and sifted to the left at the lumbar sacral promontory in six cases (60%); from both anatomic and histological view, the autonomic nerve plexus lying in an fascia layer of retroperitoneum. At the anterior approach lumbar surgery of trans-peritoneum, we should choose the right-hand side incision; the SHP should be pushed aside carefully from right to left along intervertebral disc. The accurate surgical plane was at the deeper layer of autonomical nerve fascia; we also

  13. Testicular artery arising from an aberrant right renal artery | Suluba ...

    African Journals Online (AJOL)

    This case report we discovered the rare variation of the origin of the right testicular artery arising from the right aberrant renal artery with double renal artery irrigating both left and right kidneys. These variations in the testicular arteries and renal arteries have implication to surgical procedures such as orchidopexy repair for ...

  14. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma.

    Science.gov (United States)

    Tannoury, Chadi; Degiacomo, Anthony

    2015-01-01

    Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5-C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  15. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    Directory of Open Access Journals (Sweden)

    Chadi Tannoury

    2015-01-01

    Full Text Available Study Design. This case illustrates complications to a vertebral artery injury (VAI resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  16. Duplicated middle cerebral artery

    Science.gov (United States)

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel

    2009-01-01

    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion. PMID:22140405

  17. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries.

    Science.gov (United States)

    Glineur, David; Boodhwani, Munir; Poncelet, Alain; De Kerchove, Laurent; Etienne, Pierre Yves; Noirhomme, Philippe; Deceuninck, Paul; Michel, Xavier; El Khoury, Gebrine; Hanet, Claude

    2010-09-01

    Composite Y-grafts, using the left internal thoracic artery as the inflow, allow a more efficient use of conduits without the need to touch a diseased ascending aorta. Among other conduits, the saphenous vein graft may be an alternative to the radial artery in elderly patients. We evaluated the hemodynamic characteristics of 17 composite Y-grafts made with the left internal thoracic artery anastomosed to the left anterior descending coronary artery in all cases and with either the free right internal thoracic artery (RITA group, n = 10) or a saphenous vein graft (SVG group, n = 7) implanted proximally to the left internal thoracic artery and distally to the circumflex territory 6 months after the operation. At baseline, the pressure gradient measured with a 0.014-inch pressure wire was minimal between the aorta and the internal thoracic artery stem (2 +/- 1 mm Hg), the internal thoracic artery and left anterior descending (4 +/- 2 mm Hg), the internal thoracic artery and left circumflex (3 +/- 1 mm Hg), and the saphenous vein graft and left circumflex (2 +/- 2 mm Hg). During hyperemia induced by adenosine, the pressure gradient increased significantly to 6 +/- 2 mm Hg in the internal thoracic artery stem, 9 +/- 4 mm Hg in the internal thoracic artery and left anterior descending artery, 9 +/- 3 mm Hg in the internal thoracic artery and left circumflex, and 7 +/- 4 mm Hg in the saphenous vein graft and left circumflex. Fractional flow reserve was 0.94 +/- 0.02 in internal thoracic artery stem, 0.90 +/- 0.04 mm Hg in the internal thoracic artery and left anterior descending, 0.91 +/- 0.03 mm Hg in the internal thoracic artery and left circumflex, and 0.92 +/- 0.06 mm Hg in the saphenous vein graft and left circumflex. No difference between the two types of composite Y-grafts was observed for pressure gradients or fractional flow reserve measured in internal thoracic artery stem or in distal branches. Composite Y-grafts with saphenous vein or right internal thoracic

  18. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  19. Duplication of hepatic artery

    OpenAIRE

    Saeed Muhammad; Rufai Amin

    2001-01-01

    Background: The hepatic arterial anatomy is aberrant in almost 33-41% of individuals. The variant arterial anatomy recognized during routine cadaveric dissection offers great learning potential. Such findings provide an alternative perspective to view common morphology and its structural and functional importance. These impart the concept of patient individuality and subsequent individualization of medical and surgical therapies. Adequate knowledge of normal and abnormal arterial anat...

  20. Heritability of cilioretinal arteries

    DEFF Research Database (Denmark)

    Taarnhøj, Nina Charlotte; Munch, Inger C; Kyvik, Kirsten O

    2005-01-01

    of healthy monozygotic and dizygotic twins were examined using digital fundus photography and visual assessment of grayscale fundus photographs and color transparencies to detect the presence of cilioretinal arteries. RESULTS: Cilioretinal arteries were present in 45.1% of participants and 28.8% of eyes...... environmental factors. CONCLUSIONS: The presence or absence of one or more cilioretinal arteries in healthy persons is markedly influenced by genetic factors....

  1. A New Sling Technique in Cervical Radiculopathy Caused by Vertebral Artery Loop Compression.

    Science.gov (United States)

    Ju, Chang Il; Kim, Jeong Mok; Kim, Jong Gyu; Kim, Seok Won; Lee, Seung Myung

    2017-08-01

    A 52-year-old woman had a 20-month history of progressive radiating pain in the left arm and numbness on C7 dermatome. On physical examination, left head rotation aggravated the radiculopathic pain. For an anatomic diagnosis of the vertebral artery and nerve root, magnetic resonance angiography was performed (computed tomography angiography was not possible because of her dye allergy history). Magnetic resonance angiography showed a left vertebral artery loop entering at the C6-7 intervertebral foramen. Surgical microvascular decompression was performed by an anterior cervical approach and the loop of the artery was fixed using a sling technique. Postoperative computed tomography angiography showed that the left vertebral artery was retracted anteriorly and the C7 nerve root was decompressed in the intervertebral foramen at the left C6-7 level. The patient's radiculopathic symptoms were improved and especially the aggravated pain by left head rotation subsided dramatically. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Post-irradiation vasculopathy of intracranial major arteries in children; Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Nishizawa, Shigeru; Ryu, Hiroshi; Yokoyama, Tetsuo; Ninchoji, Toshiaki; Shimoyama, Ichiro; Yamamoto, Seiji; Uemura, Kenichi (Hamamatsu Univ. School of Medicine, Shizuoka (Japan))

    1991-06-01

    We report two rare cases of post-irradiation vasculopathy of intracranial major arteries in children. A 13-year-old girl suffered from transient right hemiparesis 1 year after irradiation for suprasellar germinoma. Left carotid angiograms revealed marked stenoses of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries, which were previously normal, and moyamoya vessels. A 2.5-year-old girl underwent internal irradiation with {sup 198}Au colloid for cystic craniopharyngioma. At the age of 10 years, she suddenly became unconscious after vomiting. Computed tomographic scans showed a right frontal intracerebral hematoma. Right carotid angiograms disclosed complete obstruction of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries and moyamoya vessels, previously not present. The danger of radiation therapy causing occlusive vasculopathy in small and major cerebral arteries in children is emphasized. To prevent permanent ischemic neurological deficits, vasculopathy should be treated either medically or surgically as early as possible. (author).

  3. Gnathostomiasis of the anterior chamber

    Directory of Open Access Journals (Sweden)

    Barua P

    2007-01-01

    Full Text Available Ocular involvement with Gnathostoma spinigerum occurs years after the initial infection that is acquired by ingestion of poorly cooked, pickled seafood or water contaminated with third stage larvae. Here we report a case of gnathostomiasis of the left eye of a 32-year-old lady hailing from Meghalaya, India. Her vision had deteriorated to hand movement. Slit lamp examination revealed a live, actively motile worm in the anterior chamber, which was extracted by supra temporal limbal incision and visual acuity was restored.

  4. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Zhou, Chun Gao [First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing, Jangsu (China)

    2017-04-15

    To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

  5. Effect of stenosed and occluded coronary arteries on immediate and late myocardial uptake of thallium-201.

    Science.gov (United States)

    Clitsakis, D; Layton, C A; Battersby, W; Johns, M; Stockley, A V

    1981-01-01

    Exercise and redistribution myocardial scintigraphy using thallium-201 was compared with the left ventricular angiogram and with the presence of stenosis or occlusion of coronary arteries on angiography. Irreversible scintigraphic defects representing areas of myocardial infarction were found in all patients with occlusion of the left anterior descending artery but nearly one-third of patients with stenosis of that artery also showed evidence of infarction. For the right coronary or circumflex arteries the incidence of infarction was 82% with vessel occlusion and 57% with vessel stenosis. Of abnormally contracting segments on the left ventricular angiogram, 95% showed irreversible scintigraphic defects but 33% of normally contracting segments supplied by a diseased artery also showed this. Myocardial infarction is not uncommon in patients with angina even in the absence of coronary occlusion. The incidence is underestimated by the left ventricular angiogram. These findings are of importance in the assessment of patients with coronary disease and their evaluation before coronary artery surgery. PMID:7272129

  6. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

    Science.gov (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy). PMID:25714222

  7. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2014-12-01

    Full Text Available Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy.

  8. Anterior chest wall examination reviewed

    Directory of Open Access Journals (Sweden)

    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  9. [Anterior skull-base schwannoma].

    Science.gov (United States)

    Esquivel-Miranda, Miguel; De la O Ríos, Elier; Vargas-Valenciano, Emmanuelle; Moreno-Medina, Eva

    Schwannomas are nerve sheath tumours that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. Intracranial schwannomas tend to manifest on the eighth cranial nerve, particularly in patients with neurofibromatosis type2. Anterior skull-base schwannomas represent less than 1% of all intracranial schwannomas. They are more frequent in young people and are typically benign. These tumours represent a diagnostic challenge due to their rarity and difficult differential diagnosis, and numerous theories have been postulated concerning their origin and development. In this article, we present the case of a 13-year-old male with a single anterior cranial-base tumour not associated with neurofibromatosis who presented with headache, papilloedema, eye pain and loss of visual acuity. Complete resection of the tumour was performed, which was histopathologically diagnosed as a schwannoma. The patient made a complete clinical recovery with abatement of all symptoms. We conducted a review of the literature and found 66 cases worldwide with this diagnosis. We describe the most relevant epidemiological and clinical characteristics of this kind of tumour and its relation with the recently discovered and similar olfactory schwannoma. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Morphological variability of the renal artery branching pattern: a brief review and an anatomical study.

    Science.gov (United States)

    Dăescu, Ecaterina; Zăhoi, Delia Elena; Motoc, A; Alexa, Aurora; Baderca, Flavia; Enache, Alexandra

    2012-01-01

    The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior) and five segmental arteries: four from the anterior branch and one from the posterior one. The purpose of this study is to evaluate the renal artery branching pattern, the number and origin of the segmental arteries, as well as to review data from similar studies. The study material consisted of 60 formalin-fixed adult kidneys. Dissections and microdissections were performed on the renal arteries and their branches. The branching of the renal artery was prehilar in 81.67% of cases, hilar in 10% and intra-sinusal in 8.33%. The number branches varied as follows: two branches in 42 cases (70%), three branches in 14 cases (23.33%) and four branches in four cases (6.67%). We subsequently analyzed the origin of the segmental arteries and found that in 53% of the cases the segmental arteries arose independently from the renal artery's branches, while in 47% of the cases they derived from common trunks of type I (85%) or II (15%). Type I trunks are those that originate directly from the main renal artery. They divide either into 2-3 segmental branches, or into just 1-2 branches and a smaller trunk (type II). The type II trunks further divide into 2-3 other segmental branches. These common trunks must be taken into account to avoid confusion with the segmental arteries. Knowledge of these variations is useful not only morphologically, but also clinically.

  11. Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep.

    Science.gov (United States)

    Resetar, Michaela Elisabeth; Ullmann, Cris; Broeske, Petra; Ludwig-Schindler, Kristin; Doll, Nicolas K; Salameh, Aida; Dhein, Stefan; Mohr, Friedrich W

    2007-05-01

    Some patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model. In the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment. The ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 +/- 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography. Retrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy.

  12. Artery Agenesis: Ipsilateral Common Carotid Artery Hypoplasia

    Directory of Open Access Journals (Sweden)

    Omer Kaya

    2014-01-01

    Full Text Available A 42-year-old female patient, who had been diagnosed with an occlusion of her left internal carotid artery (ICA following Doppler ultrasonographic (US and digitally-subtracted angiographic (DSA examinations performed in an outer healthcare center in order to eliminate the underlying cause of her complaint of amorosis fugax, later applied to our hospital with the same complaint. At Doppler US performed in our hospital’s radiology department, her right common carotid artery (CCA was normal, but her left CCA was hypoplastic. The right internal artery (ICA was validated as normal. At the left side, however, the ICA was apparent only as a stump and it did not demonstrate a continuity. The diagnosis of ICA agenesis was confirmed by the utilization of Doppler US, CT, and DSA imaging, and it was concluded also that ipsilateral CCA hypoplasia could be evaluated as an important clue to the diagnosis of ICA agenesis.

  13. Anterior Uveitis as an Initial Manifestation of Polymyalgia Rheumatica

    Directory of Open Access Journals (Sweden)

    Hiromasa Tsuda

    2011-01-01

    Full Text Available A 74-year-old woman without contributory medical history presented with acute iridocyclitis in the right eye. Although the iridocyclitis disappeared within two weeks under topical steroid, she complained of acute progressing bilateral shoulder pain and morning stiffness of upper extremities. She was diagnosed as having polymyalgia rheumatica (PMR, and iridocyclitis was considered as its related manifestation. PMR and giant cell arteritis (GCA are closely related conditions and frequently occur together. GCA with uveitis has been rarely noted. However, ocular symptoms in PMR have not been previously mentioned. This is a first reported case of PMR presented with uveitis, without a complication of GCA. This anterior uveitis might be caused by ischemia of the posterior ciliary arteries and their branches.

  14. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    Directory of Open Access Journals (Sweden)

    James Barr

    2016-01-01

    Full Text Available Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

  15. Imaging findings of anterior hip dislocations

    Energy Technology Data Exchange (ETDEWEB)

    Pfeifer, Kyle [Mallinckrodt Institute of Radiology, Department of Radiology, St. Louis, MO (United States); Leslie, Michael [Yale School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT (United States); Menn, Kirsten; Haims, Andrew [Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT (United States)

    2017-06-15

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI. (orig.)

  16. Imaging findings of anterior hip dislocations

    International Nuclear Information System (INIS)

    Pfeifer, Kyle; Leslie, Michael; Menn, Kirsten; Haims, Andrew

    2017-01-01

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI. (orig.)

  17. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  18. Flow territory mapping of the cerebral arteries with regional perfusion MRI.

    Science.gov (United States)

    Hendrikse, Jeroen; van der Grond, Jeroen; Lu, Hanzhang; van Zijl, Peter C M; Golay, Xavier

    2004-04-01

    Conventional contrast-enhanced angiography is the gold standard for visualization of the vascular tree supplied by the major cerebral arteries and assessment of collateral flow. Thus far, however, no methods are available to assess the actual flow territories of the individual cerebral arteries. In the present study, we evaluate a noninvasive arterial spin labeling MRI method for selective mapping of the flow territories of the left and right internal carotid arteries and posterior circulation (basilar artery and vertebral arteries). A spatially selective labeling approach, regional perfusion imaging, was developed on the basis of selective slab inversion of the arterial water with a pulsed arterial spin labeling sequence. The selectivity of this method was demonstrated. Regional perfusion imaging enables assessment of the perfusion territories of the major cerebral arteries. With selective labeling of an internal carotid artery, signal is present in both the ipsilateral anterior cerebral artery and ipsilateral middle cerebral artery flow territory. With labeling of the basilar artery, perfusion-weighted signal is symmetrically present in both posterior cerebral artery flow territories. Cerebral blood flow values measured with regional perfusion imaging in the complete hemisphere (40.1 mL x min(-1) x 100 g(-1) tissue), white matter (22.1 mL x min(-1) x 100 g(-1) tissue), and gray matter (65.8 mL x min(-1) x 100 g(-1) tissue) are in agreement with data in the literature. We present the first imaging method capable of evaluating both quantitatively and qualitatively the flow territories of the individual brain-feeding arteries in vivo.

  19. Multimodality Imaging of Left Circumflex Artery to Coronary Sinus Fistula

    Science.gov (United States)

    Sze, Tan Ling; Abdul Aziz, Yang Faridah; Abu Bakar, Norzailin; Mohd Sani, Fadhli; Oemar, Hamid

    2015-01-01

    Coronary artery fistula (CAF) is a rare anomaly