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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. [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.

  3. Prediction of parent artery of anterior communicating artery aneurysm on CT angiography

    International Nuclear Information System (INIS)

    Chung, Jin Young; Han, Tae Il; Kim, Dae Hong; Han, Hyun Young; Kim, Hyun Jung; Song, Mun Kab

    1999-01-01

    To determine whether CT angiography can predict the parent artery of an anterior communicating aneurysm on the basis of characteristics of the aneurysm and precommunication anterior cerebral artery. Eighteen patients with anterior communication aneurysm were studied prospectively using CT angiography and conventional angiography. The parent artery of an aneurysm was predicted by evaluating aneurysm neck location, direction of aneurysm projection, and size of the precommunicating anterior cerebral artery, as seen on CT angiography. A somatom Plus-4 spiral CT scanner was used and shaded-surface display three-dimensional images were constructed. Aneurysm neck was located near the parent artery in 12 cases(66.7%), and aneurysm projection was against the parent artery in 11 cases(61.1%). The parent artery of the anterior cerebral artery was larger in 15 cases(83.3%), including ten cases of hypoplasia or agenesis of the contralateral anterior cerebral artery. In 17 of 18 aneurysms(94.4%) the parent artery seen on DSA was correctly predicted by CT angiography. The parent artery of an anterior communicating aneurysm can be predicted by evaluating aneurysm neck location, direction of aneurysm projection, and precommunicating anterior cerebral artery, as seen on CT angiography

  4. Hemodynamics Modeling and Simulation of Anterior Communicating Artery Aneurysms

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    Jianjun Li

    2014-07-01

    Full Text Available It is a general agreement that hemodynamics plays very important role in the initiation, growth, and rupture of cerebral aneurysms and hemodynamics in the anterior communicating artery aneurysms is considered the most complex in all cerebral aneurysms and it is difficult to find some reasonable relationship between the hemodynamics parameters and the rupture risk. In this paper, the 3D geometries of four anterior communicating artery aneurysms were generated from the CTA data and the computational models with bilateral feeding arteries for the four aneurysms were constructed. The blood flow was simulated by computational fluid dynamics software and the hemodynamics parameters such as velocity, wall shear stress, and oscillatory shear index were calculated. The following results were observed: one of the four models only needs the left feeding artery; the max normalized wall shear stress locates at the aneurysmal neck of the largest aneurysm; the max oscillatory shear index locates at the aneurysmal sac of the largest aneurysm. The conclusion was drawn that the anterior communicating artery aneurysm has higher rupture risk from the hemodynamics viewpoint if the max wall shear stress locates at the neck and the max oscillatory shear index locates at the dome.

  5. Treatment of anterior communicating artery aneurysms with Guglielmi detachable coils

    International Nuclear Information System (INIS)

    Xu Yi; Liu Jianmin; Hong Bo; Zhao Wenyuan; Huang Qinghai; Zhang Xin; Zhang Long

    2003-01-01

    Objective: To summarize the experience on endovascular treatment of anterior communicating artery aneurysms with Guglielmi detachable coils (GDCs) in 262 cases. Methods: All aneurysms were embolized with GDCs. Catheterization at both ICA was used to monitor the patency of parent arteries for patients with well-developed A1 segment of both ACAs. Microcatheter-assisted or microwire-assisted technique was undertaken to keep patency of parent arteries if the aneurysmal neck was involved with A2 segment. Thirty-four cases with multiple aneurysms had been treated successfully only in one session. Results: Complete embolization was achieved in 160 cases, while subtotal in 56 (>90%) and partial in 46 (<90%). Occlusion of parent arteries developed in 10 cases because of over-occlusion, and cerebral infarction was found in 16 cases after the procedure. Three cases with procedure-related thrombosis were revascularized by urokinase profusion. Follow-up angiograms of 3-6 months showed recanalization in 8 cases requiring a second time session. One case of recurrent aneurysm after GDC treatment was cured by surgical clipping. Conclusions: The result of endovascular treatment of anterior communicating artery aneurysms is fruitful and seems to be an alternative method in improving the rate of occlusion and reducing the cerebral infarction

  6. Steal phenomenon through the anterior communicating artery in Moyamoya disease

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    Lim, Soo Mee [Ewha Womans University, Department of Radiology, Mok-dong Hospital, College of Medicine, Seoul (Korea); Chae, Eun Jin; Kim, Min Yeong; Kim, Sang Joon; Choi, Choong Gon; Pyun, Hae Wook; Suh, Dae Chul [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Kim, Jae Kyun [Seoul Veterans Hospital, Department of Radiology, Seoul (Korea); Ahn, Jae Sung; Ra, Young-Shin [University of Ulsan, Asan Medical Center, Department of Neurosurgery, College of Medicine, Seoul (Korea); Kim, Jong-Uk; Hahm, Kyung Don [University of Ulsan, Asan Medical Center, Department of Anesthesiology, College of Medicine, Seoul (Korea)

    2007-01-15

    Branch occlusion of the anterior cerebral artery (ACA) is regarded as a part of Moyamoya disease. The purpose of this study is to define the ACA steal phenomenon (SP) in Moyamoya disease and to evaluate temporal changes according to the disease progression. From 139 Moyamoya patients we defined ACASP as narrowing of the ipsilateral A1-2 junction while preserving the anterior communicating artery and supplying the contralateral ACA cortical branches with the development of leptomeningeal collaterals by the ipsilateral middle cerebral artery into the hypoperfused ipsilateral ACA territory. Direction of the steal related to the stage in both hemispheres by Suzuki classification was statistically analyzed using the binomial test based on binomial distribution. Follow-ups of ACASP were evaluated in five patients. We identified ACASP in 13 (9%) patients (male:female=7:6, mean age 18 years, range: 2-58 years) of the 139 study patients. The presenting pattern was ischemic in 12 and hemorrhagic in one. The direction of SP occurred from the hemisphere in the lower to the higher stage of Suzuki classification (two-tail P value=0.0002). After revascularization surgery, ACASP disappeared or diminished. ACASP may occur in bilaterally different stages of Moyamoya disease as a transient self-adaptive process. It regresses after revascularization surgery. (orig.)

  7. 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.

  8. Management of ruptured anterior communicating artery aneurysms presenting with sudden paraplegia

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    Jiu-hong MA

    2016-10-01

    Full Text Available Objective  To explore the causes of ruptured anterior communicating artery aneurysms presenting with paraplegia, and summarize the key points of diagnosis and treatment methods. Methods  A total of 260 patients with ruptured anterior communicating artery aneurysms were received medical treatment in the Department of Neurosurgery, Shanxi Provincial People's Hospital from Jan. 2012 to Mar. 2015. Of which 6 patients were clinically presented with paraplegia, their clinical data including CT/MR/DSA were retrospectively analyzed, and based on the analysis, aneurysm embolization and anti-vasospasm treatment were performed. Results  Besides headache and discomfort in the neck, 5 of the 6 patients were with double lower limbs paraplegia, and the another one presented quadriplegia. By symptomatic treatment of aneurysm embolization and anti vasospasm, the myodynamia of the paraplegic limbs recovered from 0-Ⅰto Ⅳ-Ⅴgrade, and 2 of the 6 patients spent a shorter recovery time (about 2 weeks, the other 4 recovered in 3 months. The limbs myodynamia of the 6 patients recovered completely in half-and one year follow up. Conclusions  The mechanism of ruptured anterior communicating artery aneurysms presenting with paraplegia may be the insufficient blood supply to the primary motor area and supplementary motor area (SMA of brain cortex caused by aneurysms rupture. Aneurysm embolization should be performed in clinical treatment, supplemented with anti vasospasm and symptomatic treatment of improving neurological function. DOI: 10.11855/j.issn.0577-7402.2016.09.14

  9. An autopsy case of a giant aneurysm of the anterior communicating artery

    International Nuclear Information System (INIS)

    Shinmura, Fujio; Takayasu, Kenji; Ohiwa, Yasuyuki; Sakata, Ryuichi; Ariwa, Rokuro

    1983-01-01

    A 64-year-old female was admitted to our hospital on 8, July, 1980 with a history of three previous subarachnoid hemorrhages. Neurological examinations revealed incontinentia urinae, gait disturbance, recent memory disturbance and motor weakness on the left side. The results of the neuroradiological examinations were as follows. Plain X-ray films showed a ring-like calcification in the right frontal region. A plain CT scan showed a ring-shaped iso- and high-density area in the intra hemispheric region, the intra bilateral anterior horn of the lateral ventricle, the intra septum pellucidum, and the intra anterior part of the third ventricle. A small high-density region was enhanced as an island within it by means of a Conray infusion. Left carotid angiography showed a large aneurysmal shadow arising from the anterior communicating artery and another from the left middle cerebral artery. In the venous phase the venous angle was supero-posteriorly shifted, and the septal vein was elevated. She died unexpectedly with a status epilepticus of unknown origin. Clinically, rerupture was not verified. An autopsy specimen revealed that a giant aneurysm (6 x 5 x 4 cm in size) arising from the anterior communicating artery occupied the intra ventricular space, the anterior horn of the lateral ventricle, and the right thalamic region. Also, there was a large berry aneurysm (2 x 1.7 x 1.5 cm in size) arising from the middle cerebral artery. A coronary section through the giant aneurysm showed a markedly compressed left lateral ventricle, right thalamus, and hypothalamus, while the third ventricle had shifted toward the left side. (J.P.N.)

  10. Evaluation of three-dimensional angiography for surgery of aneurysms on the anterior communicating artery

    International Nuclear Information System (INIS)

    Isobe, Naoyuki; Oki, Shuichi; Murakami, Taro; Ooyama, Shigeru; Kureshima, Makoto; Kurokawa, Yasuharu

    2007-01-01

    Obtaining detailed anatomical information is crucial before aneurysm microsurgery. The anterior cerebral communicating artery complex (AcoC) is particularly complicated compared to other parts. The anatomical structure of the AcoC is sometimes difficult to understand using conventional angiography. We evaluated the advantages of 3-dimensional digital angiography (3D-DA) for aneurysm microsurgery on the anterior cerebral communicating artery. Subjects comprised 10 men and 5 women (mean age, 61 years; range, 33-79 years) who underwent surgery in our hospital between November 2002 and October 2005. Twelve aneurysms were ruptured, and 3 aneurysms were unruptured. We compared 3D-DA images and surgical findings to assess aneurysmal morphology and relationships to neighboring vessels. We also examined both the presence and visualization of variations on AcoC. In all cases, surgical findings corresponded well to 3D-DA images. Variations on AcoC included fenestration (n=3), azygos (n=1) and aplasia or hypoplasia of the A1 segment of a unilateral anterior cerebral artery (n=9), and these were all well-visualized in 3D-DA. In addition, 3D-DA was also useful for aneurysms with 2 domes for selection of surgical approach, and provided assessment of not only aneurysmal morphology, but also variations of AcoC. This tool provided useful information for the selection of operation approach and intraoperative manipulations by using it together with 2-dimensional digital substraction angiography. (author)

  11. Three-dimensional imaging of the optic nerve using magnetic resonance angiography. Application to anterior communicating artery aneurysm and craniopharingioma

    International Nuclear Information System (INIS)

    Okuyama, Tohru; Fukuyama, Atsushi; Fukuyama, Koichi; Ikeno, Kunihiro; Araki, Hiroyuki; Okada, Kinya; Sohma, Noriko

    2005-01-01

    The purpose of this investigation was to analyze three-dimensional images of the optic nerve obtained by magnetic resonance angiography (MRA) in cases of anterior communicating artery aneurysm and craniopharingioma. Four ruptured anterior communicating artery aneurysms, five non-ruptured anterior communicating artery aneurysms and two craniopharingiomas were examined. The images were taken using MR/i Hispeed Plus 1.5 T Infinity version, and analyzed by Advantage Work station AW4.1. The routine MR imaging parameters are shown in Table. The imaging time was about 10 minutes. Analysis was made by reformation of images parallel to the optic nerve obtained from the original MRA images. The optic nerve and brain tumor were traced with paintbrush from one sheet to another of the reformed images after subtraction of the blood vessels around the anterior communicating artery in these reformed images, and then three-dimensional images were constructed. Three-dimensional images of the blood vessels were reconstructed from MIP (maximum intensity projection) images using the threshold method. The optic nerve and anterior communicating arterial aneurysm or brain tumor were both observed in the overlapped 3D-SSD (shaded surface display) images. The analysis time was about 15 minutes. Three-dimensional images of the optic nerve and anterior communicating artery aneurysm or brain tumor were able to be made in all cases. As a preoperative investigation for anterior communicating artery aneurysm or suprasellar brain tumor, we considered that three-dimensional imaging of the optic nerve is useful in the operative approach because the optic nerve acts as a merkmal for the anterior communicating aneurysm or brain tumor. (author)

  12. 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.

  13. De novo giant A2 aneurysm following anterior communicating artery occlusion.

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    Ibrahim, Tarik F; Hafez, Ahmad; Andrade-Barazarte, Hugo; Raj, Rahul; Niemela, Mika; Lehto, Hanna; Numminen, Jussi; Jarvelainen, Juha; Hernesniemi, Juha

    2015-01-01

    De novo intracranial aneurysms are reported to occur with varying incidence after intracranial aneurysm treatment. They are purported to be observed, however, with increased incidence after Hunterian ligation; particularly in cases of carotid artery occlusion for giant or complex aneurysms deemed unclippable. We report a case of right-sided de novo giant A2 aneurysm 6 years after an anterior communicating artery (ACoA) aneurysm clipping. We believe this de novo aneurysm developed in part due to patient-specific risk factors but also a significant change in cerebral hemodynamics. The ACoA became occluded after surgery that likely altered the cerebral hemodynamics and contributed to the de novo aneurysm. We believe this to be the first reported case of a giant de novo aneurysm in this location. Following parent vessel occlusion (mostly of the carotid artery), there are no reports of any de novo aneurysms in the pericallosal arteries let alone a giant one. The patient had a dominant right A1 and the sudden increase in A2 blood flow likely resulted in increased wall shear stress, particularly in the medial wall of the A2 where the aneurysm occurred 2 mm distal to the A1-2 junction. ACoA preservation is a key element of aneurysm surgery in this location. Suspected occlusion of this vessel may warrant closer radiographic follow-up in patients with other risk factors for aneurysm development.

  14. 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.

  15. 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.

  16. 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.

  17. Autopsy case of a giant aneurysm of the anterior communicating artery. Correlation of CT findings and angiographic findings

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    Shinmura, Fujio; Takayasu, Kenji; Ohiwa, Yasuyuki; Sakata, Ryuichi; Ariwa, Rokuro

    1983-06-01

    A 64-year-old female was admitted to the hospital with a history of three previous subarachnoid hemorrhages. Neurological examinations revealed incontinentia urinae, gait disturbance, recent memory disturbance and motor weakness on the left side. Plain X-ray films showed a ring-like calcification in the right frontal region. A plain CT scan showed a ring-shaped iso- and high-density area in the intra hemispheric region, the intra bilateral anterior horn of the lateral ventricle, the intra septum pellucidum, and the intra anterior part of the third ventricle. Left carotid angiography showed a large aneurysmal shadow arising from the anterior communicating artery and another from the left middle cerebral artery. In the venous phase the venous angle was supero-posteriorly shifted, and the septal vein was elevated. She died unexpectedly with a status epilepticus of unknown origin. An autopsy specimen revealed that a giant aneurysm occupied the intra ventricular space, the anterior horn of the lateral ventricle, and the right thalamic region. Also, there was a large berry aneurysm arising from the middle cerebral artery. A coronary section through the giant aneurysm showed a markedly compressed left lateral ventricle, right thalamus, and hypothalamus, while the third ventricle had shifted toward the left side.

  18. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

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    Kamide, Tomoya; Burkhardt, Jan-Karl; Tabani, Halima; Safaee, Michael M; Lawton, Michael T

    2018-01-01

    Although most posterior communicating artery (PCoA) aneurysms can be clipped easily with excellent results, some require anterior clinoidectomy for safe and complete clipping. To review our microsurgical series of ruptured PCoA aneurysms and identify the preoperative predictors for anterior clinoidectomy during microsurgical clipping for PCoA aneurysms. Results from microsurgical clipping of 104 patients with ruptured PCoA aneurysms were reviewed retrospectively. Distances and angles were obtained from computed tomographic angiography and compared between the anterior and nonanterior clinoidectomy groups. Anterior clinoidectomy was required in 19 of the 104 cases (18%). None developed surgical complications due to anterior clinoid process (ACP) resection, including postoperative visual deficit. Univariate and multivariate analyses revealed that the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were statistically significant predictive factors for the need of anterior clinoidectomy. Based on a receiver operating characteristic analysis, the distances from the ACP tip to the aneurysmal proximal neck PCoA aneurysm surgery, the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were both found to be useful predictors of whether anterior clinoidectomy was required. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

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    Rajasekar Arumugam

    2017-01-01

    Full Text Available Perioperative management of neurosurgical patients with an underlying myocardial dysfunction poses a unique challenge to the neuroanaesthesiologist and the neurointensivist. Sudden catecholamine surge during the aneurysmal subarachnoid haemorrhage (SAH can cause severe cardiac dysfunction such as myocardial ischaemia and cardiomyopathy. SAH in a patient with restrictive cardiomyopathy could be hazardous to the myocardium leading to severe cardiac morbidity. We report the successful management of an acute post-operative diastolic heart failure with a milrinone infusion in a patient with restrictive cardiomyopathy, following anterior communicating artery aneurysm clipping. We have discussed the 'dual beneficial' role of milrinone on the heart and the brain in this clinical setting. In addition, the importance of peri-operative utilisation of transoesophageal echocardiography and transthoracic echocardiography for the successful management of diastolic heart failure is highlighted.

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

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    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.

  1. 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.)

  2. anomalous left anterior cerebral artery with hypoplastic right anterior ...

    African Journals Online (AJOL)

    2018-02-28

    Feb 28, 2018 ... We report an extremely rare anomalous variation of left anterior cerebral artery arising from the ... paraclinoid internal carotid artery and right ... Studies on the arteries of the brain: II-The anterior cerebral artery: Some anatomic ...

  3. Morphometric Study of the Anterior Thalamoperforating Arteries

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    Kim, Sung-Ho; Yeo, Dong-Kyu; Shim, Jae-Joon; Yoon, Seok-Mann; Chang, Jae-Chil

    2015-01-01

    Objective To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). Methods A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. Results The anterior and middle segments of the ATPAs arose at mean intervals of 1.75±1.62 mm and 5.86±2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17±1.64 mm. The posterior segment arose at a mean interval of 2.43±1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45±1.39 mm. The mean numbers of perforators were 2.66±1.19, 3.03±1.84, and 1.67±0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. Conclusion Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa. PMID:26113962

  4. Fenestration of the anterior cerebral artery

    International Nuclear Information System (INIS)

    Ito, J.; Washiyama, K.; Hong Kim, C.; Ibuchi, Y.

    1981-01-01

    Three cases of angiographically demonstrated fenestration of the anterior cerebral artery are reported. Fenestration occurred at the medial half of the horizontal segment of the anterior cerebral artery in all cases. Its embryology and clinical significance are briefly discussed, and the anatomical and radiological literature on fenestration of the anterior cerebral artery is reviewed. (orig.)

  5. 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

  6. Reversible Edema-Like Changes Along the Optic Tract Following Pipeline-Assisted Coiling of a Large Anterior Communicating Artery Aneurysm.

    Science.gov (United States)

    La Pira, Biagia; Brinjikji, Waleed; Hunt, Christopher; Chen, John J; Lanzino, Giuseppe

    2017-06-01

    Aneurysmal volume expansion after endovascular treatment is caused by intra-aneurysmal thrombosis in the early postembolization period. Although postembolization mass effect on cranial nerves and other adjacent structures has been previously reported, we are unaware of reports involving the anterior visual pathway. A 66-year-old woman with a 2-week history of blurred vision without headache was found to have a large, unruptured anterior communicating artery aneurysm. One month after endovascular treatment of the aneurysm with coiling and flow diversion, the patient developed decreased vision in her right eye and a left homonymous hemianopia. Magnetic resonance imaging demonstrated compression of the right optic nerve, chiasm, and edema of the right optic tract. The patient was treated with a course of high dose corticosteroids, and over the course of several weeks, her vision improved and the optic tract edema resolved. We alert clinicians to this rare but potentially reversible visual complication of endovascular treatment of intracranial aneurysms.

  7. 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.

  8. Bypass grafting to the anterior tibial artery.

    Science.gov (United States)

    Armour, R H

    1976-01-01

    Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. One graft failed on the fifth postoperative day and another occluded 4 months after operation. The literature on femorotibial grafting has been reviewed. The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.

  9. 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

  10. 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.

  11. Differentiating aneurysm from infundibular dilatation by volume rendering MRA. Techniques for improving depiction of the posterior communicating and anterior choroidal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Takaaki; Ito, Takeo; Hasunuma, Masahiro; Sakamoto, Yasuo; Kohama, Ikuhide; Yonemori, Terutake; Izumo, Masaki [Hakodate Shintoshi Hospital, Hokkaido (Japan)

    2002-12-01

    With the spread of brain dock procedures, non-invasive magnetic resonance angiography (MRA) is being utilized to broadly screen for brain blood vessel diseases. However, diagnosis of cerebral aneurysm can be difficult by routine MRA. In particular, differentiating aneurysms and infundibular dilatations (IDS) of the posterior communicating artery (PCoA) and anterior choroidal artery (AChA) at their bifurcations with the internal carotid artery (ICA) is extremely difficult and additional studies are frequently necessary. In this situation, three-dimensional computed tomography angiography (3D-CTA) and cerebral angiography have been utilized, but both techniques are invasive. Furthermore, images from cerebral angiography are only two-dimensional, and 3D-CTA requires differentiation between aneurysm and ID by observing configurational changes at the apex of the protrusion and by following gradual changes to the threshold. We therefore undertook the following steps to improve both depiction of the PCoA and AChA and differential diagnosis between aneurysm and ID: reduced slice thickness and increased number of excitations; utilized volume rendering methods to construct images; lowered thresholds for the beginning of the PCoA and AChA arteries, which represent the regions of interest. In all 11 cases that we operated on, cerebral aneurysms were diagnosed correctly and the minimum neck diameter of the cerebral aneurysm was 1.2 mm. In addition, the number of AChAs and PCoAs present in target MRA and in operational views were evaluated. In one case with an AChA aneurysm, a PCoA was not detected by target MRA, because the ICA deviated posterolaterally and pushed the PCoA to the posterior clinoid process, and blood flow was poor in operational views. In another 2 cases with AChA aneurysms, only one AChA was described in target MRA, whereas two aneurysms were present. However, one of these had a diameter less than 1 mm. In conclusion, this method offers an extremely useful aid

  12. Differentiating aneurysm from infundibular dilatation by volume rendering MRA. Techniques for improving depiction of the posterior communicating and anterior choroidal arteries

    International Nuclear Information System (INIS)

    Kato, Takaaki; Ito, Takeo; Hasunuma, Masahiro; Sakamoto, Yasuo; Kohama, Ikuhide; Yonemori, Terutake; Izumo, Masaki

    2002-01-01

    With the spread of brain dock procedures, non-invasive magnetic resonance angiography (MRA) is being utilized to broadly screen for brain blood vessel diseases. However, diagnosis of cerebral aneurysm can be difficult by routine MRA. In particular, differentiating aneurysms and infundibular dilatations (IDS) of the posterior communicating artery (PCoA) and anterior choroidal artery (AChA) at their bifurcations with the internal carotid artery (ICA) is extremely difficult and additional studies are frequently necessary. In this situation, three-dimensional computed tomography angiography (3D-CTA) and cerebral angiography have been utilized, but both techniques are invasive. Furthermore, images from cerebral angiography are only two-dimensional, and 3D-CTA requires differentiation between aneurysm and ID by observing configurational changes at the apex of the protrusion and by following gradual changes to the threshold. We therefore undertook the following steps to improve both depiction of the PCoA and AChA and differential diagnosis between aneurysm and ID: reduced slice thickness and increased number of excitations; utilized volume rendering methods to construct images; lowered thresholds for the beginning of the PCoA and AChA arteries, which represent the regions of interest. In all 11 cases that we operated on, cerebral aneurysms were diagnosed correctly and the minimum neck diameter of the cerebral aneurysm was 1.2 mm. In addition, the number of AChAs and PCoAs present in target MRA and in operational views were evaluated. In one case with an AChA aneurysm, a PCoA was not detected by target MRA, because the ICA deviated posterolaterally and pushed the PCoA to the posterior clinoid process, and blood flow was poor in operational views. In another 2 cases with AChA aneurysms, only one AChA was described in target MRA, whereas two aneurysms were present. However, one of these had a diameter less than 1 mm. In conclusion, this method offers an extremely useful aid

  13. 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

  14. 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.

  15. 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.)

  16. 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.)

  17. Third nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior-posterior clinoid process.

    Science.gov (United States)

    Anan, Mitsuhiro; Nagai, Yasuyuki; Fudaba, Hirotaka; Kubo, Takeshi; Ishii, Keisuke; Murata, Kumi; Hisamitsu, Yoshinori; Kawano, Yoshihisa; Hori, Yuzo; Nagatomi, Hirofumi; Abe, Tatsuya; Fujiki, Minoru

    2014-08-01

    Third nerve palsy (TNP) caused by a posterior communicating artery (PCoA) aneurysm is a well-known symptom of the condition, but the characteristics of unruptured PCoA aneurysm-associated third nerve palsy have not been fully evaluated. The aim of this study was to analyze the anatomical features of PCoA aneurysms that caused TNP from the viewpoint of the relationship between the ICA and the skull base. Forty-eight unruptured PCoA aneurysms were treated surgically between January 2008 and September 2013. The characteristics of the aneurysms were evaluated. Thirteen of the 48 patients (27%) had a history of TNP. The distance between the ICA and the anterior-posterior clinoid process (ICA-APC distance) was significantly shorter in the TNP group (pPCoA aneurysms can cause third nerve palsy if the ICA runs close to the skull base. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

    Science.gov (United States)

    Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

    2008-02-01

    Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

  19. 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.)

  20. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    Science.gov (United States)

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Conijn, Mandy M.A.; Hendrikse, Jeroen; Takahara, Taro; Mali, Willem P.T.M. [University Medical Center Utrecht, Department of Radiology (Hp E 01.132), P.O. Box 85500, Utrecht (Netherlands); Zwanenburg, Jaco J.M. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Geerlings, Mirjam I. [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Luijten, Peter R. [University Medical Center Utrecht, Department of Radiology (Hp E 01.132), P.O. Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2009-12-15

    The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0 Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy volunteers underwent TOF MR angiography at 7.0 Tesla. With 7.0-Tesla imaging, we visualised for the first time perforating arteries originating from the PCoA in vivo without the use of contrast agents. A perforating artery from the PCoA was found in a large proportion of the PCoAs (64%). The presence was associated with a larger diameter of the underlying PCoA (1.23 versus 1.06 mm, P = 0.03). The anterior choroidal artery was visible bilaterally in all participants. In 83% of all P1s, one or two perforating branches were visible. Non-invasive assessment of the perforating arteries of the PCoA together with the anterior choroidal artery and the perforating arteries of the P1 may increase our understanding of infarcts in the deep brain structures supplied by these arteries. (orig.)

  2. Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study

    International Nuclear Information System (INIS)

    Conijn, Mandy M.A.; Hendrikse, Jeroen; Takahara, Taro; Mali, Willem P.T.M.; Zwanenburg, Jaco J.M.; Geerlings, Mirjam I.; Luijten, Peter R.

    2009-01-01

    The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0 Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy volunteers underwent TOF MR angiography at 7.0 Tesla. With 7.0-Tesla imaging, we visualised for the first time perforating arteries originating from the PCoA in vivo without the use of contrast agents. A perforating artery from the PCoA was found in a large proportion of the PCoAs (64%). The presence was associated with a larger diameter of the underlying PCoA (1.23 versus 1.06 mm, P = 0.03). The anterior choroidal artery was visible bilaterally in all participants. In 83% of all P1s, one or two perforating branches were visible. Non-invasive assessment of the perforating arteries of the PCoA together with the anterior choroidal artery and the perforating arteries of the P1 may increase our understanding of infarcts in the deep brain structures supplied by these arteries. (orig.)

  3. Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study.

    Science.gov (United States)

    Conijn, Mandy M A; Hendrikse, Jeroen; Zwanenburg, Jaco J M; Takahara, Taro; Geerlings, Mirjam I; Mali, Willem P Th M; Luijten, Peter R

    2009-12-01

    The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0 Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy volunteers underwent TOF MR angiography at 7.0 Tesla. With 7.0-Tesla imaging, we visualised for the first time perforating arteries originating from the PCoA in vivo without the use of contrast agents. A perforating artery from the PCoA was found in a large proportion of the PCoAs (64%). The presence was associated with a larger diameter of the underlying PCoA (1.23 versus 1.06 mm, P = 0.03). The anterior choroidal artery was visible bilaterally in all participants. In 83% of all P1s, one or two perforating branches were visible. Non-invasive assessment of the perforating arteries of the PCoA together with the anterior choroidal artery and the perforating arteries of the P1 may increase our understanding of infarcts in the deep brain structures supplied by these arteries.

  4. Patterns of prefrontal dysfunction in alcoholics with and without Korsakoff’s syndrome, patients with Parkinson’s disease, and patients with rupture and repair of the anterior communicating artery

    Science.gov (United States)

    Dirksen, Courtney L; Howard, Julie A; Cronin-Golomb, Alice; Oscar-Berman, Marlene

    2006-01-01

    This study compared patterns of frontal-lobe dysfunction in alcoholics with Korsakoff’s syndrome (KS: n = 9), non-Korsakoff alcoholics (AL: n = 28), patients with Parkinson’s disease (PD: n = 18), and patients with rupture and repair of the anterior communicating artery (ACoA: n = 4) relative to healthy non-neurological control (NC) participants (n = 70). The tests administered were sensitive to functions of dorsolateral prefrontal and orbito-frontal subsystems. Measures included perseverative errors on the Wisconsin Card Sorting Test (WCST-pe), errors on object alternation (OA), errors on Trails B, number of words generated on the Controlled Oral Word Association Test (COWAT), and number of categories completed on the WCST (WCST-cc). KS patients were as impaired as AL participants on orbitofrontal measures and, on dorsolateral prefrontal measures, were impaired relative to AL participants, whose performance did not differ from controls. Patients with PD also were impaired on tests of orbitofrontal and dorsolateral prefrontal functioning but to a lesser extent than the KS patients. Moreover, most of the PD deficits were driven by the impaired performance of patients whose initial symptoms were on the right side of the body. The ACoA patients were significantly impaired on tests of orbitofrontal but not dorsolateral prefrontal functioning relative to the control group. Together, the results confirm different patterns of frontal-system impairments in patient groups having compromised frontal lobe functioning consequent to varying etiologies. PMID:19412479

  5. Right Coronary Artery Originated from the Left Anterior Descending Artery in a Patient with Congenital Pulmonary Valvular Stenosis

    Directory of Open Access Journals (Sweden)

    Yusuf Hoşoğlu

    2013-01-01

    Full Text Available The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation.

  6. Hemodynamic effects of innominate artery occlusive disease on anterior cerebral artery.

    Science.gov (United States)

    Tan, Teng-Yeow; Lien, Li-Ming; Schminke, Ulf; Tesh, Paul; Reynolds, Patrick S; Tegeler, Charles H

    2002-01-01

    Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.

  7. Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study

    OpenAIRE

    Conijn, Mandy M. A.; Hendrikse, Jeroen; Zwanenburg, Jaco J. M.; Takahara, Taro; Geerlings, Mirjam I.; Mali, Willem P. Th. M.; Luijten, Peter R.

    2009-01-01

    The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0?Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy ...

  8. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-01-01

    Full Text Available A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  9. Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player

    Directory of Open Access Journals (Sweden)

    Ichiro Tonogai

    2017-01-01

    Full Text Available Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.

  10. Paired anterior spinal arteries in a case of locked-in syndrome

    International Nuclear Information System (INIS)

    Kawamura, J.; Matsubayashi, K.; Fukuyama, H.; Kitanaka, H.

    1981-01-01

    Paired anterior spinal arteries have rarely been demonstrated angiographically, although several anatomical studies have shown that they are not uncommonly observed. This report describes the angiographic and autopsy findings of such a variation, which was observed in a 65-year-old man with a locked-in syndrome. The paired trunks of the anterior spinal artery were visualized in a retrograde fashion through the left inferior thyroid artery and a radical branch at the 5th cervical level by left retrograde brachial angiography. The uppermost segments of either vertebral artery and the lower portion of the basilar artery were opacified through these channels. The autopsy confirmed the paired trunks of the anterior spinal artery, occlusion of the vertebral arteries just caudal to the origin of the main branches of the anterior spinal artery, and an old infarct involving the pontine tegmentum and cerebellum. (orig.)

  11. Identification of the segmental artery feeding the anterior spinal artery. Correlation between helical CT and angiography

    International Nuclear Information System (INIS)

    Nishimura, Jun-ichi; Lee, Jin; Koike, Shigeomi

    2005-01-01

    We investigated whether identification of the segmental artery feeding the anterior spinal artery (ASA) is possible by single-slice helical CT. Enhanced CT and angiography were performed in 14 patients with retroperitoneal, liver, or bone tumor. A single-slice helical CT scanner with 7 mm collimation and a 1.0 helical pitch was used. Scanning was started 25 to 30 sec after an intravenous injection of 100 ml of contrast medium at a rate of 3.0 ml/sec. We predicted the segmental artery feeding the ASA in all 14 patients using enhanced CT images. In 12 of the 14 patients, the segmental artery feeding the ASA was angiographically identified. In 7 of these 12 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was the same level as that predicted by enhanced CT. In the remaining 5 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was one level higher or lower than the predicted spinal level. We could identify the segmental artery feeding the ASA by detailed examination and interpretation of single-slice helical CT images. (author)

  12. 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.)

  13. Asterixis in the leg induced by anterior cerebral artery infarction.

    Science.gov (United States)

    Sunwoo, Mun Kyung; Jang, Hyun-Soon; Roh, Sook Young; Yoo, Hyun Jung; Jeong, Eun Hye; Kim, Byung-Su; Choe, Yeo Reum; Lee, Ko-Eun

    2016-06-01

    Asterixis commonly occurs in a patient with metabolic encephalopathy, whereas focal brain lesions such as thalamus, cerebellum, or frontal area also cause focal or unilateral asterixis in the arms. We report a novel case of asterixis in the leg after unilateral anterior cerebral artery territory infarction. A 76-year-old man was admitted with sudden-onset mild right leg weakness and postural instability due to knee buckling. He was diagnosed with ischemic stroke in the left prefrontal area and cingulated gyrus by brain magnetic imaging. Needle electromyography of the right vastus lateralis muscle while standing showed intermittent periods of EMG silence, consistent with asterixis. There were no abnormal involuntary movements in the upper extremities. This case suggests that gait disturbance or postural instability after structural lesions in the prefrontal area may be directly related to asterixis in the leg, not in the arm associated with postural failure.

  14. The anterior choroidal artery syndrome. Pt. 2. CT and/or MR in angiographically verified cases

    International Nuclear Information System (INIS)

    Takahashi, S.; Ishii, K.; Matsumoto, K.; Higano, S.; Ishibashi, T.; Suzuki, M.; Sakamoto, K.

    1994-01-01

    We reviewed 12 cases of infarcts in the territory of the anterior choroidal artery (AChA) on CT and/or MRI. In each case vascular occlusion in the region was verified angiographically. Although the extent of the lesion on CT/MR images was variable, all were located on the axial images within an arcuate zone between the striatium anterolaterally and the thalamus posteromedially. The distribution of the lesions on mutiplanar MRI conformed well to the territory of the AChA demonstrated microangiographically. The variability of the extent of the infarcts may be explained by variations in the degree of occlusive changes in the AChA or the development of collateral circulation through anastomoses between the AChA and the posterior communicating and posterior cerebral arteries. The extent of the lesion appeared to be closely related to the degree of neurological deficit. (orig.)

  15. Traumatic occlusion of the anterior cerebral artery--case report.

    Science.gov (United States)

    Ishibashi, A; Kubota, Y; Yokokura, Y; Soejima, Y; Hiratsuka, T

    1995-12-01

    A 71-year-old female presented with posttraumatic occlusion of the anterior cerebral artery (ACA) after a road accident in which she was hit in the mid-frontal region. Initial computed tomography (CT) demonstrated frontal skull fractures and pneumocephalus. High density areas were also identified in the right basal cisterns, suggesting traumatic subarachnoid hemorrhage. She was alert on admission, but with attendant shock due to crush wounds. Her condition rapidly deteriorated and an emergency amputation of her left leg was performed. After aggressive treatment with transfusion and infusion, her systolic pressure increased to 120 mmHg. Her consciousness remained disturbed. Serial CT disclosed hemorrhagic infarction in the entire medial side of the right frontal lobe. Magnetic resonance angiography demonstrated decreased flow voids in the bilateral A1 segments and right ACA, and a basilar artery aneurysm, which was unruptured clinically. Three weeks after the injury, she regained consciousness. Six months later, she had motor aphasia and left upper extremity weakness. The clinicopathological mechanism causing the traumatic occlusion of the ACA in the present case was probably dissecting aneurysm.

  16. Anterior choroidal artery occlusions: Clinical and laboratory features

    Directory of Open Access Journals (Sweden)

    Lale Gündoğdu Çelebi

    2014-12-01

    Full Text Available OBJECTIVE: The anterior choroidal artery (ACHA irrigation area, this area is very volatile infarction incidence and clinical characteristics of classical knowledge. In our study, patients with infarct lesion limited irrigation area of Achan was to determine the clinical and laboratory features. METHODS: The patient group, magnetic resonance imaging, patients with lesions limited to the area by selecting Achan was created. In addition to the acute lesion Achan, the other in the sprawling grounds of the arteries of patients, additional lesions Those who define transient ischemic attack attributable to infarct Achan, the applicant passed before the first signs of neurological sequelae due to cerebrovascular disease and / or old lesions deemed capable of neurological deficits were excluded. Acha deciding that the irrigation area of the lesion, which is a deep dive irrigation area and medial thalamus, globus pallidus delimit the lateral thalamus formed the typical image of the lesion which were taken into account. For the superficial branch of the amygdala and hippocampus lentikülo-striate arteries occlusion seen in the posterior horn of the lateral ventricle of the lesion until komşuluğuna taken into account. RESULTS: A statistically significant difference in hypertension common modifiable risk factor for the highest rate (p <0.000. Pure motor or sensory examination in all patients except 1 patient showed signs of stroke. According to the classification of etiologic TOAST small vessel disease, significantly higher rate compared to other etiologies (p <0.000. Etiologic groups compared to the risk factors of hypertension and hyperlipidemia in patients with small vessel disease, atrial firillasyon (AF kardioemboli group was significantly higher (p = 0.035 and p = 0.011, p = 0.005. Introduction of the patients were between NIHSS 1-15 (6 + 3.2. Between mRS 0-4 at baseline (1.83 +1.22. Infarct area, Acha is one of the branches or the entire irrigation

  17. Endovascular coil embolization for anterior choroidal artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Moon; Chung, Eun Chul [Sungkyunkwan University School of Medicine, Department of Radiology, Kangbuk Samsung Hospital, Seoul (Korea); Kim, Dong Ik; Kim, Dong Joon; Suh, Sang Hyun [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Sun Yong [Ajou University College of Medicine, Department of Radiology, Suwon (Korea); Shin, Yong Sam [Ajou University College of Medicine, Department of Neurosurgery, Suwon (Korea); Park, Sung Il [Soonchunhyang University College of Medicine, Department of Radiology, Bucheon Hospital, Bucheon (Korea); Choi, Chun Sik; Won, Yu.Sam [Sungkyunkwan University School of Medicine, Department of Neurosurgery, Kangbuk Samsung Hospital, Seoul (Korea)

    2008-03-15

    We retrospectively evaluated the ischemic complications related to the anterior choroidal artery (AChA) and clinical outcome after coiling of AChA aneurysms. We included 37 patients (27 with subarachnoid hemorrhage, 10 without) harboring 38 AChA aneurysms (23 ruptured, 15 unruptured) who were treated by coiling at four institutions. Ischemic complications related to the AChA and clinical outcomes were retrospectively evaluated. Intraprocedural transient AChA occlusion occurred in five aneurysms, all of which had AChA incorporated into the aneurysm neck. Two of the five patients suffered postprocedural transient contralateral hemiparesis, but recovered completely. The remaining three patients had no postprocedural symptoms. Incidence of transient AChA occlusion was significantly higher in those aneurysms in which the AChA was incorporated into aneurysm neck (group 2) than in those in which the AChA was not incorporated (group 1). Of the 37 patients, 31 (83.8%) had good recoveries (modified Rankin scale score 0-2). Two patients died from the consequences of subarachnoid hemorrhage. During follow-up for a mean of 27 months (range 4-72 months), none of the 35 living patients re-bled. A total of 29 aneurysms in 28 patients were followed-up angiographically. Recurrences were found in 5 of the 29 aneurysms during follow-up (mean 18 months, range 6-45 months). Re-embolization achieved near complete occlusion of two recurrent aneurysms, both of which were still stable at the time of the next two follow-up angiographies. The other three recurrent aneurysms were not retreated due to the small size of the recurrences. Coiling of AChA aneurysms resulted in good outcomes without AChA-related permanent ischemic complications. Transient AChA occlusion, potentially associated with ischemic complications, was significantly more frequent in the aneurysm in which the AChA was incorporated into the aneurysm neck. (orig.)

  18. 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.

  19. Duplicate origin of the posterior communicating artery diagnosed by magnetic resonance angiography.

    Science.gov (United States)

    Uchino, Akira; Kamiya, Kouhei; Suzuki, Chihiro

    2013-10-01

    Extremely rarely, a posterior communicating artery (PCoA) of "duplicate origin" occurs when two branches of the PCoA arise separately from the supraclinoid segment of the internal carotid artery (ICA) and quickly fuse to form an arterial ring. Three such cases previously reported were described as "fenestration." We report the case of this rare variation diagnosed by magnetic resonance angiography and discuss the differentiation of PCoA of duplicate origin from PCoA fenestration, supraclinoid ICA fenestration, and hyperplastic anterior choroidal artery.

  20. 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.

  1. Diagnostic pitfalls associated with a large true posterior communicating artery aneurysm: a case report.

    Science.gov (United States)

    Nagatani, Kimihiro; Otani, Naoki; Seno, Soichiro; Takeuchi, Satoru; Wada, Kojiro; Mori, Kentaro

    2013-10-01

    True posterior communicating artery (PCoA) aneurysm is an aneurysm that originates from the PCoA, and large or giant true PCoA aneurysms are rare. We report a case of a large true PCoA aneurysm successfully clipped after anterior clinoidectomy and discuss the diagnostic pitfalls associated with this rare clinical entity.

  2. Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report.

    Science.gov (United States)

    Niro, A; Sborgia, G; Sborgia, A; Alessio, G

    2018-01-17

    The incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy. A 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia. Hyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.

  3. Parent artery occlusion for ruptured "true" posterior communicating artery aneurysm.

    Science.gov (United States)

    Mitsuhashi, Takashi; Takeda, Nobuaki; Oishi, Hidenori; Arai, Hajime

    2015-04-01

    A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms.

    Science.gov (United States)

    Nossek, Erez; Setton, Avi; Dehdashti, Amir R; Chalif, David J

    2014-10-01

    Proximally located posterior communicating artery (PCoA) aneurysms, projecting postero-laterally in proximity to the tentorium, may pose a technical challenge for microsurgical clipping due to obscuration of the proximal aneurysmal neck by the anterior petroclinoid fold. We describe an efficacious technique utilizing fenestration of the anterior petroclinoid fold to facilitate visualization and clipping of PCoA aneurysms abutting this aspect of the tentorium. Of 86 cases of PCoA aneurysms treated between 2003 and 2013, the technique was used in nine (10.5 %) patients to allow for adequate clipping. A 3 mm fenestration in the anterior petroclinoid ligament is created adjacent and lateral to the anterior clinoid process. This fenestration is then widened into a small wedge corridor by bipolar coagulation. In all cases, the proximal aneurysm neck was visualized after the wedge fenestration. Additionally, an adequate corridor for placement of the proximal clip blade was uniformly established. All cases were adequately clipped, with complete occlusion of the aneurysm neck and fundus with preservation of the PCoA. There were two intraoperative ruptures not related to creation of the wedge fenestration. One patient experienced post-operative partial third nerve palsy, which resolved during follow-up. We describe a technique of fenestration of the anterior petroclinoid fold to establish a critical and safe corridor for both visualization and clipping of PCoA aneurysms.

  5. Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. Pt. 1. Anterior cerebral artery

    International Nuclear Information System (INIS)

    Gloger, S.; Gloger, A.; Vogt, H.; Kretschmann, H.J.

    1994-01-01

    We present a three-dimensional anatomical computer model of the terminal branches of the anterior cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlation. (orig.)

  6. Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. Pt. 1. Anterior cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Gloger, S. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Gloger, A. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Vogt, H. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Kretschmann, H.J. (Dept. of Neuroanatomy, Hannover Medical School (Germany))

    1994-04-01

    We present a three-dimensional anatomical computer model of the terminal branches of the anterior cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlation. (orig.)

  7. Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

    International Nuclear Information System (INIS)

    Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung

    2013-01-01

    Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

  8. Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul, (Korea, Republic of)

    2013-10-15

    Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

  9. Anatomical Variability of the Posterior Communicating Artery.

    Science.gov (United States)

    Gunnal, Sandhya Arvind; Farooqui, Mujibuddin S; Wabale, Rajendra N

    2018-01-01

    Although posterior communicating artery (PCoA) is a smaller branch of the internal carotid artery, it gives the main contribution in the formation of circle of Willis (CW) by communicating with the internal carotid arterial system and the vertebro-basilar arterial system. The size of PCoA varies frequently. The present work aims to study the PCoA regarding its morphology, morphometry, and symmetry. This study was conducted on 170 human cadaveric brains. Brains were dissected carefully and delicately to expose all components of CW, especially PCoA. Morphological variations of PCoA were noted along with its morphometry and symmetry. Morphological variations of PCoA were aplasia (3.52%), hypoplasia (25.29%), fenestration (0.58%), and persistent fetal pattern (16.47%). In the present study, we found the five different types of terminations of PCoA. Type I termination was the most common type, seen in 92.94% of cases, Type II termination was seen in 1.17%, Type III and Type IV terminations both were seen in 0.58%, and Type V was seen in 1.17%. The mean length of PCoA was 15.9 mm and 15.3 mm on the right and left sides, respectively. The mean diameter of PCoA was 2.1 mm and 1.9 mm on the right and left sides, respectively. Symmetry of PCoA was seen in 65.29% and asymmetric PCoA was seen in 34.70% of cases. The present study provides the complete description of PCoA regarding its morphology, symmetry, and morphometry. Awareness of these anatomical variations is important in neurovascular procedures.

  10. Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery.

    Science.gov (United States)

    Takeda, Masaru; Kashimura, Hiroshi; Chida, Kohei; Murakami, Toshiyuki

    2015-01-01

    Aneurysms arising from the posterior communicating artery (PCoA) itself are rare in which aneurysms usually located in the proximal portion of the PCoA. The authors report a case of the true PCoA ruptured aneurysm in the distal portion of the PCoA. The patient was an 83-year-old man who suffered subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm arising on the fetal type right PCoA itself in the distal portion of the PCoA. 2 days after the onset of symptoms, the patient underwent right interfascial pterional craniotomy, with anterior temporal approach. The aneurysm was successfully clipped with the preservation of both the PCoA and the thalamoperforating artery. We speculated that blood flow into the PCoA gradually increased after occlusion of the left vertebral artery, which induced tortuosity of the PCoA. As a result, hemodynamic stress might increase near the curvature and cause aneurysm formation.

  11. 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, ...

  12. 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.

  13. [Trampoline accident with anterior knee dislocation caused popliteal artery disruption].

    Science.gov (United States)

    Pedersen, Peter Heide; Høgh, Annette Langager

    2011-10-17

    Only a few reports describe the risk of neurovascular damage following knee dislocation while trampolining. A 16 year-old male in a trampoline accident, sustained multi-ligament damage and occlusion of the popliteal artery. The occlusion did not show clinically until 24 hours after the trauma. He underwent vascular surgery (short saphenous bypass). We recommend implementing algorithms, for the management of suspected knee dislocation and possible accompanying neurovascular injuries in all trauma centers.

  14. 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.

  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. Left anterior descending coronary artery dissection during ventricular tachycardia ablation – case report

    Directory of Open Access Journals (Sweden)

    Kordic Kresimir

    2018-03-01

    Full Text Available Fascicular left ventricular tachycardia (VT is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD occlusion during fascicular ventricular tachycardia ablation.

  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. 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.)

  19. The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery.

    Science.gov (United States)

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

    2017-10-01

    OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

  20. Analysis of transit time flow of the right internal thoracic artery anastomosed to the left anterior descending artery compared to the left internal thoracic artery

    Science.gov (United States)

    Milani, Rodrigo; de Moraes, Daniela; Sanches, Aline; Jardim, Rodrigo; Lumikoski, Thais; Miotto, Gabriela; Santana, Vitor Hugo; Brofman, Paulo Roberto

    2014-01-01

    Introduction We evaluated with transit time flow the performance of the right and left thoracic arteries when used as a graft for the left anterior descending artery. Methods Fifty patients undergoing surgery for myocardial revascularization without cardiopulmonary bypass were divided into two groups. In group A patients received graft of right internal mammary artery to the anterior interventricular branch. In group B patients received graft of left internal mammary artery to the same branch. At the end of the operation the flow was assessed by measuring transit time. Results In group A, mean age was 60.6±9.49 years. The average height and weight of the group was 80.4±10.32 kg and 169.2±6.86 cm. The average number of grafts per patient in this group was 3.28±1.49. The mean flow and distal resistance obtained in right internal thoracic artery was 42.1±23.4 ml/min and 2.8±0.9 respectively. In group B, the mean age was 59.8±9.7 years. The average height and weight of this group was 77.7±14.22 kg and 166.0±8.2 cm. The average number of grafts per patient in this group was 3.08 ±0.82. The mean flow and distal resistance observed in this group was 34.2±19.1 ml/min and 2.0±0.7. There were no deaths in this series. Conclusion Right internal mammary artery presented a similar behavior to left internal mammary artery when anastomosed to the anterior interventricular branch of the left coronary artery. There was no statistical difference between the measured flow obtained between both arteries. PMID:25140463

  1. Morphometry of A1 segment of the anterior cerebral artery and its clinical importance.

    Science.gov (United States)

    Krishnamurthy, A; Nayak, S R; Bagoji, I B; D'Costa, S; Pai, M M; Jiji, P J; Kumar, C G; Rai, R

    2010-01-01

    Anterior cerebral artery, one of the terminal branches of the internal carotid artery is an important vessel taking part in the formation of circle of Willis. It supplies a large part of the medial surface of the cerebral hemisphere containing the areas of motor and somatosensory cortices of the lower limb. Aim of this study was the morphometry of A1 segment of the anterior cerebral artery. 93 formalin fixed brain specimen of either sex and of Indian origin were studied. The mean length, mean external diameter and the anomalies present in A1 segment of the vessel were studied in detail and photographed. The mean length of A1 segment of the vessel was 14.49+/-0.28 mm and 14.22+/-0.22 mm on right and left side respectively. The mean external diameter of the vessel on right and left side was 2.12+/-0.07 mm and 2.32+/-0.06 mm respectively. Narrowing, aneurysm formation, buttonhole formation and median anterior cerebral artery were the anomalies seen with an occurrence of 15.05%, 5.37%, 3.22% and 12.9%, respectively. The above anomalies did not have any sex or side predilection. Knowledge of morphometry of the vessel will be of use to neurosurgeons while performing the shunt operation, in assessing the feasibility of such operations and in the choice of patients. From this study we infer that the morphometry of anterior cerebral artery varies in different population and that the neurosurgeons operating should have a thorough knowledge of the possible variations.

  2. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review

    OpenAIRE

    H?rtl, Roger; Alimi, Marjan; Abdelatif Boukebir, Mohamed; Berlin, Connor D.; Navarro-Ramirez, Rodrigo; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Retrospective study and literature review. Objective: To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. Methods: We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17?625 patients who went through cervical spine surgery (levels from C2 to C7) between Januar...

  3. Anterior ischemic optic neuropathy after conventional coronary artery bypass graft surgery.

    Science.gov (United States)

    Dorecka, Mariola; Miniewicz-Kurkowska, Joanna; Romaniuk, Dorota; Gajdzik-Gajdecka, Urszula; Wójcik-Niklewska, Bogumiła

    2011-06-01

    Perioperative optic neuropathy is a disease which can lead to serious, irreversible damage of vision. This complication could be the result of non-ocular surgery, for example, cardiac or spinal procedures. We present a case of anterior ischemic neuropathy (AION) which occurred following a conventional coronary artery bypass graft procedure. A 57-year-old man, 4 days after Conventional Coronary Artery Bypass Graft surgery as result of multi-vessel stabile coronary artery disease and history of anterolateral wall myocardial infarction, was admitted to the Eye Clinic due to significant loss of vision in his right eye. The patient had hypertension and was a heavy smoker. On admission, the slit lamp examination revealed a relative afferent pupillary defect in the right eye. The fundus examination showed optic disc edema with the presence of flame hemorrhages. Best corrected visual acuity (BCVA) was 0.02. The results of eye examination and fluorescein angiography confirmed the diagnosis of AION. Anti-aggregation and antithrombotic treatment was continued with steroids and vasodilators. After 7 days of this treatment we noticed the improvement of BCVA to 0.2. At 6-month follow-up, the vision was stable, and fundus examination revealed optic disc atrophy. After cardiac surgical operations, such as coronary artery bypass graft procedures, anterior ischemic optic neuropathy may occur. In those cases, close cooperation between the various specialists is necessary.

  4. Microanatomical bases for intraoperative division of the posterior communicating artery.

    Science.gov (United States)

    Gabrovsky, N

    2002-11-01

    Micro-anatomical parameters of the hypoplastic posterior communicating artery (PCoA) are assessed and compared with the micro-anatomical parameters of the adult type PCoA. Based on the results obtained, the safest place is proposed for PCoA division during basilar tip aneurysm surgery via the pterional route. In 35 human cadaver brains, red coloured latex was injected and micro-anatomical dissection was performed. Seventy PCoA were found. Adult type PCoA was found in 29 cases (41.43%) with mean length 12.58 mm. Reduction of the PCoA diameter from its anterior to its posterior third by up to 20% was found in 27% and by more than 20% in 10% of the cases. The mean perforating vessel number was 8.17, distributed in each third: 3.48, 2.90 and 1.79, respectively. A hypoplastic PCoA was found in 33 cases (47.14%) with mean length 16.09 mm. The PCoA's diameter reduction by up to 20% was found in 24% and by more in 27% of the cases. In 6% of the cases an extreme reduction by up to 70% was observed. The mean perforating vessel (PV) number was 8.82, distributed in each third: 3.18, 3.36 and 2.27, respectively. Hypoplastic PCoA tends to be longer and with a more distinct diameter reduction from the anterior to the posterior third than the adult type PCoA. The PV anatomical parameters are similar for both groups. The posterior third of the PCoA seems to be the area where the risk of perforating vessel damage is the least when performing intra-operative PCoA division.

  5. Endovascular treatment of a true posterior communicating artery aneurysm

    OpenAIRE

    Munarriz, Pablo M.; Castaño-Leon, Ana M.; Cepeda, Santiago; Campollo, Jorge; Alén, Jose F.; Lagares, Alfonso

    2014-01-01

    Background: Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. Case Description: A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. F...

  6. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review.

    Science.gov (United States)

    Härtl, Roger; Alimi, Marjan; Abdelatif Boukebir, Mohamed; Berlin, Connor D; Navarro-Ramirez, Rodrigo; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective study and literature review. To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis. Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA. CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.

  7. 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

  8. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

    Directory of Open Access Journals (Sweden)

    Zhiva Taherpour

    2013-05-01

    Full Text Available Please cite this article as: Taherpour Z, Seyedian M, Alasti M. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report. Novel Biomed 2013;1:29-33.Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man.The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery (LADA and spasm of right coronary artery (RCA. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient.

  9. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct.

    Science.gov (United States)

    Xu, Yongfeng; Liu, Lan

    2016-07-01

    Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.

  10. 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....

  11. Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study.

    Science.gov (United States)

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

    2017-09-22

    OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M 3 -M 4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured. RESULTS Seventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm. CONCLUSIONS The ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

  12. Endovascular treatment of a true posterior communicating artery aneurysm.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Cepeda, Santiago; Campollo, Jorge; Alén, Jose F; Lagares, Alfonso

    2014-01-01

    Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.

  13. 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.

  14. The Anterior Branch of the Left Inferior Phrenic Artery Arising from the Right Inferior Phrenic Artery: An Angiographic and CT Study

    International Nuclear Information System (INIS)

    Hieda, Masashi; Toyota, Naoyuki; Kakizawa, Hideaki; Ishikawa, Masaki; Horiguchi, Jun; Ito, Katsuhide

    2009-01-01

    The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

  15. Endovascular Treatment of Unusual Multiple Aneurysms of the Internal Carotid Artery-Posterior Communicating Artery Complex

    OpenAIRE

    Kubo, Michiya; Kuwayama, Naoya; Hirashima, Yutaka; Ohi, Masayoshi; Takami, Masaaki; Endo, Shunro

    2000-01-01

    A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery(PCoA)aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery(ICA)-PCoA complex. Superselective an-giography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the I...

  16. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    International Nuclear Information System (INIS)

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-01-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups

  17. 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.

  18. The anterior cerebral artery is an appropriate arterial input function for perfusion-CT processing in patients with acute stroke

    International Nuclear Information System (INIS)

    Wintermark, Max; Lau, Benison C.; Chien, Jeffrey; Arora, Sandeep

    2008-01-01

    Dynamic perfusion-CT (PCT) with deconvolution requires an arterial input function (AIF) for postprocessing. In clinical settings, the anterior cerebral artery (ACA) is often chosen for simplicity. The goals of this study were to determine how the AIF selection influences PCT results in acute stroke patients and whether the ACA is an appropriate default AIF. We retrospectively identified consecutive patients suspected of hemispheric stroke of less than 48 h duration who were evaluated on admission by PCT. PCT datasets were postprocessed using multiple AIF, and cerebral blood volume (CBV) and flow (CBF), and mean transit time (MTT) values were measured in the corresponding territories. Results from corresponding territories in the same patients were compared using paired t-tests. The volumes of infarct core and tissue at risk obtained with different AIFs were compared to the final infarct volume. Of 113 patients who met the inclusion criteria, 55 with stroke were considered for analysis. The MTT values obtained with an ''ischemic'' AIF tended to be shorter (P=0.055) and the CBF values higher (P=0.108) than those obtained using a ''nonischemic'' AIF. CBV values were not influenced by the selection of the AIF. No statistically significant difference was observed between the size of the PCT infarct core (P=0.121) and tissue at risk (P=0.178), regardless of AIF selection. In acute stroke patients, the selection of the AIF has no statistically significant impact of the PCT results; standardization of the PCT postprocessing using the ACA as the default AIF is adequate. (orig.)

  19. 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 ...

  20. Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

    International Nuclear Information System (INIS)

    Jodocy, Daniel; Aglan, Iman; Friedrich, Guy; Mallouhi, Ammar; Pachinger, Otmar; Jaschke, Werner; Feuchtner, Gudrun M.

    2010-01-01

    Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 ± 6.5 mm; depth, 2.6 ± 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p 50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

  1. Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Jodocy, Daniel; Aglan, Iman [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Friedrich, Guy [Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Mallouhi, Ammar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Pachinger, Otmar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Jaschke, Werner [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Feuchtner, Gudrun M. [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria)], E-mail: gudrun.feuchtner@i-med.ac.at

    2010-01-15

    Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 {+-} 6.5 mm; depth, 2.6 {+-} 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p < 0.001); with a higher diameter reduction of 27% for end-systole compared to end-diastole with 15% (p = 0.006). Systolic LAD intramyocardial luminal narrowing >50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

  2. Clinical importance of the anterior choroidal artery: a review of the literature.

    Science.gov (United States)

    Yu, Jing; Xu, Ning; Zhao, Ying; Yu, Jinlu

    2018-01-01

    The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.

  3. Fusiform aneurysm associated with fenestration of the posterior communicating artery.

    Science.gov (United States)

    Baba, Shiro; Fukuda, Yuutaka; Mizota, Shingo; Hayashi, Kentaro; Suyama, Kazuhiko; Nagata, Izumi

    2010-01-01

    A 62-year-old male presented with a rare case of fenestration of the supraclinoid segment of the internal carotid artery (ICA) at the origin of the posterior communicating artery (PCoA). The patient had a fusiform aneurysm at the proximal branch of the PCoA, which was successfully clipped, sparing the anterograde blood flow. The double origin and fenestration of the PCoA branching off at the C(2) segment of the left ICA suggested that this anomalous fenestration might have developed as the origin of the PCoA rather than the supraclinoid ICA during the early embryonal stage.

  4. Aneurysmal subarachnoid hemorrhage with concomitant posterior communicating artery fenestration.

    Science.gov (United States)

    Weiner, Gregory M; Grandhi, Ramesh; Zwagerman, Nathan T; Agarwal, Nitin; Friedlander, Robert M

    2015-02-01

    Fenestrations of the posterior communicating artery (PCoA) are extremely rare. Associated aneurysms have only been documented three times in the literature, and none associated with a subarachnoid hemorrhage. We describe a 52-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured saccular aneurysm at the proximal limb of a fenestrated right PCoA. The patient was also found to have bilateral middle cerebral artery (MCA) aneurysms. Surgical management included surmising the etiology of the subarachnoid hemorrhage with subsequent clipping of both the right PCoA and MCA aneurysm. The potential embryological mechanisms leading to a PCoA fenestration are discussed.

  5. 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.

  6. Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm

    Science.gov (United States)

    Takeda, Nobuaki; Oishi, Hidenori; Arai, Hajime

    2015-01-01

    A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm. PMID:25953771

  7. Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm

    OpenAIRE

    Mitsuhashi, Takashi; Takeda, Nobuaki; Oishi, Hidenori; Arai, Hajime

    2015-01-01

    A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgi...

  8. 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.

  9. 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)

  10. 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…

  11. A Segmental Hypoplastic Anterior Tibial Artery Coexisting with a Hypertrophied Perforating Fibular Artery a Case Report and Clinical Implications

    OpenAIRE

    Ariyo, Olutayo

    2015-01-01

    Vascular injuries of the lower limb, especially from penetrating gunshot wounds, and peripheral arterial diseases are on the increase and management of these and many other lower limb injuries involve increasing usage of vascular interventions like by-pass surgery, per-cutaneous transluminal angioplasty, arterial cannulation, arterial bypass graft or minimally invasive measures like percutaneous trans-arterial catheterization, among others. A thorough knowledge of infrapopliteal branching mos...

  12. Assessment of resting-state blood flow through anterior cerebral arteries using trans-cranial doppler recordings.

    Science.gov (United States)

    Huang, Hanrui; Sejdić, Ervin

    2013-12-01

    Trans-cranial Doppler (TCD) recordings are used to monitor cerebral blood flow in the main cerebral arteries. The resting state is usually characterized by the mean velocity or the maximum Doppler shift frequency (an envelope signal) by insonating the middle cerebral arteries. In this study, we characterized cerebral blood flow in the anterior cerebral arteries. We analyzed both envelope signals and raw signals obtained from bilateral insonation. We recruited 20 healthy patients and conducted the data acquisition for 15 min. Features were extracted from the time domain, the frequency domain and the time-frequency domain. The results indicate that a gender-based statistical difference exists in the frequency and time-frequency domains. However, no handedness effect was found. In the time domain, information-theoretic features indicated that mutual dependence is higher in raw signals than in envelope signals. Finally, we concluded that insonation of the anterior cerebral arteries serves as a complement to middle cerebral artery studies. Additionally, investigation of the raw signals provided us with additional information that is not otherwise available from envelope signals. Use of direct trans-cranial Doppler raw data is therefore validated as a valuable method for characterizing the resting state. Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  13. 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.

  14. Spatial relationship between intrahepatic artery and portal vein based on the fusion image of CT-arterial portography (CTAP) and CT-angiography (CTA): New classification for hepatic artery at hepatic hilum and the segmentation of right anterior section of the liver

    International Nuclear Information System (INIS)

    Ibukuro, Kenji; Takeguchi, Takaya; Fukuda, Hozumi; Abe, Shoko; Tobe, Kimiko; Tanaka, Rei; Tagawa, Kazumi

    2012-01-01

    Purpose: To clarify the variations of the intrahepatic artery and portal vein and to verify the proper segmentation for the right anterior section of the liver. Materials and methods: CT during arterial portography and CT angiography were performed on 64-slice multi detector row CT in 147 patients. All images were transferred to a workstation for analysis using multi-image-fusion mode. We investigated the spatial relationship between hepatic artery and portal vein in the right hemiliver and the segmentation of the right anterior hepatic artery and portal vein. Results: The spatial anatomy of right hepatic arteries and portal vein was (1) anterior and posterior hepatic artery run superior and inferior to anterior portal vein, respectively (47.6%), (2) one anterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (15%), (3) anterior and posterior hepatic arteries run superior to anterior portal vein (11.6%), (4) anterior and posterior hepatic arteries run inferior to anterior portal vein (7.5%), and (5) one posterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (6.8%). The combined anatomy of right anterior artery and portal vein with regard to segmentation was classified as (1) dorso-ventral (26.5%), (2) dorso-ventral and inferior (10.9%), (3) multiple (18.4%), and (4) superior and inferior segments (1.4%). Conclusion: There are various types of spatial anatomy of intrahepatic artery and portal vein. The hepatic arteries as well as portal veins of right anterior section of the liver could be divided into dorsal and ventral, not superior and inferior.

  15. Morphological and clinical risk factors for posterior communicating artery aneurysm rupture.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Fujii, Motoharu; Akaike, Gensuke; Uemura, Akihiro; Takahashi, Osamu; Niimi, Yasunari; Shinoda, Masaki

    2014-01-01

    Recent studies have shown that posterior circulation aneurysms, specifically posterior communicating artery (PCoA) aneurysms, are more likely to rupture than other aneurysms. To date, few studies have investigated the factors contributing to PCoA aneurysm rupture. The authors aimed to identify morphological and clinical characteristics predisposing to PCoA aneurysm rupture. The authors retrospectively reviewed 134 consecutive patients with PCoA aneurysms managed at their facility between July 2003 and December 2012. The authors divided patients into groups of those with aneurysmal rupture (n = 39) and without aneurysmal rupture (n = 95) and compared morphological and clinical characteristics. Morphological characteristics were mainly evaluated by 3D CT angiography and included diameter of arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery), size of the aneurysm, dome-to-neck ratio, neck direction of the aneurysmal dome around the PCoA (medial, lateral, superior, inferior, and posterior), aneurysm bleb formation, whether the PCoA was fetal type, and the existence of other intracranial unruptured aneurysm(s). Patients with ruptured PCoA aneurysms were significantly younger (a higher proportion were PCoA aneurysms showed a lateral direction of the aneurysmal dome around the PCoA, had bleb formation, and the aneurysm was > 7 mm in diameter and/or the dome-to-neck ratio was > 2.0. Multivariate logistic regression analysis showed age PCoA (OR 6.7, p = 0.0001), and bleb formation (OR 11, p PCoA aneurysm rupture. The present results demonstrated that lateral projection of a PCoA aneurysm may be related to rupture.

  16. 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

  17. Cilioretinal artery occlusion and anterior ischemic optic neuropathy as the initial presentation in a child female carrier of Fabry disease.

    Science.gov (United States)

    Ersoz, M Giray; Ture, Gamze

    2018-04-01

    To report the youngest female carrier of Fabry disease, complicated by cilioretinal artery occlusion and anterior ischemic optic neuropathy (AION). Case report. An 11-year-old girl was referred to our clinic with painless, acute loss of vision in her right eye. Posterior segment examination and fluorescein angiography revealed cilioretinal artery occlusion and AION. Systemic evaluations were unremarkable, except for a low blood α-galactosidase A enzyme level of 242.27 pmol/spot*20 h (reference range: 450-2000 pmol/spot*20 h). The patient was diagnosed with female carrier of Fabry disease. Retinal vascular occlusions are rare in childhood, and Fabry disease may present with retinal vascular occlusion. Ophthalmological examinations may be contributing for early detection of the disease. To the best of our knowledge, this is the first report of a child female carrier of Fabry disease, complicated by cilioretinal artery occlusion and AION.

  18. Local immobilization of the left anterior descending artery for minimally invasive coronary bypass grafting

    NARCIS (Netherlands)

    Boonstra, PW; Grandjean, JG; Mariani, MA

    We describe a device for coronary artery stabilization during minimally invasive coronary artery bypass grafting performed without cardiopulmonary bypass via a small (8 to 10 cm) left anterolateral thoracotomy. This device facilitates the anastomosis of the left internal mammary artery to the left

  19. Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery

    OpenAIRE

    Takeda, Masaru; Kashimura, Hiroshi; Chida, Kohei; Murakami, Toshiyuki

    2015-01-01

    Background: Aneurysms arising from the posterior communicating artery (PCoA) itself are rare in which aneurysms usually located in the proximal portion of the PCoA. The authors report a case of the true PCoA ruptured aneurysm in the distal portion of the PCoA. Case Description: The patient was an 83-year-old man who suffered subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm arising on the fetal type right PCoA itself in the distal portion of the PCoA. 2 days after...

  20. The internal carotid artery stenosis or occlusion. The evaluation for the posterior communicating artery on DSA and MRA

    International Nuclear Information System (INIS)

    Zhao Yunhui; Gao Xinjiang; Ma Zhubin; Xu Yikai

    2003-01-01

    Objective: To study the changes of the posterior communicating artery in patients with internal carotid artery (ICA) severe stenosis or occlusion on digital subtract angiography (DSA) and magnetic resonance angiography (MRA). Methods: DSA or MRA findings were analyzed in 74 patients with ICA stenosis or occlusion and in 120 persons selected in the control group, who were unremarkable on cerebral DSA or MRA. Results: On DSA, the presence rate of ipsilateral posterior communicating artery (PCoA) between the study group and the control group had no significant difference; on MRA the rate in the study group was significantly higher than the control group (P 0.05). In the study group, the presence rate of PCoA on DSA was significantly higher than that on MRA (P 0.05). The presence rate of PCoA shown no significant difference between the cases with unilateral ICA involved and cases with bilateral ICA involved. Conclusion: The posterior communicating artery is very important to the patients with the internal carotid artery stenosis or occlusion. Its dilatation on DSA and MRA or appearance on MRA shows its compensation. DSA is valuable in the evaluation of the posterior communicating artery. MRA is a noninvasive and functional imaging method for evaluation the posterior communicating artery

  1. 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

  2. Tuberothalamic artery infarction following coil embolization of a ruptured posterior communicating artery aneurysm belonging to a transitional type posterior cerebral artery. A case report.

    Science.gov (United States)

    Lee, Kyeong Duk; Kwon, Soon Chan; Muniandy, Sarawana; Park, Eun Suk; Sim, Hong Bo; Lyo, In Uk

    2013-09-01

    There are many potential anatomical variations in the connection between the internal carotid artery and the posterior circulation through the posterior communicating artery (PCoA). We describe the endovascular treatment of an aneurysm arising near the origin of the PCoA belonging to a transitional type posterior cerebral artery. Coil embolization subsequently resulted in thrombo-occlusion of the adjacent PCoA causing thalamic infarction even though sufficient retrograde flow had been confirmed pre-operatively by Allcock's test.

  3. Tuberothalamic Artery Infarction Following Coil Embolization of a Ruptured Posterior Communicating Artery Aneurysm Belonging to a Transitional Type Posterior Cerebral Artery: A Case Report

    OpenAIRE

    Lee, Kyeong Duk; Kwon, Soon Chan; Muniandy, Sarawana; Park, Eun Suk; Sim, Hong Bo; Lyo, In Uk

    2013-01-01

    There are many potential anatomical variations in the connection between the internal carotid artery and the posterior circulation through the posterior communicating artery (PCoA). We describe the endovascular treatment of an aneurysm arising near the origin of the PCoA belonging to a transitional type posterior cerebral artery. Coil embolization subsequently resulted in thrombo-occlusion of the adjacent PCoA causing thalamic infarction even though sufficient retrograde flow had been confirm...

  4. 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.

  5. A RARE CASE OF PERSISTENT TRIGEMINAL ARTERY IN AN ADULT FEMALE WITH PARA POSTERIOR COMMUNICATING ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Banavathu Daya Bharath Singh

    2015-05-01

    Full Text Available Anastomosis found in the adulthood between the carotid and vertebro - basilar systems, apart from the posterior communicating artery, are extremely infrequent and are due to the persistence of vessels that joined both systems during the fetal period. This carotid - vertebrobasilar anastomosis are the trigeminal, otic, and hypoglossal and proatlantal arteries. P ersistent trigeminal artery is the commonest of the above mentioned four arteries. The reported incidence is about 0.2%. Patients may be asymptomatic or present symptoms due to low flow of posterior circulation or carotid microembolization from posterior circulation. PTA can cause trigemina l neuralgia. We report in this paper a case of a persistant trigeminal artery found in an adult female with a para p com aneurysm who had persistent trigeminal artery which was seen in C T angiogram .

  6. Association Between Vascular Anatomy and Posterior Communicating Artery Aneurysms.

    Science.gov (United States)

    Can, Anil; Ho, Allen L; Emmer, Bart J; Dammers, Ruben; Dirven, Clemens M F; Du, Rose

    2015-11-01

    Hemodynamic stress, conditioned by the geometry and morphology of the vessel trees, plays an important role in the formation of intracranial aneurysms. The aim of this study was to identify image-based location-specific morphologic parameters that are associated with posterior communicating artery (PCoA) aneurysms. Morphologic parameters obtained from computed tomography angiography of 56 patients with PCoA aneurysms and 23 control patients were evaluated with 3D Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vasculature. Segment lengths, diameters, and vessel-to-vessel angles were examined. To control for genetic and clinical risk factors, the unaffected contralateral side of patients with unilateral PCoA aneurysms was used as a control group for internal carotid artery (ICA)-related parameters. A separate control group with visible PCoAs and aneurysms elsewhere was used as a control group for PCoA-related parameters. Internal carotid artery-related parameters were not statistically different between the PCoA aneurysm and control groups. Univariate and multivariate subgroup analysis for patients with visualized PCoAs demonstrated that a larger PCoA diameter was significantly associated with the presence of a PCoA aneurysm (odds ratio = 12.1, 95% confidence interval = 1.3-17.1, P = 0.04) after adjusting for other morphologic parameters. Larger PCoA diameters are associated with the presence of PCoA aneurysms. These parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    African Journals Online (AJOL)

    ... LAD originating from the right coronary artery (RCA). Dual LAD is a benign coronary artery anomaly, but should be recognised especially before interventional procedures. With the increasing use of multidedector computed tomography (MDCT), it is essential for radiologists to be aware of this entity and the cross-sectional ...

  8. Advanced technical skills are required for microsurgical clipping of posterior communicating artery aneurysms in the endovascular era.

    Science.gov (United States)

    Sanai, Nader; Caldwell, Nolan; Englot, Dario J; Lawton, Michael T

    2012-08-01

    Many neurosurgeons feel competent clipping posterior communicating artery (PCoA) aneurysms and include this lesion in their practice. However, endovascular therapy removes simple aneurysms that would have been easiest to clip with the best results. What remains are aneurysms with complex anatomy and technical challenges that are not well described. A contemporary surgical series with PCoA aneurysms is reviewed to define the patients, microsurgical techniques, and outcomes in current practice. A total of 218 patients had 218 PCoA aneurysms that were treated microsurgically during an 11-year period. Complexities influencing aneurysm management included (1) large/giant size; (2) fetal posterior cerebral artery; (3) previous coiling; (4) anterior clinoidectomy; (5) adherence of the anterior choroidal artery (AChA); (6) intraoperative aneurysm rupture; (7) complex clipping; and (8) atherosclerotic calcification. Simple PCoA aneurysms were encountered in 113 patients (51.8%) and complex aneurysms in 105 (48.2%). Adherent AChA (13.8%) and intraoperative rupture (11.5%) were the most common complexities. Simple aneurysms had favorable outcomes in 86.6% of patients, whereas aneurysms with 1 or multiple complexities had favorable outcomes in 78.2% and 75.0%, respectively. Intraoperative rupture (P PCoA aneurysms requires advanced techniques including clinoidectomy, AChA microdissection, complex clipping, and facility with intraoperative rupture. Microsurgery is recommended for recurrent aneurysms after coiling, complex branches, aneurysms causing oculomotor nerve palsy, multiple aneurysms, and patients with hematomas.

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

    Directory of Open Access Journals (Sweden)

    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

  10. Bilateral Distal Anterior Cerebral Artery Aneurysms Mimicking So-called "Kissing Aneurysms": A Case Report

    OpenAIRE

    山口, 竜一; 伊藤, 宣行; 前村, 栄治; 塩川, 芳昭; 齋藤, 勇; Ryuichi, YAMAGUCHI; Nobuyuki, ITO; Eiji, MAEMURA; Yoshiaki, SHIOKAWA; Isamu, SAITO; 公立阿伎留病院脳神経外科; 公立阿伎留病院脳神経外科; 公立阿伎留病院脳神経外科; 杏林大学医学部脳神経外科; 杏林大学医学部脳神経外科

    2003-01-01

    A 71-year-old woman presented disturbance of consciousness due to subarachnoid hemorrhage (SAH). A computed tomography (CT) on admission revealed diffuse thick SAH and intracerebral hematoma in the right frontal lobe. Conventional angiography and three-dimensional CT angiography showed symmetrical aneurysms located on the bilateral pericallosal arteries at bifurcation of the callosomarginal arteries. The operation was performed on the next day after onset of SAH. The aneurysms were clipped vi...

  11. 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.

  12. 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

  13. Surgical management of giant posterior communicating artery aneurysms.

    Science.gov (United States)

    Velat, Gregory J; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

    2012-09-01

    Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.

  14. Extremely long posterior communicating artery diagnosed by MR angiography: report of two cases.

    Science.gov (United States)

    Uchino, Akira; Suzuki, Chihiro; Tanaka, Masahiko

    2015-07-01

    We report two cases of an extremely long left posterior communicating artery (PCoA) diagnosed by magnetic resonance (MR) angiography. The PCoA arose from the normal point of the supraclinoid internal carotid artery and fused with the posterior cerebral artery (PCA) at its posterior ambient segment, forming an extremely long PCoA and extremely long precommunicating segment of the PCA. To our knowledge, this is the first report of such variation. Careful observation of MR angiographic images is important for detecting rare arterial variations. To identify these anomalous arteries on MR angiography, partial maximum-intensity-projection images are useful.

  15. Endovascular treatment of ruptured true posterior communicating artery aneurysms.

    Science.gov (United States)

    Yang, Yonglin; Su, Wandong; Meng, Qinghai

    2015-01-01

    Although true posterior communicating artery (PCoA) aneurysms are rare, they are of vital importance. We reviewed 9 patients with this fatal disease, who were treated with endovascular embolization, and discussed the meaning of endovascular embolization for the treatment of true PCoA aneurysms. From September 2006 to May 2012, 9 patients with digital substraction angiography (DSA) confirmed true PCoA aneurysms were treated with endovascular embolization. Patients were followed-up with a minimal duration of 17 months and assessed by Glasgow Outcome Scale (GOS) score. All the patients presented with spontaneous subarachnoid hemorrhage from the ruptured aneurysms. The ratio of males to females was 1:2, and the average age of onset was 59.9 (ranging from 52 to 72) years. The preoperative Hunt-Hess grade scores were I to III. All patients had recovered satisfactorily. No permanent neurological deficits were left. Currently, endovascular embolization can be recommended as the top choice for the treatment of most true PCoA aneurysms, due to its advanced technique, especially the application of the stent-assisted coiling technique, combined with its advantage of mininal invasiveness and quick recovery. However, the choice of treatment methods should be based on the clinical and anatomical characteristics of the aneurysm and the skillfulness of the surgeon.

  16. Impact of posterior communicating artery on basilar artery steno-occlusive disease.

    Science.gov (United States)

    Hong, J M; Choi, J Y; Lee, J H; Yong, S W; Bang, O Y; Joo, I S; Huh, K

    2009-12-01

    Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. This report investigates the prognostic impact of the posterior communicating artery (PcoA) and whether its anatomy is a safeguard or not. Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography (CTA) were studied. The configuration of PcoA was divided into two groups upon CTA: "textbook" group (invisible PcoA with good P1 and P2 segment) and "fetal-variant of PcoA" group (only visible PcoA with absent P1 segment). Baseline demographics, radiological findings and stroke mechanisms were analysed. A multiple regression analysis was performed to predict clinical outcome at 30 days (modified Rankin disability Scale (mRSPcoA (26 bilateral, 18 unilateral). By multiple logistic regression analysis, the atherosclerotic mechanism (OR 18.0; 95% CI 3.0 to 107.0) and presence of fetal-variant PcoA (OR 5.1; 95% CI 1.4 to 18.8) were independent predictors for good prognosis and initial NIH stroke scale score (OR 1.24 per one-point increase; 95% CI 1.1 to 1.4) for poor prognosis. Fetal-variant PcoA appears to act as a safeguard against ischaemic insult in acute stroke victims involving the brainstem with BA occlusive disease. This result can be explained by the fact that patients with fetal-variant PcoA have a smaller area of posterior circulation and a possibility of retrograde filling into the upper brainstem through the fetal-variant PcoA.

  17. Tuberothalamic Artery Infarction Following Coil Embolization of a Ruptured Posterior Communicating Artery Aneurysm Belonging to a Transitional Type Posterior Cerebral Artery

    Science.gov (United States)

    Lee, Kyeong Duk; Kwon, Soon Chan; Muniandy, Sarawana; Park, Eun Suk; Sim, Hong Bo; Lyo, In Uk

    2013-01-01

    Summary There are many potential anatomical variations in the connection between the internal carotid artery and the posterior circulation through the posterior communicating artery (PCoA). We describe the endovascular treatment of an aneurysm arising near the origin of the PCoA belonging to a transitional type posterior cerebral artery. Coil embolization subsequently resulted in thrombo-occlusion of the adjacent PCoA causing thalamic infarction even though sufficient retrograde flow had been confirmed pre-operatively by Allcock’s test. PMID:24070079

  18. Assessment of Intrafraction Breathing Motion on Left Anterior Descending Artery Dose During Left-Sided Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    El-Sherif, Omar, E-mail: Omar.ElSherif@lhsc.on.ca [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Xhaferllari, Ilma [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Gaede, Stewart [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2016-07-01

    Purpose: To use 4-dimensional computed tomography (4D-CT) imaging to predict the level of uncertainty in cardiac dose estimates of the left anterior descending artery that arises due to breathing motion during radiation therapy for left-sided breast cancer. Methods and Materials: The fast helical CT (FH-CT) and 4D-CT of 30 left-sided breast cancer patients were retrospectively analyzed. Treatment plans were created on the FH-CT. The original treatment plan was then superimposed onto all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion through 4D dose accumulation (4D-dose). Dose-volume histograms for the heart, left ventricle (LV), and left anterior descending (LAD) artery obtained from the FH-CT were compared with those obtained from the 4D-dose. Results: The 95% confidence interval of 4D-dose and FH-CT differences in mean dose estimates for the heart, LV, and LAD were ±0.5 Gy, ±1.0 Gy, and ±8.7 Gy, respectively. Conclusion: Fast helical CT is a good approximation for doses to the heart and LV; however, dose estimates for the LAD are susceptible to uncertainties that arise due to intrafraction breathing motion that cannot be ascertained without the additional information obtained from 4D-CT and dose accumulation. For future clinical studies, we suggest the use of 4D-CT–derived dose-volume histograms for estimating the dose to the LAD.

  19. Progressive hematoma in anterior neck after endovascular treatment of middle cerebral artery aneurysm

    Directory of Open Access Journals (Sweden)

    Aysun Ankay Yilbas

    Full Text Available Abstract Background: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm. Case report: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5 mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6 mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube. Conclusions: Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.

  20. Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique.

    Science.gov (United States)

    Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

    2014-10-01

    Surgical approach for persistent ductus arteriosus ligation is typically a left lateral thoracotomy opening the pleural-space with left lung retraction. We describe an alternative approach, with a minimally invasive anterior parasternal incision. This is particularly adapted to preterm infants weighing less than 1.5 kg. This approach ensures a good exposure of vessels. We believe that it is safe, reliable and reproducible. The learning curve should not be an issue for surgeons used to manage low weight patients. Georg Thieme Verlag KG Stuttgart · New York.

  1. 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.

  2. Second generation drug-eluting stents versus bare-metal stents for percutaneous coronary intervention of the proximal left anterior descending artery

    DEFF Research Database (Denmark)

    Mangione, Fernanda Marinho; Biering-Sørensen, Tor; Nochioka, Kotaro

    2017-01-01

    OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to b...

  3. 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.

  4. 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...

  5. [Bilateral hypoplasia of the internal carotid arteries associated with aneurysm of the right posterior communicating artery. Apropos of a case].

    Science.gov (United States)

    el Khamlichi, A; Amrani, F; el Azzusi, M; el Oufir, M; Khamlichi, A M

    1989-01-01

    The authors report a case of bilateral hypoplasia of the internal carotid arteries associated with aneurysm of the right posterior communicating artery in a 17 year old female patient. This anomaly was discovered following a meningeal haemorrhage, which recurred 18 months later, causing the patient's death. Surgical operation was refused by the patient and her family. Bilateral hypoplasia of the internal carotid arteries is a rare congenital malformation (16 cases have been reported in the literature, our case constitutes the 17th). It is distinguished from aplasia by the presence of a patent but very reduced vascular lumen, while aplasia is associated with vestiges of non-patent vessels. The mechanism of development of such a malformation is unclear: some authors have suggested secondary regression of the internal carotid artery following a phase of normal development, while others consider it to represent arrest of the development of the internal carotid artery, at a given moment in time. The frequency of associated aneurysm would be due to the haemodynamic disruption induced by the malformation, especially as parietal defects are more frequent in a malformed vasculature. Bilateral hypoplasia of the internal carotid arteries may be compatible with normal life for an indefinite period of time due to the development of a large number of collateral vessels. However, the new vasculature is threatened by rupture with meningeal haemorrhage and by acute ischaemia, which would probably involve another aetiological factor.

  6. 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...... of neural activity is possible with a measure of cerebral hemoglobin oxygenation using near-infrared spectroscopy (NIRS). In principal accordance, NIRS can capture the hemodynamic response to tDCS but the challenge remains in removing the systemic interference occurring in the superficial layers of the head...... identify systemic interference using this short-separation NIRS. Moreover, NIRS-EEG joint-imaging during anodal tDCS was used to measure changes in mean cerebral haemoglobin oxygen saturation (rSO2) along with changes in the log-transformed mean-power of EEG within 0.5 Hz-11.25 Hz. We found that percent...

  7. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  9. 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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Study of Anthropometric Measurements of the Anterior Ethmoidal Artery using Three-dimensional Scanning on 300 Patients

    Science.gov (United States)

    Bortoli, Vinicius Tomadon; Martins, Rafael Ferri; Negri, Krystal Calmeto

    2017-01-01

    Introduction The anterior ethmoidal artery (AEA) is one of the main arteries that supply both the nasal mucosa and the ethmoid sinuses. The AEA shows variability regarding its distance from adjacent structures. Several studies have developed techniques to identify the AEA. Objective This study aimed to compare the measurements from the AEA to the ethmoid bulla and to the frontal beak by using computed tomography of the face, while identifying their intraindividual and interindividual variations. Methods We analyzed 300 CT scans of the face performed at the CT scan Center at Hospital. The average age of subjects was 36 ± 15.1 years (range 4–84). Results We found that the average distance from the AEA to the ethmoid bulla was 17.2 ± 1.8 mm and the distance from the AEA to the frontal beak was 15.1 ± 2.2 mm. Regarding the average distance from the AEA to the frontal beak (AEA-frontal beak), there was a difference between the right and left sides, with the former being 0.4 mm higher on average than the latter. Among the age groups, there was a significant difference of distances between the AEA and the ethmoid bulla (AEA-ethmoid bulla), which were shorter in the ≤ 12 years group. There was a positive and significant correlation between both measurements analyzed, with low values (high) of AEA-ethmoid bulla distance corresponding to low values (high) of AEA-frontal beak distance. Conclusion The measurements obtained adds anatomical knowledge that can serve as a parameter in frontal and ethmoid sinus surgery. PMID:28382116

  12. Assessment of hemodynamic significance of isolated stenoses of the left anterior descending coronary artery using thallium-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Kalff, V.; Kelly, M.J.; Soward, A.; Harper, R.W.; Currie, P.J.; Lim, Y.L.; Pitt, A.

    1985-01-01

    This study tests the hypothesis that the results of stress thallium-201 myocardial perfusion scans (TI-201) are related to the mean transstenotic pressure gradient of coronary stenoses independent of the percent luminal diameter narrowing seen at angiography. The 22 study patients (20 men, 2 women, mean age 47 years, range 30 to 62) had no previous myocardial infarction. Each underwent a symptom-limited, erect bicycle TI-201 test off antianginal therapy, shortly before percutaneous transluminal coronary angioplasty for isolated left anterior descending coronary artery stenosis. The percent narrowing, mean gradient at percutaneous transluminal coronary angioplasty and presence of a visually apparent TI-201 defect were independently evaluated and results compared. All 4 patients with 90% or greater diameter narrowing had positive TI-201 responses, and the mean gradient was 72 +/- 11 mm Hg. Among the 18 patients with less than 90% diameter narrowing, the mean gradient was higher (p less than 0.001) in the 11 with a positive TI-201 (63 +/- 15 mm Hg) than in the 7 with a negative TI-201 (33 +/- 20 mm Hg), but their percent narrowing did not differ significantly (72 +/- 14% vs 66 +/- 19%). Multiple regression analysis showed that the presence of a TI-201 defect was a strong (p . 0.003) and percent narrowing (p . 0.048) a weak independent predictor for gradient. When the mean gradient was normalized for the prestenotic pressure, both percent narrowing (p . 0.003) and TI-201 defects (p . 0.006) were significant independent predictors

  13. 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

  14. 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.)

  15. 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

  16. Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

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    Salgueiro Sandro

    2002-01-01

    Full Text Available OBJECTIVE: To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. METHODS: We retrospectively analyzed the in-hospital and late evolution of 189 patients with multivessel coronary disease, who underwent percutaneous coronary stent placement. These patients were divided into 2 groups as follows: group I (GI - 59 patients with involvement of the proximal segment of the anterior descending coronary artery; and group II (GII - 130 patients without involvement of the proximal segment of the anterior descending coronary artery. RESULTS: No significant difference was observed in the success rate of the procedure (91.5% versus 97.6%, p=0.86, nor in the occurrence of major adverse cardiac events (5.1% versus 1.5%, p=0.38, nor in the occurrence of major vascular complications (1.7% versus 0%, p=0.69 in the in-hospital phase. In the late follow-up, the incidence of major adverse cardiac events (15.4% versus 13.7%, p=0.73 and the need for new revascularization (13.5% versus 10.3%, p=0.71 were similar for both groups. CONCLUSION: The in-hospital and late evolution of patients with multivessel coronary disease with and without involvement of the proximal segment of the anterior descending coronary artery treated with coronary stent placement did not differ. This suggests that this revascularization method is an effective procedure and a valuable option for treating these types of patients.

  17. The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu; Hori, Yuzo; Nagatomi, Hirofumi

    2008-01-01

    We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs. (orig.)

  18. Microsurgical treatment of carotid-ophthalmic aneurysm associated with multiple anterior and posterior circulation aneurysms

    Science.gov (United States)

    Wang, Jiantao; Kan, Zhisheng; Wang, Shuo

    2017-01-01

    Abstract Background: The clipping of multiple intracranial aneurysms in 1 stage is uncommon. In this case, we report clipping of an ophthalmic aneurysm associated with multiple anterior and posterior circulation aneurysms via the Dolenc approach. Methods: The main symptoms of the patient are headache, along with nausea and vomiting. The patient's arteriogram revealed a wide-necked aneurysm of the right ophthalmic artery, an irregular aneurysm of the anterior communicating artery, and a basilar artery aneurysm. The surgical intervention for these aneurysms is a challenge because of the complex anatomical relationship with the surrounding structures. The 3 aneurysms, which were not amenable to a single intervention, were successfully clipped in 1 incision. Results: After surgery, the patient reported feeling well. One year after surgery, the patient had no SAH recurrence. Conclusions: Occasionally, surgical treatment was used even for aneurysms of the carotid-ophthalmic artery with aneurysms of anterior communicating artery and basilar artery, which are contraindicated for interventional therapy. PMID:28422878

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Partially thrombosed giant aneurysm arising from a distal anterior inferior cerebellar artery–posterior inferior cerebellar artery variant: A case report

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    Hidetoshi Ooigawa

    2015-09-01

    Full Text Available Anterior inferior cerebellar artery (AICA–posterior inferior cerebellar artery (PICA is a well-known variant in cerebral arteries. However, aneurysms located on the variant are rare and a giant one has not been reported. We report a case of a partially thrombosed giant aneurysm arising from an AICA–PICA variant. The patient was a 42-year-old man who presented with right hearing loss and facial numbness associated with left hemidysesthesia. Magnetic resonance imaging revealed an approximately 3.0-cm mass lesion at the right cerebello-pontine angle (CPA. Angiography showed a partially thrombosed aneurysm arising from the right AICA–PICA. The aneurysm was treated with endovascular trapping and surgical thrombectomy. Although cerebral aneurysm is known to occur at this site, this case provides awareness, that manifestations of aneurysms in the CPA include progressive multiple cranial nerve palsies and sensory disturbance caused by brainstem compression.

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

    International Nuclear Information System (INIS)

    Bendel, Paula; Koskenkorva, Paeivi; Vanninen, Ritva; Koivisto, Timo; Aeikiae, Marja; Niskanen, Eini; Koenoenen, Mervi; Haenninen, Tuomo

    2009-01-01

    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.)

  2. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. Effects of coil closure of patent ductus arteriosus on left anterior descending coronary artery blood flow using transthoracic Doppler echocardiography.

    Science.gov (United States)

    Harada, Kenji; Toyono, Manotomo; Tamura, Masamichi

    2004-06-01

    Transthoracic Doppler echocardiography provides noninvasive measurements of coronary blood flow in the left anterior descending coronary artery (LAD). This method has the potential to show the effects of acute changes in loading conditions on blood flow. Coil closure of patent ductus arteriosus (PDA) is a model of acute changes in blood pressure and left ventricular (LV) preload that influences coronary blood flow. We applied this technique to assess the coronary blood flow changes for patients with PDA before and immediately after PDA coil closure. We examined 9 patients (1.8 +/- 1.1 years) with simple PDA and 8 age-matched healthy children. LV dimensions and LV mass were measured. Maximum peak flow velocity and flow volume in the LAD were measured. Pulmonary to systemic flow ratios (Qp/Qs) were obtained by cardiac catheterization. After PDA coil closure, LV end-diastolic dimension decreased, and systolic and diastolic blood pressures increased significantly. The maximum peak flow velocity, LAD flow volume, and the ratio of LAD flow volume to LV mass increased significantly. The changes in maximum peak flow velocity and the ratio of LAD flow volume to LV mass (F/M) correlated positively with the changes in diastolic pressure and Qp/Qs. In 5 patients who had Qp/Qs > 1.5, the mean F/M was significantly lower compared with control subjects, but they increased to normal values after coil closure of PDA. PDA coil closure increases diastolic pressure and decreases Qp/Qs, resulting in improvement of myocardial perfusion. These findings provide new insights into the relationship between cardiac function and coronary circulation in pediatric patients with heart diseases associated with PDA.

  5. Velocity profile and wall shear stress of saccular aneurysms at the anterior communicating artery.

    Science.gov (United States)

    Yamaguchi, Ryuhei; Ujiie, Hiroshi; Haida, Sayaka; Nakazawa, Nobuhiko; Hori, Tomokatsu

    2008-01-01

    It has recently been shown that the aspect ratio (dome/neck) of an aneurysm correlates well with intraaneurysmal blood flow. Aneurysms with an aspect ratio larger than 1.6 carry a higher risk of rupture. We examined the effect of aspect ratio (AR) on intra-aneurysmal flow using experimental models. Flow visualization with particle imaging velocimetry and measurement of wall shear stress using laser Doppler anemometry were performed on three different aneurysm models: AR 0.5, 1.0, and 2.0. Intraaneurysmal flow consists of inflow, circulation, and outflow. Rapid inflow impinged on the distal neck creating a stagnant point. Rapid flow and maximum wall shear stress were observed in the vicinity of the stagnant point. By changing the Reynold's number, the stagnant point moved. By increasing the AR of the aneurysm, vortices inside the aneurysm sac closed and very slow flow was observed, resulting in very low shear stress markedly at a Reynold's number of 250, compatible with the diastolic phase. In the aneurysm model AR 2.0, both rapid flow at the neck and vortices inside the aneurysm are sufficient to activate platelets, making a thrombus that may anchor on the dome where very slow flow takes place. Hemodynamics in aneurysms larger than AR 2.0 definitely contribute to thrombus formation.

  6. 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.

  7. Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion.

    Science.gov (United States)

    Chuang, Yu-Ming; Liu, Chih-Yang; Pan, Po-Jung; Lin, Ching-Po

    2008-12-01

    Posterior communicating artery (PCoA) hypoplasia is a fetal variant of the Circle of Willis. According to angiograms and autopsy reports, this congenital variation is found in 6-21% of the general population. PCoA hypoplasia only becomes a risk factor for ischemic stroke in the presence of ipsilateral internal carotid artery (ICA) occlusion. The aim of our study was to determine the role of PCoA hypoplasia in acute ischemic stroke in the absence of ICA occlusion. We examined 310 acute ischemic stroke patients (mean age+/-standard deviation; 68.9+/-15.6 years). Cerebral magnetic resonance angiography was performed within 72 hours of ischemic stroke onset. For comparison, a risk factor-matched control group was recruited. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to estimate the independent effect of potential risk factors. The overall incidence of PCoA hypoplasia in our experimental group was 19.35% (n=60), which was significantly higher than in the control group (8.20%, n=22, p=0.036, OR, 3.21; 95% CI, 1.43-9.62). The most common ischemic event was ipsilateral thalamic lacunar infarctions with or without occipital lobe involvement. Based on our results, PCoA hypoplasia appears to be a contributor to the risk of ischemic stroke, even in the absence of ICA occlusion. This risk is especially pronounced for strokes involving arteries that penetrate the thalamus.

  8. 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

  9. Posterior communicating and vertebral artery configuration and outcome in endovascular treatment of acute basilar artery occlusion.

    Science.gov (United States)

    Haussen, Diogo C; Dharmadhikari, Sushrut S; Snelling, Brian; Lioutas, Vasileios-Arsenios; Thomas, Ajith; Peterson, Eric C; Elhammady, Mohamed Samy; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2015-12-01

    We aimed to evaluate if vertebrobasilar anatomic variations impact reperfusion and outcome in intra-arterial therapy (IAT) for basilar artery occlusion (BAO). Consecutive BAO patients with symptom onset PCoA) diameters were measured (CT angiography or MR angiography). The presence of PCoA atresia, VA hypoplasia, VAs that end in the posterior inferior cerebellar artery (PICA), and extracranial VA occlusion was recorded. 38 BAO patients were included. Mean age was 63±15 years; 52% were men. Baseline National Institutes of Health Stroke Scale score was 21±9, and mean/median time from symptom onset to IAT were 10/7 h. First generation thrombectomy devices were mostly used. Overall Treatment in Cerebral Ischemia 2b-3 reperfusion was 68.4%. Good outcome (modified Rankin Scale score ≤2) was observed in 17.8% and mortality in 64.3% of cases at 90 days. 55% of patients had an atretic PCoA while 47% had a hypoplastic VA. The mean sum of the bilateral PCoA and VA diameters were 2.3±1.2 and 5.2±5.2 mm, respectively. VAs that end in the PICA was noted in 23% of patients, and extracranial VA occlusion in 42%. BAO was proximal/mid/distal in 36%/29%/34%. Multivariate linear regression analysis indicated hypertensive disease (β=2.97; 95% CI 1.15 to 4.79; p<0.01) and reperfusion rate (β=-0.40; 95% CI -0.74 to -0.70; p=0.02) independently associated with outcome. Multivariate analysis for predictors of reperfusion failed to identify other associations. A trend for better reperfusion with stent retrievers was noted (β=1.82; 95% CI -0.24 to 3.88; p=0.08). Reperfusion emerged as a predictor of good outcome in patients that underwent IAT for BAO. Angioarchitectural variations of the posterior circulation were not found to impact reperfusion or clinical outcome. 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/

  10. 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.

  11. 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)

  12. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Energy Technology Data Exchange (ETDEWEB)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  13. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    International Nuclear Information System (INIS)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin; Becker, Hartmut; Goetz, Friedrich

    2008-01-01

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  14. 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.

  15. Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: Technical note

    Directory of Open Access Journals (Sweden)

    Shunsuke Kakino

    2008-08-01

    Full Text Available Shunsuke Kakino, Kuniaki Ogasawara, Yoshitaka Kubo, Hideaki Nishimoto, Akira OgawaDepartment of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, JapanAbstract: The subtemporal approach with division of the posterior communicating artery (PcomA is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.Keywords: basilar tip aneurysm, subtemporal approach, posterior communicating artery

  16. Myocardial infarct size vs duration of coronary artery occlusion in patients with acute anterior myocardial infarction. Assessment by thallium-201 emission tomography, gated cardiac pool study and CK-MB release

    Energy Technology Data Exchange (ETDEWEB)

    Tamaki, Shunichi; Kambara, Hirofumi; Kadota, Kazunori; Murakami, Tomoyuki; Suzuki, Yukisono [Kyoto Univ. (Japan). Faculty of Medicine

    1984-03-01

    Relationship between the duration of coronary artery occlusion and myocardial infarct size was investigated in 24 patients with acute anterior myocardial infarction associated with occlusion of the left anterior descending artery. The duration of coronary artery occlusion was divided into (A) 4 hours or less, (B) 4-10 hours, and (C) 10 hours or more. Defect score obtained by thallium-201 emission computed tomography was significantly greater, and left ventricular ejection fraction was significantly lower as the duration of coronary artery occlusion increased. Creatine kinase-MB (..sigma..CK-MB) was higher in cases of longer duration of occlusion. However, this was not significant between the groups A and B, suggesting the influence of reperfusion on the ..sigma..CK-MB release. The duration of coronary artery occlusion was considered to be an important factor to determine the infarct size, and significance of early reperfusion was suggested.

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

    OpenAIRE

    Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    Background and Purpose 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. Materials and Methods In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemo...

  18. Superior and anterior inferior cerebellar arteries and their relationship with cerebello-pontine angle cranial nerves revisited in the light of cranial cephalometric indexes: a cadaveric study.

    Science.gov (United States)

    Habibi, Zohreh; Meybodi, Ali Tayebi; Maleki, Farid; Tabatabai, Seyed

    2011-01-01

    The aim was to clarify the anatomical features of the superior and anterior inferior cerebellar arteries in relation to the trigeminal nerve and acoustic-facial complex and to the bony structures of the skull in a sample of male Iranian cadavers. Bilateral dissections, calvariectomy, and brain evacuation were performed on 31 adult human fresh brains and skull bases to assess the neurovascular associations, and skull base morphometry. Equations were defined to estimate posterior fossa volume and the relationships between bony and neurovascular elements. Eight SCAs were duplicated from origin. There were 9 cases of SCA-trigeminal contacts, which were at the root entry zone in 7. Mean distance from the origin of AICA to the vertebrobasilar junction was 11.80 mm, while 79% of AICAs originated from the lower half of the BA. This was significantly associated with "posterior fossa funneling" and "basilar narrowing" indexes. In most cases AICA crossed the acoustic-facial complex and coursed between neural bundles (48.3%). The AICA reached or entered the internal acoustic canal in 22.6% of cases and was medial to porous in 77.4%. We documented anatomical variations of the superior and anterior inferior cerebellar arteries along with some cephalometric equations with relevant neurovascular anatomy in Iranian cadavers.

  19. Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report

    OpenAIRE

    Isozaki, Makoto; Arai, Hiroshi; Neishi, Hiroyuki; Kitai, Ryuhei; Kikuta, Ken-ichiro

    2016-01-01

    We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpeduncular cistern of the midbrain. Because the shapes of the aneurysms were serpentine fusiform and the posterior communicating artery (PCoA) was the fetal type, we planned anastomosis of the occipita...

  20. 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

  1. 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)].

  2. 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.

  3. Quantitative study of the opticocarotid and carotid-oculomotor windows for the interpeduncular fossa, before and after internal carotid artery mobilization and posterior communicating division.

    Science.gov (United States)

    Kim, Young-Don; Elhadi, Ali M; Mendes, George A C; Maramreddy, Naveen; Agrawal, Abhishek; Kalb, Samuel; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

    2015-03-01

    The management of basilar apex (BX) aneurysms remains problematic. We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA). Eleven silicone-injected cadaveric heads were dissected bilaterally. The surgical dissection was divided into 4 major steps: (1) supraorbital modified orbitozygomatic craniotomy, (2) mobilization of the internal carotid artery after drilling out the anterior clinoid process intradurally and cutting the distal dural ring, (3) drilling out the posterior clinoid process and dorsum sellae, and (4) dividing the PCoA from the posterior third portion of the vessel. A frameless navigation system was used to quantify the surgical exposure area of the BX through the OCW and COW. The total surgical area increased significantly from steps 1 to 4 (P PCoA significantly increased the overall surgical area for permanent clip application (P PCoA and height of the BX.

  4. Infundibular dilatation of the posterior communicating artery in a defined population.

    Science.gov (United States)

    Vlajković, Slobodan; Vasović, Ljiljana; Trandafilović, Milena; Jovanović, Ivan; Ugrenović, Slađana; Dorđević, Gordana

    2015-01-01

    Unusual widening of the posterior communicating artery (PCoA) at its beginning from the cerebral portion of the internal carotid artery (ICA) was described as its infundibular dilatation (ID). A possibility of ID rupture or progression to aneurysm was the reason for an investigation of its frequency and morphologic features in specimens of the Serbian population. Cerebral arteries on the brain base of 267 adult cadavers of both genders and varying age and causes of death were dissected. The images of the PCoA in 190 fetuses were also reviewed. ID of the PCoA was defined as a funnel shaped beginning of different width from ICA, wherein PCoA continues from ID apex to the posterior cerebral artery. There were no cases of ID in fetuses. ID and aneurysms of the PCoA were found in 6/267 or 2.2% and 3/267 or 1.12% of adults, respectively. Unilaterally, they existed on the left side and, frequently, in male cases aging 70 years and older, that had died without cerebral cause. Bilaterally, ID was found in 2/6 cases. There was only one case of ID and aneurysm of the PCoA, but from the ID. We are of the opinion that ID of the PCoA only develops postnatally and probably is due to the influence of hemodynamic factors or hypertension. Copyright © 2014 Elsevier GmbH. All rights reserved.

  5. 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.

  6. Compression of the medulla oblongata and acute respiratory failure caused by rupture of a thrombosed large aneurysm of the anterior inferior cerebellar artery.

    Science.gov (United States)

    Oyama, Hirofumi; Kito, Akira; Maki, Hideki; Hattori, Kenichi; Tanahashi, Kuniaki

    2010-01-01

    A 65-year-old female presented with an extremely rare case of a ruptured thrombosed large aneurysm of the anterior inferior cerebellar artery (AICA) in which a local hematoma compressed the medulla oblongata and caused acute respiratory failure. She first presented with dizziness, general fatigue, and nausea 2 months before admission. She was hospitalized for intense general fatigue, nausea, and occipitalgia. Computed tomography and T(1)-weighted magnetic resonance imaging showed a heterogeneous lesion around the right cerebello-medullary cistern. Angiography revealed a fusiform aneurysm of the right AICA. Asphyxia occurred 4 days after admission and the patient underwent an emergency operation. No subarachnoid hematoma was present, but a hematoma around the ruptured portion markedly compressed the medulla oblongata. The medulla oblongata was adequately decompressed after subtotal removal of the aneurysm. The patient's respiratory status and consciousness level recovered after the operation.

  7. Ideal Internal Carotid Artery Trapping Technique without Bypass in a Patient with Insufficient Collateral Flow

    OpenAIRE

    Chung, Joon Ho; Shin, Yong Sam; Lim, Yong Cheol; Park, Minjung

    2009-01-01

    Internal carotid artery (ICA) trapping can be used for treating intracranial giant aneurysm, blood blister-like aneurysms and ICA rupture during the surgery. We present a novel ICA trapping technique which can be used with insufficient collaterals flow via anterior communicating artery (AcoA) and posterior communicating artery (PcoA). A patient was admitted with severe headache and the cerebral angiography demonstrated a typical blood blister-like aneurysm at the contralateral side of PcoA. F...

  8. 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.

  9. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Laura Hollar

    2015-10-01

    Full Text Available Wellens’ syndrome, also known as LAD coronary T-wave syndrome or the ‘widow maker’, is a pre-infarction syndrome with non-classical ischemic ECG changes and unremarkable cardiac biomarkers. This syndrome continues to be a ‘can't miss’ for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction, left ventricular dysfunction, arrhythmias, and death. We describe a case followed by a discussion of identification criteria and clinical implications.

  10. 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.

  11. Evaluation of the anterior ethmoidal artery by 3D dual volume rotational digital subtraction angiography and native multidetector CT with multiplanar reformations. Initial findings.

    Science.gov (United States)

    Pandolfo, Ignazio; Vinci, Sergio; Salamone, Ignazio; Granata, Francesca; Mazziotti, Silvio

    2007-06-01

    Our purpose is to codify the anterior ethmoidal artery (AEA) course and its relationship with adjacent structures. Twenty patients with cerebrovascular disease underwent selective internal carotid dual volume angiography. Fusion of the vascular and bony images was obtained successively on a second console. MDCT of the cranium was performed in all patients. To identify the AEA course, multiplanar CT reformations were obtained. In all cases the entry-point of AEA and its course were identified by means of dual volume angiography. The information was confirmed by MDCT. In a second phase, we studied another 78 patients affected by inflammatory disease and polyposis only by means of MDCT, in order to confirm the previous data obtained by comparison between angiography and MDCT. In this second phase, 110/156 vessels were indirectly detected by means of visualization of the ethmoidal entry point. In the remaining cases, AEA was directly shown due to integrity of the thin ethmoidal bone lamellae or bony canal. Dual volume angiography is essential to identify the course of the AEA (standard of reference for the interpretation of CT). In patients with benign rhinosinusal pathology, where invasivity techniques are not justified, MPR reconstructions were of pivotal importance in the evaluation of the course of the artery with particular reference to its relationship with the frontal recess.

  12. Successful flow reduction surgery for a ruptured true posterior communicating artery aneurysm caused by the common carotid artery ligation for epistaxis.

    Science.gov (United States)

    Yamao, Yukihiro; Takahashi, Jun C; Satow, Tetsu; Iihara, Koji; Miyamoto, Susumu

    2014-01-01

    Carotid artery occlusion can lead to the development of rare true posterior communicating artery (PCoA) aneurysms because of hemodynamic stress on the PCoA. Surgical treatment of these lesions is challenging. The authors report a case of a true PCoA aneurysm that developed and ruptured 37 years after ligation of the ipsilateral common carotid artery for epistaxis. The lesion was successfully treated with clipping of the distal M1 segment of the middle cerebral artery (MCA) after the occipital artery-radial artery free graft-MCA bypass, which led to extreme reduction in collateral flow through the PCoA. A cortical branch, located just proximal to the obliteration site, functioned as a sufficient flow outlet. The aneurysm shrank, and the patient has been doing well without any symptoms for 5 years after surgery. M1 obliteration combined with high-flow extra-intracranial bypass might be a promising option for a true PCoA aneurysm, and therapeutic design that leaves a sufficient flow outlet on the M1 is mandatory to avoid unexpected occlusion of the M1 and its perforators.

  13. Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device.

    Science.gov (United States)

    Daou, Badih; Valle-Giler, Edison P; Chalouhi, Nohra; Starke, Robert M; Tjoumakaris, Stavropoula; Hasan, David; Rosenwasser, Robert H; Hebert, Ryan; Jabbour, Pascal

    2017-02-01

    OBJECTIVE The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the posterior communicating artery (PCoA) following treatment of PCoA aneurysms using the PED. METHODS All patients with PCoA aneurysms treated with the PED who had angiographic follow-up were retrospectively identified. The patency of the PCoA at follow-up was evaluated by 2 authors who were not involved in the intervention. Univariate and multivariate analyses were performed to identify factors associated with the following: 1) PCoA patency versus no or diminished flow, and 2) PCoA patency and diminished flow versus PCoA occlusion. RESULTS Thirty patients with an angiographic follow-up of 6 months were included. Aneurysm obliteration was achieved in 25 patients (83.3%). The PCoA was patent in 7 patients (23.3%), had diminished flow in 7 patients (23.3%), and was occluded in 16 patients (53.3%). In the univariate analysis of outcome, there was a trend for aneurysms with incomplete occlusion, aneurysms not previously treated, those with presence of a fetal PCoA, and those with an artery coming from the aneurysm to have higher odds of the PCoA remaining patent. In univariate and multivariate analyses of factors associated with outcome, fetal PCoA and presence of an artery coming from the aneurysm were associated with the PCoA remaining open with or without diminished flow. No patients had symptoms related to PCoA occlusion. CONCLUSIONS Occlusion and diminished flow through the PCoA is common following PED treatment of PCoA aneurysms. However, it is clinically insignificant in most cases.

  14. Fenestrations and Various Duplications of the Posterior Communicating Artery in the Prenatal and Postnatal Periods.

    Science.gov (United States)

    Trandafilović, Milena; Vasović, Ljiljana; Vlajković, Slobodan; Đorđević, Gordana; Stojanović, Borisav; Mladenović, Marija

    2016-07-01

    The 2 paired arteries-the posterior communicating arteries (PCoAs) and the precommunicating parts of the posterior cerebral arteries-form the so-called posterior segment of the cerebral arterial circle on the base of the brain. A number of (ab)normal morphologic features were described in the literature (e.g., unusual kinking, or extreme elongations, hypoplasia, duplications, fenestrations, the infundibular widening, or aplasia of the PCoA in the prenatal and/or postnatal periods). The aim of this study was to analyze an incidence of various fenestrations and duplications of the PCoA, and describe their general features and their association with other vascular abnormalities. The research was performed on the brains of 200 human fetuses and 377 adult cadavers of both genders and different ages using microdissection and macrodissection methods. There were 0.34% cases with PCoA fenestrations and 3.12% cases with various PCoA duplications. Their morphologic features were described and compared with the similar PCoA abnormalities recorded in the scientific literature. There was no association between the PCoA and either duplication or aneurysm in adult cases. After thorough examination, the fenestrations and duplications of the PCoA are distinguished as 2 special forms of vascular abnormalities, and the PCoA duplications are characterized as partial and total. Furthermore, whereas the low incidence of a fenestration of the PCoA suggests it to be a sufficiently rare phenomenon, the duplications of the PCoA trunk are fairly frequent, especially concerning its terminal segment. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. True posterior communicating artery aneurysms: are they more prone to rupture? A biomorphometric analysis.

    Science.gov (United States)

    He, Wenzhuan; Hauptman, Jason; Pasupuleti, Latha; Setton, Avi; Farrow, Maria G; Kasper, Lydia; Karimi, Reza; Gandhi, Chirag D; Catrambone, Jeffrey E; Prestigiacomo, Charles J

    2010-03-01

    Posterior communicating artery (PCoA) aneurysms can occur at the junction with the internal carotid artery, posterior cerebral artery (PCA), or the proximal PCoA itself. Hemodynamic stressors contribute to aneurysm formation and may be associated with parent vessel size and aneurysm location. This study evaluates the correlation of various biomorphometric characteristics in 2 of the aforementioned types of PCoA aneurysms. Patients with PCoA aneurysms were analyzed using CT angiography. Source images and reconstructions were used to determine which aneurysms originated purely from the PCoA and those that originated from the internal carotid artery/PCoA junction. Morphometric analysis was performed on the aneurysm, the precommunicating segment of the PCA (P(1)), the ambient segment of the PCA (P(2)), and both PCoA arteries and were correlated to clinical presentation. Parametric and nonparametric analyses were performed to test for significance. A total of 77 PCoA aneurysms were analyzed, and 10 were found to be true PCoA aneurysms (13.0%). The ipsilateral PCoA/P(1) ratio (1.77 +/- 0.44 vs 0.82 +/- 0.46, p = 0.0001) and ipsilateral P(2)/P(1) ratio (1.73 +/- 0.40 vs 1.22 +/- 0.41, p = 0.0003) were significantly larger in true PCoA aneurysms. Interestingly, aneurysm size was statistically larger in the junctional aneurysms (0.14 +/- 0.1 vs 0.072 +/- 0.04 cm(3), p = 0.03). The prevalence of ruptured aneurysms was similar in both groups (approximately 80%, p value not significant). These data suggest that true PCoA aneurysms have a larger PCoA relative to the ipsilateral P(1) segment. To the authors' knowledge, this represents the first such biomorphometric comparison of these different types of PCoA aneurysms. Although statistically smaller in size, true PCoA aneurysms also have a similar prevalence of presenting as a ruptured aneurysm, suggesting that they might be more prone to rupture than a junctional aneurysms of similar size. Further analysis will be required to

  16. 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)

  17. Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy.

    Science.gov (United States)

    Sussman, Eric S; Kellner, Christopher P; Mergeche, Joanna L; Bruce, Samuel S; McDowell, Michael M; Heyer, Eric J; Connolly, E Sander

    2014-09-01

    Approximately 25% of patients exhibit cognitive dysfunction 24 hours after carotid endarterectomy (CEA). One of the purported mechanisms of early cognitive dysfunction (eCD) is hypoperfusion due to inadequate collateral circulation during cross-clamping of the carotid artery. The authors assessed whether poor collateral circulation within the circle of Willis, as determined by preoperative CT angiography (CTA) or MR angiography (MRA), could predict eCD. Patients who underwent CEA after preoperative MRA or CTA imaging and full neuropsychometric evaluation were included in this study (n = 42); 4 patients were excluded due to intraoperative electroencephalographic changes and subsequent shunt placement. Thirty-eight patients were included in the statistical analyses. Patients were stratified according to posterior communicating artery (PCoA) status (radiographic visualization of at least 1 PCoA vs of no PCoAs). Variables with p PCoAs was the only independent predictor of eCD (OR 9.64, 95% CI 1.43-64.92, p = 0.02). The absence of both PCoAs on preoperative radiographic imaging is predictive of eCD after CEA. This finding supports the evidence for an underlying ischemic etiology of eCD. Larger studies are justified to verify the findings of this study. Clinical trial registration no.: NCT00597883 ( http://www.clinicaltrials.gov ).

  18. Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations.

    Science.gov (United States)

    Kocak, Burak; Tureci, Ercan; Kizilkilic, Osman; Islak, Civan; Kocer, Naci

    2013-09-01

    Posterior communicating artery (PCoA) itself is an unusual location for intracranial aneurysms in that isolated dissections or dissecting aneurysms are extremely rare. In the way of correct diagnosis of dissecting aneurysms of PCoA itself, a proper understanding of (1) the anatomy of the PCoA and its perforator branches, (2) some particular diagnostic features, and (3) related clinical aspects is of significant importance. Although there are no established treatment strategies for this particular type of aneurysms, the endovascular approach might be considered as a plausible one. In this paper, our scope was to report five cases with dissecting aneurysm of the PCoA itself and to discuss this rare vascular pathology from anatomical, diagnostic, clinical, and therapeutical perspectives.

  19. Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

    Science.gov (United States)

    Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

    2000-01-01

    Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

  20. Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling.

    Science.gov (United States)

    McCracken, D Jay; Lovasik, Brendan P; McCracken, Courtney E; Caplan, Justin M; Turan, Nefize; Nogueira, Raul G; Cawley, C Michael; Dion, Jacques E; Tamargo, Rafael J; Barrow, Daniel L; Pradilla, Gustavo

    2015-12-01

    Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment. EUH, Emory University HospitalIQR, interquartile rangeJHU, Johns Hopkins UniversitymRS, modified Rankin ScaleONP, oculomotor nerve palsyPCoA, posterior communicating arterySAH, subarachnoid hemorrhage.

  1. Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

    International Nuclear Information System (INIS)

    Huber, G.

    1980-01-01

    A rare arterial anastomosis between the right and left interal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis. (orig.)

  2. Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Huber, G.

    1980-12-01

    A rare arterial anastomosis between the right and left internal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis.

  3. Microneurosurgical management of aneurysms at A4 and A5 segments and distal cortical branches of anterior cerebral artery.

    Science.gov (United States)

    Lehecka, Martin; Dashti, Reza; Hernesniemi, Juha; Niemelä, Mika; Koivisto, Timo; Ronkainen, Antti; Rinne, Jaakko; Jääskeläinen, Juha

    2008-10-01

    Aneurysms originating distal to the A3 segment of the ACA, located on the A4 and the A5 segments or the distal cortical branches of the ACA (AdistAs) are rare, forming about 0.5% of all IAs. There are only few reports on management of AdistAs. In this article, we review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of AdistAs. This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (J. H.) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland. These 2 centers have treated more than 10000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients and 4253 IAs, there were 26 patients carrying 26 AdistAs, forming 0.9% of all patients with IAs, 0.6% of all IAs, and 2% of all ACA aneurysms. A total of 10 (38%) patients presented with ruptured AdistAs, with ICH in 4 (40%) and IVH in 2 (20%); 16 patients (62%) had multiple aneurysms. AdistAs are small, even when ruptured, with relatively wide base, and they are frequently associated with ICHs. Our data suggest that AdistAs rupture at smaller size than IAs in general. The challenge is to locate the aneurysm inside the interhemispheric fissure and to clip the neck adequately without obstructing branching arteries at the base. Unruptured AdistAs also need microneurosurgical clipping even when they are small.

  4. 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.

  5. 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.

  6. 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

  7. Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report.

    Science.gov (United States)

    Isozaki, Makoto; Arai, Hiroshi; Neishi, Hiroyuki; Kitai, Ryuhei; Kikuta, Ken-Ichiro

    2016-10-01

    We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpeduncular cistern of the midbrain. Because the shapes of the aneurysms were serpentine fusiform and the posterior communicating artery (PCoA) was the fetal type, we planned anastomosis of the occipital artery to the P4 portion of the PCA followed by endovascular obliteration of the parent artery including the aneurysms. Endovascular treatment was performed via a femoral approach one week after the anastomosis. Super-selective balloon test occlusion (BTO) of the PCoA was performed by using an occlusion balloon microcatheter before endovascular treatment. Occlusion of the proximal segment of the PCoA induced disturbance of consciousness of the patient. Occlusion of the distal segment other than the first point of the PCoA did not induce any neurological symptoms. The information from this super-selective BTO helped us to perform precise endovascular obliteration. The aneurysm was successfully obliterated, and the diplopia almost disappeared in a few months. Super-selective BTO of the PCoA might be a useful method for preventing ischemic complications due to occlusion of invisible perforators.

  8. Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK

    DEFF Research Database (Denmark)

    Lorenzen, Ebbe L; Taylor, Carolyn W; Maraldo, Maja

    2013-01-01

    BACKGROUND AND PURPOSE: To determine the extent of inter-observer variation in delineation of the heart and left anterior descending coronary artery (LADCA) and its impact on estimated doses. METHODS AND MATERIALS: Nine observers from five centres delineated the heart and LADCA on fifteen patient...... guidelines were used. In contrast, for the LADCA there was substantial variation in the estimated dose, which was not reduced with guidelines....

  9. Reconstruction of cica-contracture on the face and neck with skin flap and expanded skin flap pedicled by anterior branch of transverse cervical artery.

    Science.gov (United States)

    Chen, Baoguo; Song, Huifeng; Xu, Minghuo; Gao, Quanwen

    2016-09-01

    A high-quality flap is necessary for repairing faciocervical scar contractures. The supraclavicular region and chest wall are the preferred choices for reconstruction. The supraclavicular island flap (SIF) pedicled by the transverse cervical artery (TCA) has been reported. Compared to the traditional SIF flap, another type of flap pedicled by the anterior perforator of transverse cervical artery (ap-TCA) is more convenient for transfer to the faciocervical area. In this article, we use this type of perforator flap and expanded perforator flap to repair the faciocervical contracture. In this study, 10 cases (deformity caused by burn or trauma to the face and neck sites) with an average age of 32 years-old, were treated by ap-TCA flap and this type of expanded flap. In between, the flap was pre-expanded for approximately 3 months prior to transfer in 6 patients. Another 4 cases did not want the expander because of the long duration required for saline filling and potential complications of the expander. Bilateral prefabricated flaps were designed in two female cases. All 12 flaps in 10 patients were transferred tension-free to the defects and no flap was lost. The size of the flap ranged from 12 cm × 8 cm to 15 cm × 20 cm. All 12 flaps survived completely. The donor sites were closed directly in the above 6 patients where an expander had been used and reconstructed by split skin graft in 4 patients where no expander had been employed. Through a mean time of 6 months' follow-up, only one female patient was disappointed with the cicatrix that presented on the upper polar skin of both breasts, the other 9 patients were satisfied with both recipient function and appearance. The color and the texture matched well with the recipient area. The ap-TCA flap and expanded ap-TCA flap can be considered reliable options for faciocervical deformities as it can be easily elevated and it matches well with faciocervical area in color. With regards to the expanded flap, we

  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. 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 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.

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

    Science.gov (United States)

    Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    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 PCoA aneurysms.

  13. 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.

  14. Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms.

    Science.gov (United States)

    Zhang, Ying; Jing, Linkai; Liu, Jian; Li, Chuanhui; Fan, Jixing; Wang, Shengzhang; Li, Haiyun; Yang, Xinjian

    2016-08-01

    To identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status. 173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. Two clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, pPCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms. 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/

  15. Successful Transarterial Embolization of a Posttraumatic Fistula Between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus: A Case Report.

    Science.gov (United States)

    Jinbo, Yin; Jun, Liu; Kejie, Mou; Zheng, Zhou

    2015-01-01

    Posterior communicating artery (PCoA) aneurysm-cavernous sinus fistulae are an extremely rare complication of head injury . The treatment of PCoA aneurysm-cavernous sinus fistulae has not been well described. A 27-year-old man was admitted with a retroocular bruit and blurred vision of the left eye seven months after a severe head injury. We report the angiographic appearance of a posterior communicating artery (PCoA) aneurysm with a fistula to the cavernous sinus. This injury had been previously misinterpreted to be a PCoA aneurysm by computerized tomographic angiography (CTA). The patient was successfully treated with coils and Onyx of a fistula between the PCoA aneurysm and cavernous sinus.

  16. Association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery.

    Science.gov (United States)

    Behari, Sanjay; Krishna, Himanshu; Kumar, Marakani V Kiran; Sawlani, Vijay; Phadke, Rajendra V; Jain, Vijendra K

    2004-05-01

    Basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.

  17. Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

    Science.gov (United States)

    Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

    2012-11-01

    Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

  18. Impact of Aneurysm Projection on Intraoperative Complications During Surgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

    Science.gov (United States)

    Fukuda, Hitoshi; Hayashi, Kosuke; Yoshino, Kumiko; Koyama, Takashi; Lo, Benjamin; Kurosaki, Yoshitaka; Yamagata, Sen

    2016-03-01

    Surgical clipping of ruptured posterior communicating artery (PCoA) aneurysms is a well-established procedure to date. However, preoperative factors associated with procedure-related risk require further elucidation. To investigate the impact of the direction of aneurysm projection on the incidence of procedure-related complications during surgical clipping of ruptured PCoA aneurysms. A total of 65 patients with ruptured PCoA aneurysms who underwent surgical clipping were retrospectively analyzed from a single-center, prospective, observational cohort database in this study. The aneurysms were categorized into lateral and posterior projection groups, depending on direction of the dome. Characteristics and operative findings of each projection group were identified. We also evaluated any correlation of aneurysm projection with the incidence of procedure-related complications. Patients with ruptured PCoA aneurysms with posterior projection more likely presented with good-admission-grade subarachnoid hemorrhage (P = .01, χ test) and were less to also have intracerebral hematoma (P = .01). These aneurysms were found to be associated with higher incidence of intraoperative rupture (P = .02), complex clipping with fenestrated clips (P = .02), and dense adherence to PCoA or its perforators (P = .04) by univariate analysis. Aneurysms with posterior projection were also correlated with procedure-related complications, including postoperative cerebral infarction or hematoma formation (odds ratio, 5.87; 95% confidence interval, 1.11-31.1; P = .04) by multivariable analysis. Ruptured PCoA aneurysms with posterior projection carried a higher risk of procedure-related complications of surgical clipping than those with lateral projection.

  19. Infundibular dilations of the posterior communicating arteries: pathogenesis, anatomical variants, aneurysm formation, and subarachnoid hemorrhage.

    Science.gov (United States)

    Chen, Ching-Jen; Moosa, Shayan; Ding, Dale; Raper, Daniel M; Burke, Rebecca M; Lee, Cheng-Chia; Chivukula, Srinivas; Wang, Tony R; Starke, Robert M; Crowley, R Webster; Liu, Kenneth C

    2016-08-01

    Cerebrovascular infundibular dilations (IDs) are triangular-shaped widenings less than 3 mm in diameter, which are most commonly found at the posterior communicating artery (PCoA). The aims of this systematic review are to elucidate the natural histories of IDs, determine their risk of progression to significant pathology, and discuss potential management options. A comprehensive literature search of PubMed was used to find all case reports and series relating to cerebral IDs. IDs were classified into three types: type I IDs do not exhibit morphological change over a long follow-up period, type II IDs evolve into saccular aneurysms, while type III IDs are those that result in subarachnoid hemorrhage without prior aneurysmal progression. Data were extracted from studies that demonstrated type II or III IDs. We reviewed 16 cases of type II and seven cases of type III IDs. For type II IDs, 81.3% of patients were female with a median age at diagnosis of 38. All type II IDs were located at the PCoA without a clear predilection for sidedness. Median time to aneurysm progression was 7.5 years. For type III IDs there was no clear gender preponderance and the median age at diagnosis was 51. The PCoA was involved in 85.7% of cases, with 57.1% of IDs occurring on the left. Most patients were treated with clipping. Risk factors for aneurysm formation appear to be female gender, young age, left-sided localization, coexisting aneurysms, and hypertension. IDs can rarely progress to aneurysms or rupture. Young patients with type II or III IDs with coexisting aneurysms or hypertension may benefit from long-term imaging surveillance. 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/

  20. 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

  1. Arterial blood supply to the thalamus and midbrain on CT sections, 2

    International Nuclear Information System (INIS)

    Takeshita, Gen; Ottomo, Michinori; Satoh, Nobuko; Yokoyama, Yoshiaki.

    1984-01-01

    The selective injection of a dyestuff into thalamoperforating arteries from the posterior part of the circle of Willis, using five postmortem brains, was performed. After fixation, sections parallel to the orbito-meatal line were obtained. In cases which showed a standard development of the posterior communicating arteries, the usual patterns were as follows: the area supplied by perforators of the posterior communicating artery (anterior thalamoperforating artery) was visualized in the hypothalamus and the antero-lateral part of the thalamus; the area supplied by perforators of the proximal segment of the posterior cerebral artery (interpeduncular thalamoperforating artery) was visualized in the midbrain and the medial part of thalamus; the area supplied by perforators of the ambient segment of the posterior cerebral artery (thalamogeniculate artery) was visualized in the medial part of the geniculate body and the posterior part of the thalamus. According to the development of the posterior communicating artery, the area supplied by each perforator was quite variable. Three CT sections were obtained containing three different patterns of the posterior communicating artery: 1) well-developed; 2) moderately developed; and 3) poorly developed. The identification of the area supplied by thalamoperforating arteries on CT sections was quite useful in the CT diagnosis of cerebrovascular disorders which involved the thalamus and the midbrain. (author)

  2. 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.

  3. 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.

  4. 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

  5. Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases.

    Science.gov (United States)

    Shi, Lei; Yu, Jing; Zhao, Ying; Xu, Kan; Yu, Jinlu

    2018-02-01

    It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I-III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms.

  6. Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation.

    Science.gov (United States)

    Vaujois, Laurence; Boucoiran, Isabelle; Preuss, Christophe; Brassard, Myriam; Houde, Christine; Fouron, Jean C; Raboisson, Marie-Josée

    2017-09-01

    The relationship between interatrial communication, ductus arteriosus, and pulmonary flow in transposition of the great arteries and intact ventricular septum may help predict postnatal desaturation. Echocardiographic data of 45 fetuses with transposition of the great arteries and intact ventricular septum and 50 age-matched controls were retrospectively reviewed. Interatrial communication, left and right ventricular output, flow in the ductus arteriosus, as well as effective pulmonary flow were measured. Patients were divided into two groups on the basis of postnatal saturations: group 1 had saturations ⩽50% and group 2 >50%. Of 45 fetuses, 13 (26.7%) were classified into group 1. Compared with fetuses in group 2, they had a smaller interatrial communication (2.9 versus 4.0 mm, p=0.004) and more retrograde diastolic flow in the ductus arteriosus (92 versus 23%, p=0.002). Both groups showed a significant decrease in ductal flow compared with controls. Patients in group 2 had a higher effective pulmonary flow compared with controls. There was a mild correlation between left ventricular output and size of the interatrial communication (Spearman's rank correlation 0.44). A retrograde diastolic flow is present in most of the fetuses with postnatal desaturation. Fetuses with transposition of the great arteries have a lower flow through the ductus arteriosus compared with controls. Fetuses without restrictive foramen ovale have higher effective pulmonary flow. Peripheral pulmonary vasodilatation due to higher oxygen saturation in pulmonary arteries in the case of transposition of the great arteries could be one possible cause.

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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

    Directory of Open Access Journals (Sweden)

    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.

  9. Anterior ankle arthroscopy, distraction or dorsiflexion?

    Science.gov (United States)

    de Leeuw, Peter A J; Golanó, Pau; Clavero, Joan A; van Dijk, C Niek

    2010-05-01

    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 limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.

  10. A case study of an axillary artery pseudoaneurysm following anterior dislocation of the glenohumeral joint: A rare presentation on plain film radiographs

    International Nuclear Information System (INIS)

    Whittam, Katie; Hardy, Maryann

    2007-01-01

    Axillary pseudoaneurysm is a rare but important complication of anterior glenohumeral joint dislocation. Diagnosis of axillary pseudoaneurysm is predominantly undertaken following clinical examination but where diagnosis is uncertain, Doppler ultrasound is the imaging examination of choice to confirm diagnosis. In this case study, the initial clinical signs of axillary pseudoaneurysm were masked by the presenting trauma and, although findings indicative of pseudoaneurysm were present on late plain film images, they were not immediately recognised. Misdiagnosis or delayed diagnosis of axillary pseudoaneurysm may result in upper limb morbidity or patient mortality. Consequently, the prompt and accurate identification of an axillary pseudoaneurysm on plain film radiographs, although rare, is essential. Yet for inexperienced film readers, correctly identifying an axillary pseudoaneurysm can be difficult due to its apparent similarity to other pathologies. This article will highlight the differences in radiological appearances between a pseudoaneurysm and a gleno-humeral joint effusion to raise radiographer awareness of the risks and clinical signs of an axillary pseudoaneurysm post gleno-humeral joint dislocation and discuss the difficulties encountered in its diagnosis. Finally, this review will evaluate current diagnostic practices in comparison with best practice, as identified in the literature [Fitzgerald JF, Keates J. False aneurysm as a late complication of anterior shoulder dislocation. Ann Surg 1975;6:785-6; Drury JK, Scullion JE. Vascular complications of anterior dislocation of the shoulder. Br J Surg 1980;67(8):579-81. Waxman DL, France MP, Douglas T, Harryman I. Late lateral displacement of the humeral head after closed reduction of dislocation: a sign of vascular injury. J Bone Joint Surg 1996;78(6):907-10

  11. Comparison of exercise ECG and radionuclide ventriculography in the assessment of myocardial ischemia in patients with isolated stenoses of the left anterior descending artery

    International Nuclear Information System (INIS)

    Klepzig, H. Jr.; Mildenberger, D.; Kaltenbach, M.; Standke, R.; Baum, R.P.; Tezak, S.; Maul, F.D.; Hoer, G.

    1988-01-01

    21 patients with LAD-stenoses of at least 70% and 21 patients with LAD-stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81% of all patients without infarction and in 71% of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81%, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2(11%) in the corresponding group with intramural infaction. The global ejection fraction was pathological in 1(5%) healthy subject without infarction and in 3(17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently. (orig.) [de

  12. Pontine infarction caused by medial branch injury of the basilar artery as a rare complication of cisternal drain placement

    OpenAIRE

    Horiuchi, Tetsuyoshi; Yamamoto, Yasunaga; Kuroiwa, Masafumi; Rahmah, Nunung Nur; Hongo, Kazuhiro

    2012-01-01

    We present a rare complication of cisternal drain placement during aneurysm surgery. A ruptured anterior communicating artery aneurysm was clipped through a right pterional approach. A cisternal drain was inserted from the retro-carotid to the prepontine cistern. Postoperatively, a left-sided paresis of the upper extremity had developed. A CT brain scan revealed that the drain was located between the pons and the basilar artery, resulting in a pontine infarction. Vascular neurosurgeons should...

  13. Infundibular dilation and aneurysm at the origin of the posterior communicating artery: differential diagnosis by CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Min, Kyung-Jun; Yoon, Dae-Young [Hallym University College of Medicine, Department of Radiology, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of); Kim, Heung-Chul [Hallym University College of Medicine, Department of Radiology, Chuncheon Sacred Heart Hospital, Chuncheon (Korea, Republic of); Lee, Jong-Young; Cho, Byung-Moon [Hallym University College of Medicine, Department of Neurosurgery, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of)

    2014-11-15

    Infundibular dilation (ID) and aneurysm at the internal carotid artery (ICA)-posterior communicating artery (PComA) junction can be difficult to distinguish but may differ in clinical significance. The aim of this study was to evaluate the utility of CT angiography (CTA) in differentially diagnosing IDs and small unruptured aneurysms at the ICA-PComA junction. This retrospective study comprised 88 patients diagnosed with 107 protrusions (70 IDs and 37 aneurysms <5 mm; 19 bilateral lesions) at the ICA-PComA junction who underwent both CTA and digital subtraction angiography (DSA). Two neuroradiologists independently reviewed CTA and DSA images according to these criteria: (a) size (maximum dimension <3 or ≥3 mm), (b) shape (triangular or round/oval/irregular), (c) aneurysmal neck (absent or present), (d) horizontal direction (posteriomedial or posteriolateral), and (e) PComA origin (apex, no PComA, or base). The intermodality (between CTA and DSA) and interobserver (between the two readers) agreement were determined for each finding. We also evaluated the sensitivity and specificity of CTA for distinguishing ID and aneurysm, using DSA as the reference standard. The mean κ values of intermodality agreement for the size, shape, aneurysmal neck, horizontal direction, and PComA origin were 0.88, 0.87, 0.84, 0.71, and 0.56, respectively. All interobserver agreements of CTA and DSA were excellent. The sensitivity, specificity, and accuracy of CTA for differentiating aneurysms from IDs were 94.6, 100, and 98.0 %, respectively. CTA may be a useful noninvasive modality for differential diagnosis of ID and aneurysm at the ICA-PComA junction. (orig.)

  14. 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

  15. 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.

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Variations and anomalies of the posterior communicating artery in Northwest Indian brains.

    Science.gov (United States)

    Sahni, Daisy; Jit, Indar; Lal, Vivek

    2007-10-01

    The PCoA is a major branch of the supraclinoid internal carotid artery. Thorough knowledge of the anatomy and awareness of the variations and anomalies are of clinical importance. The PCoA was studied in 200 male and 80 female adults and in 20 male and 25 female children. These were medicolegal cases that died of an accident or poisoning after staying in a hospital for a few days. In addition to autopsy specimens, PCoA was also examined in 45 fetuses obtained from the department of obstetrics and gynecology of this institute. In fetal brains, at 61 to 70 mm CR stage, the average diameter of PCoA was more than that of the proximal part of the PCA; at 91 to 100 mm CR stage, the diameters of both vessels were equal and remained so until 130 mm CR stage; thereafter, the diameter of the proximal part of PCA became larger than PCoA. Incidence of tortuosity was more on the left than on the right side in children, and the reverse was the case in adults. Tortuosity was not found in fetal brains. The incidence of hypoplasticity and absence of PCoA in children and adults in both sexes were noted. The embryonic type (where the diameter of PCoA is more than the diameter of proximal part of PCA) was observed in 3 children and 20 adults. The incidence of aneurysms involving PCoA was 0.92% in adults. They were not seen in fetuses, newborns, and children. Because of hemodynamic factors in fetuses of more than 130 mm CR stage, the diameter of PCA becomes larger than that of the PCoA. An aneurysm was seen in only 1 male adult (0.5%), other anomalies present were absence, hypoplasticity, and duplication of PCoA. Present observations were different from the findings of 2 groups of the Indian workers (J Neurosurg 1984;60:572-576; J Anat Soc India 1970;19:71-79). Case history of the patients with anomalies of PCoA did not show any mental aberration.

  19. CT and angiographic analysis of posterior communicating artery aneurysms: What factors influence the amount of subarachnoid blood?

    International Nuclear Information System (INIS)

    Kim, Young Min; Jung, Kun Sik; Rho, Myung Ho; Choi, Pil Youb; Sung, Young Soon; Kwon, Jae Soo; Lee, Sang Wook

    1998-01-01

    To determine how clinical and angiographic factors relate to the amount of subarachnoid blood detected by computerized tomography in patients with a ruptured aneurysm. Between January 1996 and December 1997, 22 patients with a posterior communicating artery aneurysm were retrospectively evaluated. Oval(three of four cases), funnel(both cases), and daughter-sac (four of five cases) types of aneurysmal sac were found among the 13 patients with a large amount of subarachnoid blood;eight of these had a past history of hyertension or diabetes. Seven of eleven cases of cylindricaltype aneurysmal sac were found among the 9 patients with a small amount of sularachnoid blood;eight of these had no past history of hypertension or diabetes. The average S/N ratio (ratio of maximum sac length to neck diameter) of patients with a small amount of blood was higher than that of patients with a large amount of blood(2.72 vs 2.07). Although many factors influence the amount of subarachnoid blood in an aneurysmal rupture, we found that a large amount of blood was frequently present in the oval, funnel and daughter sac types of aneurysm, when S/N ratio was low, and when an underlying disease such as hypertension or diabetes was present. Conversely, a small amount of blood was present in the cylindrical type, when S/N ratio was high, and where there was no underlying disease.=20

  20. 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

  1. Directional atherectomy facilitates the interventional procedure and leads to a low rate of recurrent stenosis in left anterior descending and left circumflex artery ostium stenoses: subgroup analysis of the FLEXI‐CUT study

    Science.gov (United States)

    Dahm, J B; Ruppert, J; Hartmann, S; Vogelgesang, D; Hummel, A; Felix, S B

    2006-01-01

    Objectives To examine by retrospective analysis of data from the FLEXI‐CUT monocentre registry whether atherectomy can effectively simplify complex stent implantation in ostial bifurcation lesions by reducing the procedure to stenting of the left anterior descending (LAD) or left circumflex (LCX) artery ostium alone. Patients and methods All patients who had been enrolled in the prospective FLEXI‐CUT study (directional atherectomy with adjunctive balloon angioplasty) were retrospectively analysed on the basis of significant LAD or LCX ostial stenosis (⩾ 70% stenosis) deriving from an undiseased left main stem. The primary combined end point was the rate of target lesion revascularisation (TLR) and binary restenosis; secondary end points were procedural success and major adverse cardiac events (MACE) at the six‐month follow up. Results Of 30 patients enrolled with significant LAD or LCX ostium stenosis, 29 were effectively treated with directional atherectomy (96.7% procedural success). All patients underwent single‐vessel stenting procedures of solely the LAD or LCX ostium. At follow up, binary stenosis was 25% (6 of 24), TLR (angiographic plus clinical) 10.3% (3 of 29) and total MACE 6.9% (2 of 29). Conclusions Directional atherectomy with single‐vessel stenting procedures facilitates the interventional treatment of LAD and LCX ostium stenosis, and leads to remarkably low TLR and binary stenosis at follow up. PMID:16449510

  2. Intercellular communication within the rat anterior pituitary gland. XV. Properties of spontaneous and LHRH-induced Ca2+ transients in the transitional zone of the rat anterior pituitary in situ.

    Science.gov (United States)

    Hattori, Kazuki; Shirasawa, Nobuyuki; Suzuki, Hikaru; Otsuka, Takanobu; Wada, Ikuo; Yashiro, Takashi; Herbert, Damon C; Soji, Tsuyoshi; Hashitani, Hikaru

    2013-01-01

    In the transitional zone of the rat anterior pituitary, spontaneous and LHRH-induced Ca(2+) dynamics were visualized using fluo-4 fluorescence Ca(2+) imaging. A majority of cells exhibited spontaneous Ca(2+) transients, while small populations of cells remained quiescent. Approximately 70% of spontaneously active cells generated fast, oscillatory Ca(2+) transients that were inhibited by cyclopiazonic acid (10 μm) but not nicardipine (1 μm), suggesting that Ca(2+) handling by endoplasmic reticulum, but not Ca(2+) influx through voltage-dependent L-type Ca(2+) channels, plays a fundamental role in their generation. In the adult rat anterior pituitary, LHRH (100 μg/ml) caused a transient increase in the Ca(2+) level in a majority of preparations taken from the morning group rats killed between 0930 h and 1030 h. However, the second application of LHRH invariably failed to elevate Ca(2+) levels, suggesting that the long-lasting refractoriness to LHRH stimulation was developed upon the first challenge of LHRH. In contrast, LHRH had no effect in most preparations taken from the afternoon group rats euthanized between 1200 h and 1400 h. In the neonatal rat anterior pituitary, LHRH caused a suppression of spontaneous Ca(2+) transients. Strikingly, the second application of LHRH was capable of reproducing the suppression of Ca(2+) signals, indicating that the refractoriness to LHRH had not been established in neonatal rats. These results suggest that responsiveness to LHRH has a long-term refractoriness in adult rats, and that the physiological LHRH surge may be clocked in the morning. Moreover, LHRH-induced excitation and associated refractoriness appear to be incomplete in neonatal rats and may be acquired during development.

  3. True aneurysms of the posterior communicating artery: a systematic review and meta-analysis of individual patient data.

    Science.gov (United States)

    He, Wenzhuan; Gandhi, Chirag D; Quinn, John; Karimi, Reza; Prestigiacomo, Charles J

    2011-01-01

    To review and analyze systematically the reported cases of "true" posterior communicating artery (PCoA) aneurysm. A retrospective review of the published literature was performed, and a meta-analysis of individual patient data was conducted. Pooled data showed that "true" PCoA aneurysms represent about 1.3% (95% confidence interval [CI] 0.8%, 1.7%) of all intracranial aneurysms and 6.8% (95% CI 4.3%, 9.2%) of all PCoA aneurysms. Mean patient age was 53.5 years (53.5 years ± 15.4), and age range was 23-79 years. Of the 49 patients reported in the literature, 44 (89.8%) were reported as ruptured, and 4 (10.2%) were reported as unruptured. There were no significant differences in ruptured status between age (P = 0.321), left vs right aneurysm (P = 0.537), and shape of aneurysm (P = 0.408). No significant differences in complication rates were found between rupture status (P = 0.27), and operative modalities (P = 0.878). The mean ages of patients who had no complications and patients who had complications were 53 years (53 years ± 2.59) vs 53.2 years (53.2 years ± 5.02) (P = 0.972). "True" PCoA aneurysms represent about 1.3% of all intracranial aneurysms and 6.8% of all PCoA aneurysms. They are more prone to rupture compared with their counterpart junctional aneurysms. When surgical management is indicated, a good understanding of the location and configuration of the aneurysm neck before surgical treatment is critical in the successful treatment of these lesions. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. 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%.

  5. 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 ...

  6. Successful Transarterial Guglielmi Detachable Coil Embolization of Post-Traumatic Fistula between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus

    Science.gov (United States)

    Chen, Y.; Jiang, D-Y.; Tan, H-Q.; Wang, L-H.; Chen, X-Y.; Sun, J-H.

    2009-01-01

    Summary We describe a case of a post-traumatic posterior communicating artery (PCoA) aneurysmcavernous sinus fistula, which is an extremely rare complication of craniocerebral trauma, successfully treated with endosaccular coil embolization via transarterial route. Endosaccular embolization with Guglielmi detachable coils via transarterial route appears to be a feasible, effective and minimally invasive option for the treatment of post-traumatic fistula between the PCoA aneurysm with a small ostia and the cavernous sinus in the subacute phase. PMID:20465883

  7. Duplication of Inferior Gluteal Artery and Course of Superior Gluteal Artery Through the Lumbosacral Trunk

    Directory of Open Access Journals (Sweden)

    Satheesha Nayak B

    2017-07-01

    Full Text Available Internal iliac artery (IIA shows great deal of variations in its branching pattern. The knowledge of its variant branches is required for successful surgical, orthopedic, plastic surgery and radiological procedures. We observed variations of some of the branches of right IIA in an adult male cadaver. The iliolumbar artery originated from the main trunk of the IIA. After this, IIA divided into anterior and posterior divisions. The posterior division gave lateral sacral and superior gluteal arteries. Superior gluteal artery pierced the lumbosacral trunk before leaving the pelvis. The anterior division further divided into anterior and posterior trunks. Anterior trunk gave rise to superior vesical, inferior vesical, middle rectal and obturator arteries. The posterior trunk gave two inferior gluteal arteries and an internal pudendal artery.

  8. 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

  9. 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

  10. A Case of Ruptured Blood Blister-like Aneurysm Treated with Pipeline Embolization Device: Clinical Significance of Fetal-type Posterior Communicating Artery.

    Science.gov (United States)

    Park, Ki-Su; Kang, Dong-Hun; Son, Won-Soo; Park, Jaechan; Kim, Young-Sun; Kim, Byung Moon

    2017-03-01

    Blood-blister like aneurysms (BBAs) are challenging lesions because of their wide fragile neck. Flow-diverting stents (FDSs), such as the Pipeline Embolization Device (PED), have been applied to treat BBAs less amenable to more established techniques of treatment. However, the use of FDSs, including the PED, in acute subarachnoid hemorrhage (SAH) still remains controversial. We report a case of aneurysm regrowth following PED application for a ruptured BBA that overlapped the origin of the dominant posterior communicating artery (PCoA), which was successfully treated after coil trapping of the origin of the fetal-type PCoA. And, we discuss the clinical significance of the fetal-type PCoA communicating with a BBA in terms of PED failure.

  11. Radiation-Induced Carotid Artery Stenosis in a Patient with Carcinoma of the Oral Floor

    Directory of Open Access Journals (Sweden)

    Kahori Seto

    2013-01-01

    Full Text Available Radiation-induced carotid artery stenosis (RI-CS, a life-threatening condition, can occur after external radiation for head and neck cancer. We here describe a case of asymptomatic RI-CS in a 73-year-old patient treated with chemoradiotherapy and radical neck dissection for a basaloid squamous cell carcinoma of the oral floor. Stenosis of the left carotid artery, diagnosed as RI-CS, showed on an MRI performed 1.5 years after radiotherapy. Blood from the left side of the anterior cerebral artery and the middle anterior artery was flowing to the brain through the anterior and posterior communicating arteries, so no stent surgery or other treatment was necessary. The cancer has not recurred during approximately 5 years of followup after radiotherapy, and the patient has had no adverse effects from the RI-CS since it was diagnosed 3.5 years ago. This case emphasizes the necessity of early scrutiny for RI-CS in patients given radiotherapy for oral cancer.

  12. Arteria Tibial Anterior Hipoplásica Asociada con la Continuación de la Arteria Fibular como Arteria Dorsal del Pié: Un Reporte de Caso

    OpenAIRE

    Shetty, Surekha D; Nayak, Satheesha; Kumar, Naveen; Abhinitha, P

    2013-01-01

    Arterial variations of distal parts of lower limb are well documented. However, continuation of fibular artery as dorsalis pedis artery is a rare finding. Unusual course and distribution of the anterior tibial artery and fibular artery were observed during routine anatomical dissection of the right lower limb of an approximately 40-year-old male cadaver. The arteries of the crural region arose from the popliteal artery, as usual. However the anterior tibial artery was hypoplastic. The fibular...

  13. Occlusion of Heubner's artery

    International Nuclear Information System (INIS)

    Sato, Manabu; Kidooka, Minoru

    1982-01-01

    A case of occlusion of the left Heubner's artery in a right-handed, 51-year-old man is reported. Cardinal clinical features were transient right hemiparesis and mental disturbance, especially intellectual defect. Low density areas were found at CT in the globus pallidus, putamen, anterior limb of the internal capsule and a part of the caudate nucleus. It is well known that the occlusion of the Heubner's artery causes transient motor paresis of upper extremity on the contralaterl side. However, in the case where the Heubner's artery is remarkably well developed when compared with the medial striate arteries as was the case in this patient, it should be noted that the occlusion of the Heubner's artery may well causes grave mental disturbance, in addition. (author)

  14. 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

  15. 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 ...

  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. 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.

  18. Cerebellar arteries originating from the internal carotid artery: angiographic evaluation and embryologic explanations

    International Nuclear Information System (INIS)

    Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun; Kim, Eui Jong; Kim, Dae Ho

    1997-01-01

    To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation

  19. Anterior perineal hernia after anterior exenteration

    Directory of Open Access Journals (Sweden)

    Ka Wing Wong

    2017-10-01

    Full Text Available Perineal hernia is a rare complication of anterior exenteration. We reported this complication after an anterior exenteration for bladder cancer with bleeding complication requiring packing and second-look laparotomy. Perineal approach is a simple and effective method for repair of perineal hernia.

  20. Carotid artery occlusion and collateral circulation in C57Black/6J mice detected by synchrotron radiation microangiography

    International Nuclear Information System (INIS)

    Tamaki, Masahiro; Kidoguchi, Keiji; Mizobe, Takashi; Koyama, Junji; Kondoh, Takeshi; Sakurai, Takashi; Kohmura, Eiji; Yokono, Koichi; Umetani, Keiji

    2006-01-01

    Using monochromatic synchrotron radiation, we performed microangiography in C57BL/6J mice and investigated their vasculature after unilateral and bilateral carotid artery occlusion. Bilateral occlusion of the carotid artery was made by a ligation of the left common carotid artery followed by a ligation of the right internal carotid artery (ICA) two days later (n=12). Five days after the second surgery, angiography was performed. Unilateral occlusion was made by clipping the right ICA and then angiography was performed immediately (n=5). The control mice did not undergo any occlusion (n=5). We removed the brain of the bilateral occlusion mice after angiography and examined the infarction area. The cerebral microvessels in all animals were clearly visualized. In the control mice, the posterior communicating artery (Pcom) was not visualized. In the unilateral occlusion mice, the anastomosis of the pterygopalatine artery (PPA) and the external carotid artery (ECA) were recognized. The PPA is thus considered to play a role in the collateral vessel between the ICA and the ECA. The Pcom was not visualized. In the bilateral occlusion mice, the Pcom was observed either unilateraly (n=5) or bilateraly (n=5). The Pcom supplied blood flow to the anterior circulation from the vertebrobasilar arteries. The bilateral occlusion mice that had at least one visualized Pcom did not have any infarction. We could successfully visualize the cerebral vasculature of normal mice and carotid artery occluded mice in an in vivo study. Microangiography can demonstrate the development of vasculature and the blood flow dynamics in mice. (author)

  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. The cerebral arterial circle (circulus arteriosus cerebri): an anatomical study in fetus and infant samples.

    Science.gov (United States)

    Ardakani, Shahab Kamali; Dadmehr, Majid; Nejat, Farideh; Ansari, Saeed; Eftekhar, Behzad; Tajik, Parvin; El Khashab, Mostafa; Yazdani, Shahrooz; Ghodsi, Mohammad; Mahjoub, Fatemeh; Monajemzadeh, Maryam; Nazparvar, Bashir; Abdi-Rad, Afshin

    2008-01-01

    Many studies have investigated the variations in the anatomy of each segment of the cerebral arterial circle while a few have addressed the variations of the cerebral arterial circle as a whole. Thirty brains of recently deceased Iranian infants and fetuses were dissected. The dissection process was filmed and digitized so as to be readily available for further studies. The variations of the circle as a whole and segmental variations were evaluated. Variants with uni- and bilateral hypoplasia of posterior communicating arteries (PcoAs) were the most common in our study, similar to previous works. No aplasia of the precommunicating part of the anterior cerebral artery (A1), the precommunicating part of the posterior cerebral artery (P1) and anterior communicating artery was seen. Hypoplasia of the right and left PcoA was observed in 8 and 5 cases, respectively. Aplasia of the right PcoA was found in 16.6% and of the left PcoA in 3.3%. In this study, we confirmed the previously described finding that the symmetrical, circular configuration of the circulus arteriosus cerebri is present in only about 42.1%. The main differences between the fetal and adult disposition are the diameter of the PcoA and the circular part of the posterior cerebral artery. According to previous studies, the fetal brain older than 4 months has anatomical characteristics very similar to the adult's circle; our finding was mostly similar to adult samples as most samples were from infants, not fetuses. (c) 2008 S. Karger AG, Basel.

  3. 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

  4. Unsteady 3D flow simulations in cranial arterial tree

    Science.gov (United States)

    Grinberg, Leopold; Anor, Tomer; Madsen, Joseph; Karniadakis, George

    2008-11-01

    High resolution unsteady 3D flow simulations in major cranial arteries have been performed. Two cases were considered: 1) a healthy volunteer with a complete Circle of Willis (CoW); and 2) a patient with hydrocephalus and an incomplete CoW. Computation was performed on 3344 processors of the new half petaflop supercomputer in TACC. Two new numerical approaches were developed and implemented: 1) a new two-level domain decomposition method, which couples continuous and discontinuous Galerkin discretization of the computational domain; and 2) a new type of outflow boundary conditions, which imposes, in an accurate and computationally efficient manner, clinically measured flow rates. In the first simulation, a geometric model of 65 cranial arteries was reconstructed. Our simulation reveals a high degree of asymmetry in the flow at the left and right parts of the CoW and the presence of swirling flow in most of the CoW arteries. In the second simulation, one of the main findings was a high pressure drop at the right anterior communicating artery (PCA). Due to the incompleteness of the CoW and the pressure drop at the PCA, the right internal carotid artery supplies blood to most regions of the brain.

  5. Anterior fixation of the axis.

    Science.gov (United States)

    Traynelis, Vincent C; Fontes, Ricardo B V

    2010-09-01

    Although anterior fixation of the axis is not commonly performed, plate fixation of C2 is an important technique for treating select upper cervical traumatic injuries and is also useful in the surgical management of spondylosis. To report the technique and outcomes of C2 anterior plate fixation for a series of patients in which the majority presented with symptomatic degenerative spondylosis. Forty-six consecutive patients underwent single or multilevel fusions over a 7-year period; 30 of these had advanced degenerative disease manifested by myelopathy or deformity. Exposure was achieved with rostral extension of the standard anterior cervical exposure via careful soft tissue dissection, mobilization of the superior thyroid artery, and the use of a table-mounted retractor. It was not necessary to remove the submandibular gland, section the digastric muscle, or make additional skin incisions. Screws were placed an average of 4.6 mm (+/- 2.3 mm) from the inferior C2 endplate with a mean sagittal trajectory of 15.7 degrees (+/- 7.6 degrees). Short- and long-term procedure-related mortality was 4.4%, and perioperative morbidity was 8.9%. Patients remained intubated an average of 2.5 days following surgery. Dysphagia was initially reported by 15.2% of patients but resolved by the 8th postoperative week in all patients. Arthrodesis was achieved in all patients available for long-term follow-up. Multilevel fusions were not associated with longer hospitalization or morbidity. Anterior plate fixation of the axis for degenerative disease can be accomplished with acceptable morbidity employing an extension of the standard anterolateral route.

  6. Impact of Right-Sided Aneurysm, Rupture Status, and Size of Aneurysm on Perforator Infarction Following Microsurgical Clipping of Posterior Communicating Artery Aneurysms with a Distal Transsylvian Approach.

    Science.gov (United States)

    Tanabe, Jun; Ishikawa, Tatsuya; Moroi, Junta; Sakata, Yoshinori; Hadeishi, Hiromu

    2018-03-01

    Posterior communicating artery (PCoA) aneurysms are among the most common aneurysms. Because blockage of the PCoA and perforators can cause adverse outcomes, occlusion of these arteries by surgical clipping should be avoided. The impact of factors on PCoA perforator infarction when using a distal transsylvian approach for PCoA aneurysms was examined. A total of 183 patients underwent PCoA aneurysm clipping, excluding application of fenestrated clips. Patients were divided into 2 groups: patients with PCoA perforator infarction (infarction group) and patients without infarction (noninfarction group). Multiple factors were analyzed in the 2 groups. Twenty-two of the 183 patients (12.0%) showed perforator infarction, mainly on magnetic resonance imaging evaluation, resulting in permanent deficits in 2 patients (1.1%). The proportion of right-sided operations (86.4% vs. 53.4%; P = 0.005) and surgery for rupture (90.9% vs. 55.9%; P = 0.002) were significantly higher in the infarction group than in the noninfarction group. Aneurysms were significantly larger in the infarction group (8.4 ± 3.8 mm) than in the noninfarction group (6.3 ± 3.0 mm; P = 0.02). Ruptured status (odds ratio [OR], 7.35; P = 0.01), right side (OR, 5.19; P = 0.01), and aneurysm size (OR, 1.18; P = 0.02) remained independent predictors of perforator infarction on multivariate logistic regression analysis. Ruptured status, right side, and large PCoA aneurysm were independent predictors of PCoA perforator infarction. Symptoms due to PCoA perforating infarction were mostly transient and rarely affected outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. 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.

  8. Congenital coronary artery fistula

    International Nuclear Information System (INIS)

    Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

    1986-01-01

    Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

  9. 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...

  10. 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...

  11. Characteristics and Outcomes of Patients with Anterior Circulation Intracranial Aneurysm Managed with Clipping in Hospital Sungai Buloh.

    Science.gov (United States)

    Ab Ghani, Ailani; Nayan, Saiful Azli Mat; Kandasamy, Regunath; Rosman, Azmin Kas; Ghani, Abdul Rahman Izani

    2016-11-01

    The annual incidence of intracranial aneurysm in Malaysia is estimated to be 1.1-1.7 per 100,000 population based on a study done conducted in 1988. Since then, little epidemiological research has been conducted in Malaysia, and the real incidence is therefore probably unreported despite advancements in the diagnosis and treatment of this disorder. Intracranial aneurysm may be treated by microsurgical clipping or embolisation depending on its location and the surgeon's preference. This study aims to report the characteristics and outcomes of patients with a clipped anterior circulation aneurysm in Hospital Sungai Buloh. We retrospectively collected the data of patients with anterior circulation aneurysms who underwent clipping from 1 January 2013 until 30 June 2014 in Hospital Sungai Buloh. The mean age of the patients was 48.9 years old, and 56.7% of the study population were male and 63.3% were Malay. There were almost equal numbers of patients with (46.7%) and without (53.3%) co-morbidities such as hypertension and ischaemic heart disease. Half of the study population fell under Fisher grade 3 (50.0%), whereas 46.7% were Fisher grade 4. With respect to the Navarro score, 20% of patients scored 10, 16.7% scored 5 or 7, 13.3% scored 11, 10% scored 9, 6.7% scored 1 and 3.3% scored 2, 3 or 8. Most of the patients fell under grade I (33.3%) of the World Federation of Neurological Societies grading (WFNS), and the fewest number of patients were grade III (3.3%). Most (56.7%) patients had an intracranial aneurysm located at the anterior communicating artery (ACOM), followed by the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) (16.7% each), the posterior communicating artery (PCOM) (6.7%) and, finally, the internal carotid artery (ICA) (3.3%). Neurological outcomes at three and six months were assessed using the Modified Rankin Scale (mRS). At three months follow-up, the majority of the participants (33.3%) scored 0 or 6, whereas at six months

  12. [A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

    Science.gov (United States)

    Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

    2016-06-01

    A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events.

  13. Congenital Absence of Left Circumflex Coronary Artery

    Directory of Open Access Journals (Sweden)

    Zahra Ansari

    2009-09-01

    Full Text Available Congenital absence of left circumflex artery is a rare congenitalanomaly of the coronary arteries. The prevalence of theanomaly in different studies ranges from 0.6% to 1.3%. Ofthese, 80% are benign and asymptomatic and 20% are clinicallyimportant. We report a 56-year-old man presented withacute resting chest pain who was diagnosed as having acuteanterolateral infarction accompanied by electrocardiographicchanges and elevated cardiac enzymes. Coronary angiographyin different views was conducted, however, no left circumflexartery was found. The territory supplied by the artery had beenperfused by the super dominant right coronary artery. Therewas no left circumflex coronary artery with anomalous origin.Sever stenosis of left anterior ascending artery superimposedto the absent left circumflex artery was presented as acute anterolateralinfarction. Although absence of the artery is mostlyconsidered as a benign condition, atherosclerotic lesions maybe more important in such cases because of diminished compensatingmechanisms.

  14. Coronary artery with aberrant origin malignant right

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Demirkol, S.; Saglam, M.

    2012-01-01

    Full text: Introduction: Congenital anomalies of the coronary arteries is a major cause of sudden death, especially in young patients. Objectives and tasks: In this study we aim to present a young patient with chest pain who had malignant right coronary artery (RCA) with aberrant origin. Materials and methods: 24-year-old man who applied cardiology clinic for chest pain and palpitations especially after exercise, was referred to our clinic for coronary computed tomography (CT) angiography to evaluate coronary artery anomalies. Results: In CT angiography; we detected aberrant RCA with origin of tubularly part of ascendant aorta with a malignant course between aorta and pulmonary artery. Left main coronary artery, left anterior descending and circumflex artery had normal origin and course. Conclusion: Coronary artery with malignant course may cause sudden death especially after exercise. Coronary CT angiography has an important role in diagnosis of congenital coronary artery anomalies, with high resolution multiplanner reformatted images

  15. Collateral Flow and White Matter Disease in Patients with Internal Carotid Artery Occlusion.

    Science.gov (United States)

    Ishikawa, Mami; Sugawara, Hitoshi; Nagai, Mutsumi; Kusaka, Gen; Tanaka, Yuichi; Naritaka, Heiji

    2017-01-01

    When an internal carotid artery (ICA) occludes, a patient may develop cerebral infarction (CI). We investigated whether CI caused by ICA occlusion (ICAO) is associated with collateral flow through the anterior and posterior communicating arteries (ACoA and PCoA). In 100 patients with ICAO, we investigated CI and white matter disease by performing an MRI and the anatomy of the ACoA and PCoA were investigated by performing magnetic resonance angiography. All patients were divided into the symptomatic CI group or the no-CI group. The collateral flow pathway was estimated by the anterior cerebral artery (ACA)-PCoA score and the collateral flow volume after ICAO was estimated by the middle cerebral artery (MCA) flow score, based on how well the MCA was visualized. Of 100 patients with ICAO, the symptomatic CI group included 36 patients. ACA-PCoA score and white matter disease grades were significantly higher in the CI group (indicating poor collateral flow). More than 80% of patients with an ACA-PCoA score of 4 (poor collateral) experienced symptomatic CI. Thirty-one symptomatic CI patients (86%) had an MCA flow score of 1 or 2 (decreased MCA flow). The ACA-PCoA score and white matter disease grade may suggest an increased risk of CI following ICAO. © 2016 S. Karger AG, Basel.

  16. 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.

  17. 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)

  18. A checklist for endonasal transsphenoidal anterior skull base surgery.

    Science.gov (United States)

    Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

    2016-06-01

    OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management

  19. Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Gaberel, Thomas; Borha, Alin; di Palma, Camille; Emery, Evelyne

    2016-03-01

    To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy. We conducted a systematic review of the literature and meta-analysis. The meta-analysis included 11 relevant studies involving 384 patients with third nerve palsy caused by PCoA aneurysms at baseline, of whom 257 (67.0%) were treated by clipping and 127 were treated by coiling (33.0%). Pooled odds ratios of the impact of clipping or coiling on complete ONP recovery, lack of ONP recovery, and procedure-related death were calculated. The overall complete ONP recovery rate was 42.5% in the coiling group compared with 83.6% in the clipping group. The increase in complete ONP recovery in the clipping group corresponds to an overall pooled Mantel-Haenszel odds ratio of 4.44 (95% confidence interval = 1.66-11.84). Subgroup analysis revealed a clear benefit of clipping over coiling in patients with ruptured aneurysms, but not in patients with unruptured aneurysms. No procedure-related deaths were reported by any of the 11 studies. Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Safety and Outcome of Intra-Arterial Treatment for Basilar Artery Occlusion

    NARCIS (Netherlands)

    van Houwelingen, Reinier C.; Luijckx, Gert-Jan; Mazuri, Aryan; Bokkers, Reinoud P. H.; Eshghi, Omid S.; Uyttenboogaart, Maarten

    2016-01-01

    IMPORTANCE After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO). OBJECTIVE To report up-to-date outcome data of intra-arterial (IA)

  1. [Congenital anomalies of cerebral artery and intracranial aneurysm].

    Science.gov (United States)

    Nakajima, K; Ito, Z; Hen, R; Uemura, K; Matsuoka, S

    1976-02-01

    It is well known that congenital anomalies such as polycystic kidney, aortic coarctation, Marfan syndrome, Ehler-Danlos syndrome are apt to be complicated by intracranial aneurysms. In this report we attempt to reveal the relation and incidence between cerebrovascular anomalies and intracranial aneurysms. The etiology of aneurysms has been discussed, too. 12 cases of persistent trigeminl artery, 2 cases of persistent hypoglossal artery and 11 cases of fenestration were obtained from 3841 patients who were angiographically examined in our clinic for 5 years. The incidence is 0.31%, 0.05% and 0.29%, respectively. Persistent trigeminal arteries were complicated by 2 cases of intracranial aneurysms and one case of arterivenous malformations (AVM), persistent hypoglossal arteries were complicated by one case of aneurysm, and fenestrations were complicated by 2 cases of aneurysms and one case of AVM. One case of congenital agenesis of right internal carotid artery was obtained which was complicated by aneurysm of anterior communicating artery. Totally, 8 cases of aneurysms and AVM were obtained from 26 cases of cerebrovascular anomalies (incidence 30.8%). On the other hand, thalamic or caudate hemorrhage revealed the highest incidence of complication of intracranial aneurysms among intracerebral hematomas (10.7%). Compared with the incidence of aneurysms between cerebro vascular anomalies (30.8%) and thalamic or caudate hemorrhage (10.7%), the difference is statistically signigicant (P less than 0.05). The cause of intracranial aneurysm has not yet been clarified. But it is well accepted that the defect of tunica media vasorum is most responsible factor as to the occurrence of intracranial aneurysms. We concluded that the genetic error of cerebral vessels including defect of media caused intracranial aneurysms, and this result was supported from the evidence that cerebrovascular anomalies showed statistically high incidence of complication of intracranial aneurysms.

  2. 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

  3. Emergency interventional therapy of peripheral arterial stenosis and thrombosis

    International Nuclear Information System (INIS)

    Cai Fengquan; Yu Xixiang

    2004-01-01

    Objective: To evaluate the clinical value of emergency interventional therapy of stenosis and thrombosis of peripheral arteries. Methods: 26 patients suffered from stenosis and thrombosis of peripheral arteries including, 3 subclavical arteries, 5 iliac arteries, 7 femoral arteries, 4 popliteal arteries, 4 posterior or anterior tibial arteries, 2 graft vessels and 1 instent restenosis were undertaken interventional ATD or urokinase infusion thrombolysis, percutanous transluminal angioplasty (PTA) and stent placement. Results: The stenotic arteries were recanalized after PTA or stent placement and the thrombosis vanished after thrombolysis with distal flowes improved or resumed. Clinical symptom was ameliorated. No more complication occurred except one patient with alimentary hemorrhage after thrombolysis. The patients were followed up from 1 to 20 months with all the involved arteries keeping in constant patency without any amputation. Conclusions: Emergency thrombolysis by machine or drug along with PTA or stent placement can effectively cure the stenosis or thrombosis of peripheral artery with recanalization and no amputation. (authors)

  4. 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

  5. Arterial vascularization of the pineal gland.

    Science.gov (United States)

    Kahilogullari, Gokmen; Ugur, Hasan Caglar; Comert, Ayhan; Brohi, Recep Ali; Ozgural, Onur; Ozdemir, Mevci; Karahan, Suleyman Tuna

    2013-10-01

    The arterial vascularization of the pineal gland (PG) remains a debatable subject. This study aims to provide detailed information about the arterial vascularization of the PG. Thirty adult human brains were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. The dissections were carried out using a surgical microscope. The diameters of the branches supplying the PG at their origin and vascularization areas of the branches of the arteries were investigated. The main artery of the PG was the lateral pineal artery, and it originated from the posterior circulation. The other arteries included the medial pineal artery from the posterior circulation and the rostral pineal artery mainly from the anterior circulation. Posteromedial choroidal artery was an important artery that branched to the PG. The arterial supply to the PG was studied comprehensively considering the debate and inadequacy of previously published studies on this issue available in the literature. This anatomical knowledge may be helpful for surgical treatment of pathologies of the PG, especially in children who develop more pathology in this region than adults.

  6. Incidental finding of a precaval right renal artery on CT: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hae Seung; Kim, Hyun Cheol; Shin, Hyeong Cheol; Kim, Young Hwa; Nam, Deok Ho; Kim, Il Young; Kim, Hyung Hwan; Bae, Won Kyung [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2005-07-15

    The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT.

  7. Incidental finding of a precaval right renal artery on CT: a case report

    International Nuclear Information System (INIS)

    Lee, Hae Seung; Kim, Hyun Cheol; Shin, Hyeong Cheol; Kim, Young Hwa; Nam, Deok Ho; Kim, Il Young; Kim, Hyung Hwan; Bae, Won Kyung

    2005-01-01

    The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT

  8. 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.

  9. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery

    Directory of Open Access Journals (Sweden)

    Rajsrinivas Parthasarathy

    2016-01-01

    Full Text Available Embryonic carotid – basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA. The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo.

  10. Renal artery origins: best angiographic projection angles.

    Science.gov (United States)

    Verschuyl, E J; Kaatee, R; Beek, F J; Patel, N H; Fontaine, A B; Daly, C P; Coldwell, D M; Bush, W H; Mali, W P

    1997-10-01

    To determine the best projection angles for imaging the renal artery origins in profile. A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed. In patients with an abdominal aortic diameter no larger than 3.0 cm, approximately 0.5 mm of the proximal part of the renal artery and origin may be hidden from view if there is a projection error of +/-10 degrees from the ideal image. A combination of anteroposterior and 20 degrees and 40 degrees left anterior oblique projections resulted in a 92% yield of images that adequately profiled the renal artery origins. Right anterior oblique projections resulted in the least useful images. An error in projection angle of +/-10 degrees is acceptable for angiographic imaging of the renal artery origins. Patients sex, site of interest (left or right artery), and local diameter of the abdominal aorta are important factors to consider.

  11. 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.

  12. 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 ...

  13. The normal distribution of thoracoabdominal aorta small branch artery ostia

    International Nuclear Information System (INIS)

    Cronin, Paul; Williams, David M.; Vellody, Ranjith; Kelly, Aine Marie; Kazerooni, Ella A.; Carlos, Ruth C.

    2011-01-01

    The purpose of this study was to determine the normal distribution of aortic branch artery ostia. CT scans of 100 subjects were retrospectively reviewed. The angular distributions of the aorta with respect to the center of the T3 to L4 vertebral bodies, and of branch artery origins with respect to the center of the aorta were measured. At each vertebral body level the distribution of intercostal/lumbar arteries and other branch arteries were calculated. The proximal descending aorta is posteriorly placed becoming a midline structure, at the thoracolumbar junction, and remains anterior to the vertebral bodies within the abdomen. The intercostal and lumbar artery ostia have a distinct distribution. At each vertebral level from T3 caudally, one intercostal artery originates from the posterior wall of the aorta throughout the thoracic aorta, while the other intercostal artery originates from the medial wall of the descending thoracic aorta high in the chest, posteromedially from the mid-thoracic aorta, and from the posterior wall of the aorta low in the chest. Mediastinal branches of the thoracic aorta originate from the medial and anterior wall. Lumbar branches originate only from the posterior wall of the abdominal aorta. Aortic branch artery origins arise with a bimodal distribution and have a characteristic location. Mediastinal branches of the thoracic aorta originate from the medial and anterior wall. Knowing the location of aortic branch artery ostia may help distinguish branch artery pseudoaneurysms from penetrating ulcers.

  14. 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.

  15. Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

    International Nuclear Information System (INIS)

    Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

    2010-01-01

    To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

  16. 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 afte...

  17. Aborted sudden cardiac death in a young male with anomalous left coronary artery arising from the pulmonary artery

    Directory of Open Access Journals (Sweden)

    Chih-Han Huang

    2017-01-01

    Full Text Available Anomalous left coronary artery arising from the pulmonary artery (ALCAPA is a rare type of congenital coronary abnormality that may be associated with early infant mortality and sudden adult cardiac death. We report a case regarding a 23-year-old male who collapsed during a marathon race and was resuscitated with cardiopulmonary resuscitation. Subsequent workups verified the diagnosis of ALCAPA. The patient underwent surgical intervention with obliteration of the ALCAPA orifice and coronary artery bypass grafting with left internal mammary artery to left anterior descending coronary artery. The procedure was done smoothly, and he was discharged uneventfully.

  18. 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.

  19. 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

  20. Coronary artery narrowing after aortic root reconstruction with resorcin-formalin glue.

    Science.gov (United States)

    Martinelli, L; Graffigna, A; Guarnerio, M; Bonmassari, R; Disertori, M

    2000-11-01

    Severe stenosis of right and left main coronary artery ostia developed after aortic root reconstruction with gelatin-resorcin-formol glue for correction of acute type A aortic dissection. Surgical treatment of this condition required grafting of the right and left anterior descending arteries with bilateral mammary arteries on the beating heart.

  1. Anterior knee pain

    International Nuclear Information System (INIS)

    LLopis, Eva; Padron, Mario

    2007-01-01

    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

  2. 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.

  3. 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.

  4. Study of the renal segmental arterial anatomy with contrast-enhanced multi-detector computed tomography.

    Science.gov (United States)

    Rocco, Francesco; Cozzi, Luigi Alberto; Cozzi, Gabriele

    2015-07-01

    To use triphasic multi-detector computed tomography (MDCT) to study the renal segmental arterial anatomy and its relationship with the urinary tract to plan nephron-sparing surgery (NSS). One hundred and fifty nine patients underwent abdominal contrast-enhanced MDCT. We evaluated renal arteries and parenchymal vasculature. In 61 patients, the arteries and the urinary tract were represented simultaneously. 86.60% presented a single renal artery; 13.4%, multiple arteries. All single renal arteries divided into anterior and posterior branch before the hilum. The anterior artery branched into a superior, middle, and inferior branch. In 43.14%, the inferior artery arose before the others; in 45.75%, the superior artery arose before the others; in 9.80%, the branches shared a common trunk. In 26.80%, the posterior artery supplies the entire posterior surface; in 73.20%, it ends along the inferior calyx. In 96.73%, the upper pole was vascularized by the anterior superior branch and the posterior artery: the "tuning fork". MDCT showed four vascular segments in 96.73% and five in 3.27%. MDCT showed two avascular areas: the first along the projection of the inferior calyx on the posterior aspect, the second between the branches of the "tuning fork". The arterial phase provides the arterial tree representation; the delayed phase shows arteries and urinary tract simultaneously. MDCT provides a useful representation of the renal anatomy prior to intervascular-intrarenal NSS.

  5. Longitudinal anterior-to-posterior shift of collateral channels in patients with moyamoya disease: an implication for its hemorrhagic onset.

    Science.gov (United States)

    Yamamoto, Shusuke; Hori, Satoshi; Kashiwazaki, Daina; Akioka, Naoki; Kuwayama, Naoya; Kuroda, Satoshi

    2018-03-23

    OBJECTIVE This study aimed to assess longitudinal changes in the collateral channels originating from the lenticulostriate artery (LSA), posterior communicating artery (PCoA), and anterior and posterior choroidal arteries (AChA and PChA, respectively) during disease progression and/or aging. The impact of collateral channels on onset type was also examined. METHODS This study included 71 involved hemispheres in 41 patients with moyamoya disease. The disease was categorized into 6 stages according to Suzuki's angiographic staging system. The degree of development of each moyamoya vessel was categorized into 3 grades. RESULTS The LSA started to dilate in stage 2, showed the most prominent development in stage 3, and decreased in more advanced stages (p PCoA started to dilate in stage 3 and showed the most prominent development in stage 4 (p = 0.03). The PChA started to dilate in stage 3 and showed the most prominent development in stages 4 to 5 (p PCoA (p = 0.02, R = 0.28) and PChA (p PCoA, AChA, and PChA more distinctly developed in hemispheres with intracerebral or intraventricular hemorrhage than in hemispheres with ischemic stroke or transient ischemic attack (p < 0.001, p = 0.03, and p = 0.03, respectively). CONCLUSIONS This study suggests that the collateral channels through moyamoya vessels longitudinally shift from the anterior to posterior component during disease progression and aging, which may be closely related to the onset of hemorrhagic stroke in adult moyamoya disease.

  6. Angle change of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms

    International Nuclear Information System (INIS)

    Cho, W.-S.; Kang, H.-S.; Kim, J.E.; Kwon, O.-K.; Oh, C.W.; Cho, Y.D.; Han, M.H.

    2014-01-01

    Aim: To investigate the angle changes of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms. Materials and methods: The adjacent parent arterial angles before and after stent-assisted coil embolization were measured in 38 patients with aneurysms of the anterior communicating artery (ACoAA) and 41 patients with bifurcation aneurysms of the middle cerebral artery (MCABA). Variables were analysed in relation to the angle changes. Results: Vascular angles of the parent arteries significantly increased by 27.8° (±18.5°) immediately after stent-assisted coil embolization in 79 cases (p < 0.001), with 25.7° (±14.8°) in ACoAA and 29.7° (±21.4°) in MCABA, respectively. In 51 (64.6%) cases with follow-up angiography (mean interval 13.5 ± 4.1 months), vascular angles increased by 27.2° (±17.1°) immediately after treatment and further increased by 20.7° (±14.3°) at the last follow-up (all p < 0.001). More acute pre-stent angles of the parent arteries correlated with greater post-stent angle changes (p = 0.006). Younger age tended to be inversely related to post-stent angle changes (p = 0.091). Conclusion: Stent placement during coil embolization induced significant changes in the aneurysm–parent artery relationship. Further study is needed to elicit the association between angle change of the parent arteries and aneurysmal stability after coil embolization

  7. Single Coronary Artery with Aortic Regurgitation

    International Nuclear Information System (INIS)

    Katsetos, Manny C.; Toce, Dale T.

    2003-01-01

    An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively

  8. Arterial stick

    Science.gov (United States)

    ... be some throbbing. Why the Test Is Performed Blood transports oxygen, nutrients, waste products, and other materials within ... venous blood) mainly in its content of dissolved gases . Testing arterial blood shows the makeup of the blood before any ...

  9. Ideal Internal Carotid Artery Trapping Technique without Bypass in a Patient with Insufficient Collateral Flow.

    Science.gov (United States)

    Chung, Joon Ho; Shin, Yong Sam; Lim, Yong Cheol; Park, Minjung

    2009-04-01

    Internal carotid artery (ICA) trapping can be used for treating intracranial giant aneurysm, blood blister-like aneurysms and ICA rupture during the surgery. We present a novel ICA trapping technique which can be used with insufficient collaterals flow via anterior communicating artery (AcoA) and posterior communicating artery (PcoA). A patient was admitted with severe headache and the cerebral angiography demonstrated a typical blood blister-like aneurysm at the contralateral side of PcoA. For trapping the aneurysm, the first clip was placed at the ICA just proximal to the aneurysm whereas the distal clip was placed obliquely proximal to the origin of the PcoA to preserve blood flow from the PcoA to the distal ICA. The patient was completely recovered with good collaterals filling to the right ICA territories via AcoA and PcoA. This technique may be an effective treatment option for trapping the aneurysm, especially when the PcoA preservation is mandatory.

  10. Spontaneous regression of two supraophthalmic internal cerebral artery aneurysms following flow pattern alteration

    International Nuclear Information System (INIS)

    Hans, F.J.; Reinges, M.H.T.; Krings, T.; Mull, M.

    2004-01-01

    We report on a patient with fibromuscular dysplasia who presented with a right-sided giant calcified cavernous internal carotid artery (ICA) aneurysm and two additional supraophthalmic ICA aneurysms. Endovascular closure of the right ICA using detachable balloons was performed with collateralisation of the right hemisphere via the right-sided posterior communicating and the anterior communicating arteries. Repeat angiography after 6 months demonstrated spontaneous complete regression of the two supraophthalmic aneurysms, although the parent vessel was still perfused. In comparison to the former angiography, the flow within the parent vessel was reversed due to the proximal ICA balloon occlusion. MRI demonstrated that the aneurysms were not obliterated by thrombosis alone, but showed a real regression in size. This case report demonstrates that changes in cerebral hemodynamics potentially lead to plastic changes in the vessel architecture in adults and that aneurysms can be flow-related, even if not associated with high flow fistulas or arteriovenous malformations, especially in cases with an arterial wall disease. (orig.)

  11. 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.

  12. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

    Zalaquett, R; Howard, M; Irarrázaval, M J; Morán, S; Maturana, G; Becker, P; Medel, J; Sacco, C; Lema, G; Canessa, R; Cruz, F

    1999-01-01

    There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. To report the experience with minimally invasive coronary artery surgery. Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

  13. 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.

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

    African Journals Online (AJOL)

    was demonstrated angiographically, and patients with symptoms resulting from systolic .... crosses the midline. The problem of .... bridges: Overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol ...

  15. 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

  16. Bioengineered anterior cruciate ligament

    Science.gov (United States)

    Martin, Ivan (Inventor); Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (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

  17. [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.

  18. 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.

  19. 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 ...

  20. COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Masoud Poormoghaddas

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

  1. 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.

  2. 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

  3. 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

  4. Arterial supply of the upper cranial nerves: a comprehensive review.

    Science.gov (United States)

    Hendrix, Philipp; Griessenauer, Christoph J; Foreman, Paul; Shoja, Mohammadali M; Loukas, Marios; Tubbs, R Shane

    2014-11-01

    The arterial supply to the upper cranial nerves is derived from a complex network of branches derived from the anterior and posterior cerebral circulations. We performed a comprehensive literature review of the arterial supply of the upper cranial nerves with an emphasis on clinical considerations. Arteries coursing in close proximity to the cranial nerves regularly give rise to small vessels that supply the nerve. Knowledge of the arteries supplying the cranial nerves is of particular importance during surgical approaches to the skull base. © 2014 Wiley Periodicals, Inc.

  5. Arterial embolism

    Science.gov (United States)

    ... when a clot in a vein enters the right side of the heart and passes through a hole into the left side. The clot can then move to an artery and block blood flow to the brain (stroke) or other organs. If a clot involves ...

  6. 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

  7. Myocardial perfusion SPECT in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery

    International Nuclear Information System (INIS)

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga

    2014-01-01

    Pediatric myocardial perfusion imaging (MPI) is not a routine investigation in an Indian setting due to under referrals and logistic problems. However, MPI is a frequently performed and established modality of investigation in adults for the identification of myocardial ischemia and viability. We report myocardial perfusion scintigraphy in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery. Adenosine stress MPI revealed a large infarct involving anterior segment with moderate reversible ischemia of the lateral left ventricular segment. Coronary angiogram later confirmed left main coronary artery ostial occlusion with retrograde collateral supply from dilated right coronary artery

  8. 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.

  9. 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

  10. 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.

  11. Anterior cervical fusion: the role of anterior plating.

    Science.gov (United States)

    Daffner, Scott D; Wang, Jeffrey C

    2009-01-01

    Treatment of cervical pathology requires a clear understanding of the biomechanical benefits and limitations of cervical plates, their indications, and their associated complications. The use of anterior cervical plates has evolved significantly since their early application in cervical trauma. They have become widely used for anterior cervical decompression and fusion for cervical spondylosis. Plate design has undergone significant refinement and innovation, from the initial unlocked plates requiring bicortical purchase to the latest rotationally and translationally semiconstrained dynamic plates. Excellent clinical results have been reported for single-level anterior cervical decompression and fusion with or without plate fixation; however, the addition of an anterior cervical plate clearly leads to earlier fusion and better clinical results in longer fusions. Longer fusions should ideally consist of corpectomies and strut grafting because the decreased number of fusion surfaces tends to lead to higher fusion rates. Although anterior plate fixation leads to higher fusion rates in fusions of three or more levels, the associated pseudarthrosis rate is still high. The use of dynamic plates, through increased load sharing across the graft and decreased stress shielding, may improve fusion rates, particularly in long fusions. Nevertheless, adjuvant posterior fixation is recommended for fusions of more than three vertebral levels. Anterior plate fixation may be of particular benefit in the management of traumatic injuries, in revision settings, and in the treatment of smokers. Complications unique to plate fixation include hardware breakage and migration as well as ossification of the adjacent disk levels.

  12. Anterior ankle arthroscopy, distraction or dorsiflexion?

    OpenAIRE

    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 limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, where...

  13. Comunicação da equipe multiprofissional e indivíduos portadores de hipertensão arterial Comunicación entre los profesionales de la salud y los portadores de hipertensión arterial Communication between the health staff and hypertensive patients

    Directory of Open Access Journals (Sweden)

    Magda Cristina Queiroz Dell'Acqua

    1997-07-01

    Full Text Available O presente estudo tem como objetivos levantar dados sobre o que os indivíduos portadores de hipertensão arterial pensam sobre a sua doença e verificar a ocorrência do processo de comunicação entre estes e os profissionais que atuam junto aos mesmos. Foram entrevistados 66 clientes, obtendo-se 73 narrativas, constatando-se que a maioria (69 narrativas dos participantes da pesquisa faz correlação com o conceito de hipertensão arterial, ainda que de maneira pouco elaborada. Apesar de 95% dos clientes fazerem alguma referência à doença, não significa que as orientações recebidas anteriormente foram aprendidas. Espera-se que o enfermeiro por desempenhar um importante papel dentro da equipe multiprofissional, identifique as possíveis barreiras relativas ao processo de comunicação, havendo daí a intervenção junto aos elementos que podem estar dificultando ou impedindo a compreensão necessária para que o cliente assuma seu autocuidado.Este trabajo tiene como objetivo coger datos sobre lo que piensan los portadores de hipertensión arterial sobre su enfermedad y verificar el proceso de comunicación entre los mismos y con los profesionales de la salud que actuan junto a ellos. Fueron entrevistados 66 clientes, obteniendo 73 narrativas, de las cuales se constató que la mayoría (69 narrativas de los sujetos hicieron referencia al concepto de hipertensión arterial, aunque de forma pocoelaborada. A pesar de que el 95% de los clientes hacieron alguna referencia a la enfermedad, no significa que las orientaciones recibidas anteriormente fueron aprehendidas. Se espera que el enfermero, por desempenãr un importante papel dentro del equipo multiprofesional, identifique las barreras posibles del proceso de comunicación, obteniendo al mismo que interviene en las etapas que pueden estar dificultando o impidiendo la comprensión necesaria para que cliente asuma su autocuidado.This study aims to analyse data on hypertensive individuals and

  14. Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features.

    Science.gov (United States)

    Tykocki, Tomasz; Kostkiewicz, Bogusław

    2014-09-01

    Intracranial aneurysms (IAs) located in the posterior circulation are considered to have higher annual bleed rates than those in the anterior circulation. The aim of the study was to compare the morphometric factors differentiating between IAs located in the anterior and posterior cerebral circulation. A total number of 254 IAs diagnosed between 2009 and 2012 were retrospectively analyzed. All patients qualified for diagnostic, three-dimensional rotational angiography. IAs were assigned to either the anterior or posterior cerebral circulation subsets for the analysis. Means were compared with a t-test. The univariate and stepwise logistic regression analyses were used to determine the predictors of morphometric differences between the groups. For the defined predictors, ROC (receiver-operating characteristic) curves and interactive dot diagrams were calculated with the cutoff values of the morphometric factors. The number of anterior cerebral circulation IAs was 179 (70.5 %); 141 (55.5 %) aneurysms were ruptured. Significant differences between anterior and posterior circulation IAs were found for: the parent artery size (5.08 ± 1.8 mm vs. 3.95 ± 1.5 mm; p 45) and aspect ratio (AR) (1.91 ± 0.8 vs. 2.75 ± 1.8; p = 0.02). Predicting factors differentiating anterior and posterior circulation IAs were: the AR (OR = 2.20; 95 % CI 1.80-270; Is 270 correct or should it be 2.70 and parent artery size (OR = 0.44; 95 % CI 0.38-0.54). The cutoff point in the ROC curve was 2.185 for the AR and 4.89 mm for parent artery size. Aspect ratio and parent artery size were found to be predictive morphometric factors in differentiating between anterior and posterior cerebral IAs.

  15. 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)

  16. 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.)

  17. A rare anomaly: Double right coronary artery

    Directory of Open Access Journals (Sweden)

    Dursun Çayan Akkoyun

    2013-01-01

    Full Text Available Coronary artery anomalies are rare anomalies. Theseare usually asymptomatic and are discovered incidentally.Double right coronary artery (RCA is a rare coronaryartery anomaly. Although there is controversy aboutidentification and classification of double RCA, it is oftena benign condition, but it can be complicated by atherosclerosisand can lead to serious conditions such asmyocardial infarction (MI and may be accompanied byother anomalies. In our case, double RCA were detectedin coronary angiography for acute anterior MI, and in thenext session successful percutaneous coronary interventionwas performed.Key words: Coronary anomaly, coronary angiography,coronary stenosis

  18. Congenital coronary artery fistula in children: the interventional management and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Gao; Aiqing, Zhou; Zhiqing, Yu; Fen, Li; Yumin, Zhong; Yuqi, Zhang; Meirong, Huang; Kun, Sun [Department of Cardiology, Xinhua Hospital, Shanghai Children' s Medical Center Affiliated to School of Medicine, Shanghai Jiaotong Univ., Shanghai (China)

    2006-11-15

    Objective: To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas (CAFs). Methods: Retrospective analysis was performed on 19 patients mean age of (5.5 {+-} 4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization. Amplatzer PDA occluder or Amplatzer plug. One case had a residual fistula postoperatively associated with patent ductus arteriosus (PDA). Results: The abnormal parameters included mean fistula diameter (3.7 {+-} 1.6) mm (2.5-8.2 mm), pulmonary mean pressure (28.0 {+-} 5.0 mmHg (25.0-67.0 mmHg) and pulmonary to systemic shunt (Qp/Qs) 1.6 {+-} 0.8 (1.0-2.3). The sites of the fistulas were originated in right coronary artery 11, left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5. Various occlusion devices used to close these fistulas included one Gianturco coil in 10, 2-4 Gianturco coils in 3, Duct-Occlud in 3. Amplatzer duct occluder in 2 and Amplatzer plug in 1. the post-operative residul fistula with PDA was treated successfully with PDA occlusion. the immediate, one month and one year complete occlusion rates were 55.6%(10/18), 88.9%(16/18), 100%(18/18), respectively. The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps. Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt. Conclusion: Transcatheter closure of CAFs is a safe and effective alternative to surgical repair. (authors)

  19. Congenital coronary artery fistula in children: the interventional management and outcome

    International Nuclear Information System (INIS)

    Gao Wei; Zhou Aiqing; Yu Zhiqing; Li Fen; Zhong Yumin; Zhang Yuqi; Huang Meirong; Sun Kun

    2006-01-01

    Objective: To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas (CAFs). Methods: Retrospective analysis was performed on 19 patients mean age of (5.5 ± 4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization. Amplatzer PDA occluder or Amplatzer plug. One case had a residual fistula postoperatively associated with patent ductus arteriosus (PDA). Results: The abnormal parameters included mean fistula diameter (3.7 ± 1.6) mm (2.5-8.2 mm), pulmonary mean pressure (28.0 ± 5.0 mmHg (25.0-67.0 mmHg) and pulmonary to systemic shunt (Qp/Qs) 1.6 ± 0.8 (1.0-2.3). The sites of the fistulas were originated in right coronary artery 11, left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5. Various occlusion devices used to close these fistulas included one Gianturco coil in 10, 2-4 Gianturco coils in 3, Duct-Occlud in 3. Amplatzer duct occluder in 2 and Amplatzer plug in 1. the post-operative residul fistula with PDA was treated successfully with PDA occlusion. the immediate, one month and one year complete occlusion rates were 55.6%(10/18), 88.9%(16/18), 100%(18/18), respectively. The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps. Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt. Conclusion: Transcatheter closure of CAFs is a safe and effective alternative to surgical repair. (authors)

  20. 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.

  1. Intercellular communication within the rat anterior pituitary: XIV electron microscopic and immunohistochemical study on the relationship between the agranular cells and GnRH neurons in the dorsal pars tuberalis of the pituitary gland.

    Science.gov (United States)

    Shirasawa, Nobuyuki; Sakuma, Eisuke; Wada, Ikuo; Naito, Akira; Horiuchi, Osamu; Mabuchi, Yoshio; Kanai, Miharu; Herbert, Damon C; Soji, Tsuyoshi

    2007-11-01

    Although numerous investigators in 1970s to 1980s have reported the distribution of LH-RH nerve fibers in the median eminence, a few LH-RH fibers have been shown to be present in the pars tuberalis. The significance of the finding remains to be elucidated, and there are few studies on the distribution of LH-RH neurons in the pars tuberalis, especially in the dorsal pars tuberalis (DPT). Adult male Wistar-Imamichi rats were separated into two groups: one for electron microscopy and the other for immunohistochemistry to observe LH-RH and neurofilaments. Pituitary glands attached to the brain were fixed by perfusion, and the sections were prepared parallel to the sagittal plane. The typical glandular structure of the pars tuberalis was evident beneath the bottom floor of the third ventricle, and the thick glandular structure was present in the foremost region. Closer to the anterior lobe, the glandular structure changed to be a thin layer, and it was again observed at the posterior portion. Then the pituitary stalk was surrounded with the dorsal, lateral, and ventral pars tuberalis. LH-RH and neurofilaments fibers were noted in the bottom floor, and some of them vertically descended to the gland. Adjacent to the glandular folliculostellate cells in the pars tuberalis, Herring bodies with numerous dense granules invading into the gland were present between the pituitary stalk and DPT. It was postulated that the "message" carried by LH-RH might have been transmitted to the cells in the DPT to aid in the modulation of LH release. Copyright 2007 Wiley-Liss, Inc.

  2. 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

  3. Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke.

    Science.gov (United States)

    Badacz, Rafał; Przewłocki, Tadeusz; Karch, Izabela; Pieniążek, Piotr; Rosławiecka, Agnieszka; Mleczko, Szymon; Brzychczy, Andrzej; Trystuła, Mariusz; Żmudka, Krzysztof; Kabłak-Ziembicka, Anna

    2015-01-01

    The circle of Willis is thought to play a key role in development of collateral flow in patients with internal carotid artery stenosis (ICAS). To assess flow in the circle of Willis in patients with recent ischemic stroke (IS). The study included 371 patients, 102 symptomatic with severe ICAS and recent IS (within the last 3 months) (group I) and 269 asymptomatic with severe ICAS (group II). Flow in the middle (MCA), anterior (ACA) and posterior (PCA) cerebral arteries and pattern of the cross-flow through anterior (ACoA) and posterior (PCoA) communicating arteries were assessed with transcranial color-coded Doppler ultrasonography (TCCD). The ACoA or PCoA was less prevalent in group I than in group II (54% vs. 78%, p PCoA and higher PSV in the MCA and ACA were associated with significant risk reduction of IS (RR = 0.28 (95% CI = 0.16-0.49, p PCoA seem to play a key role in the evaluation of IS risk in subjects with severe ICAS.

  4. 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.

  5. 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

  6. 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.

  7. Acute arterial occlusion - kidney

    Science.gov (United States)

    ... main artery to the kidney is called the renal artery. Reduced blood flow through the renal artery can hurt kidney function. ... need include: Duplex Doppler ultrasound exam of the renal arteries to test blood flow MRI of the kidney arteries, which can show ...

  8. Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

    Directory of Open Access Journals (Sweden)

    Usha Dandekar

    2015-01-01

    Full Text Available The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

  9. 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)

  10. National trends in anterior cervical fusion procedures.

    Science.gov (United States)

    Marawar, Satyajit; Girardi, Federico P; Sama, Andrew A; Ma, Yan; Gaber-Baylis, Licia K; Besculides, Melanie C; Memtsoudis, Stavros G

    2010-07-01

    Population-based database analysis. To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions. Anterior cervical decompression and spine fusion (ACDF) is one of the most commonly performed surgical procedures of the spine. However, few data analyzing trends in patient- and healthcare-system-related characteristics, utilization and outcomes exist. Data from 1990 to 2004 collected in the National Hospital Discharge Survey were accessed. ACDF procedures were identified. Five-year periods of interest (POI) were created for temporal analysis and changes in the prevalence and utilization of this procedure as well as in patient- and healthcare-system-related variables were examined. The changes in the occurrence of procedure-related complications were evaluated. An estimated total of 771,932 discharges after ACDF were identified. Temporally, an almost 8-fold increase in total prevalence was accompanied by a similar increase in utilization (23/100.000 civilians/POI to 157/100.000/civilians/POI). The highest increase in utilization was observed in those > or =65 years (28-fold). Average age increased from 47.2 years to 50.5 years over time. Length of hospital stay decreased from 5.17 days to 2.38 days. Overall procedure-related complication rates decreased from 4.6% to 3.03%. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, pulmonary, and coronary artery increased over time among patients undergoing ACDF. Despite limitations inherent to secondary analysis of large databases, we identified a number of significant changes in the utilization, demographics, and outcomes associated with ACDF, which can be used to assess the effect of changes in medical care, direct health care resources, and future research. The effect of the increased prevalence of comorbidities on medical practice remains to be evaluated. Further studies are necessary to evaluate causal

  11. [The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine].

    Science.gov (United States)

    Wu, Xiang-Yang; Zhang, Zhe; Wu, Jian; Lü, Jun; Gu, Xiao-Hui

    2009-11-01

    To investigate the "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine. From Jan. 2000 to July 2008, 5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman's fractures (type II ), 2 of C2.3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the "window" between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman's fractures underwent the C2,3 intervertebral disc discectomy, bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy, decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting. C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months (means 13.5 months). There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion. The "window" surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure, and can get minimally invasive surgery results and few and far between wound complication, that is safe if corresponding experience is achieved.

  12. Chemoembolization through intercostal arteries in hepatocellular carcinoma: Report of a case of transient spinal cord injury

    International Nuclear Information System (INIS)

    Moon, Tae Yong; Hwang, In Tae; Kim, Byung Soo; Ko, Hyun Yoon; Yang, Ung Suk; Kim, Hak Jin

    1994-01-01

    Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective . However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experienced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction by anterior spinal arterial occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment

  13. Arterial vascularization patterns of the splenium: An anatomical study.

    Science.gov (United States)

    Kahilogullari, G; Comert, A; Ozdemir, M; Brohi, R A; Ozgural, O; Esmer, A F; Egemen, N; Karahan, S T

    2013-09-01

    The aim of this study was to provide detailed information about the arterial vascularization of the splenium of the corpus callosum (CC). The splenium is unique in that it is part of the largest commissural tract in the brain and a region in which pathologies are seen frequently. An exact description of the arterial vascularization of this part of the CC remains under debate. Thirty adult human brains (60 hemispheres) were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. Then, the brains were fixed in formaldehyde, and dissections were performed using a surgical microscope. The diameter of the arterial branches supplying the splenium of the CC at their origin was investigated, and the vascularization patterns of these branches were observed. Vascular supply to the splenium was provided by the anterior pericallosal artery (40%) from the anterior circulation and by the posterior pericallosal artery (88%) and posterior accessory pericallosal artery (50%) from the posterior circulation. The vascularization pattern of the splenium differs in each hemisphere and is usually supplied by multiple branches. The arterial vascularization of the splenium of the CC was studied comprehensively considering the ongoing debate and the inadequacy of the studies on this issue currently available in the literature. This anatomical knowledge is essential during the treatment of pathologies in this region and especially for splenial arteriovenous malformations.

  14. 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

  15. Hepatic falciform artery

    International Nuclear Information System (INIS)

    Jaques, Paul F.; Mauro, Matthew A.; Sandhu, Jeet

    1997-01-01

    The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded

  16. Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis.

    Science.gov (United States)

    Kanaan, M Z; Lorenzi, A R; Thampy, N; Pandit, R; Dayan, Margaret

    2017-12-01

    A 75-year-old hypertensive female with stable idiopathic intermediate uveitis presented with bilateral sequential optic neuropathy with optic disc swelling. The optic neuropathy in the first affected eye (right) was thought to be due to non-arteritic anterior ischaemic optic neuropathy (NAION). Asymptomatic left optic disc swelling was found at routine review 2 months later, and a diagnosis of giant cell arteritis (GCA) was sought. Temporal artery duplex ultrasound showed the "halo sign," but a subsequent temporal artery biopsy showed light-chain (AL) amyloidosis with no signs of giant cell arteritis. In this case, bilateral sequential ischaemic optic neuropathy mimicking non-arteritic anterior ischaemic optic neuropathy was the presenting sign of systemic amyloidosis involving the temporal arteries.

  17. 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.

  18. Double profunda brachii artery

    OpenAIRE

    Gavishiddappa A Hadimani; Jyoti V Hadimani; Ishwar B Bagoji; Shardha Bai Rathod; Balappa M Bannur

    2016-01-01

    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...

  19. Computed tomographic (CT) study of watershed area supplied by the posterior inferior cerebellar artery (PICA)

    International Nuclear Information System (INIS)

    Nozaki, Junichi; Hirose, Satoshi; Hosotani, Kazuo; Kubota, Tetsuya; Kubota, Norihiko.

    1990-01-01

    Thirteen patients with clinical and computed tomographic (CT) evidence of cerebellar infarction were examined during 1987-1989. Six patients had onset of cerebellar infarction at ages ranging from 45 to 69, and seven patients had onset at ages over 70. In thirteen cases, we observed infarction in the inferior region of the cerebellum, and we studied these cases. CT demonstrated decreased density in 4 distinct anatomic areas. These areas are listed below, with estimation of the distribution of the hemispheric arteries of the posterior inferior cerebellar artery (PICA): Group 1 - posterior medial area, probably territory of the inferior vermian branch, tonsillar branch and/or medial artery of the hemispheric artery of the PICA; Group 2 - posterior intermediate area, probably territory of the intermediate artery of the hemispheric artery of the PICA; Group 3 - area including both areas of group 1 and group 3; Group 4 - lateral area, just posterior to pyramis, probably territory of the anterior inferior cerebellar artery and/or lateral artery of the hemispheric artery of PICA. The medial and intermedial cerebellar hemispheric segments were most commonly affected but the lateral segment was not. The PICA least frequently supplied the lateral segments. While the anterior inferior cerebellar artery usually anastomoses with the lateral artery of the hemispheric artery of the PICA. These vascular territories may provide good collateral circulation to this segment. And we also estimate the distribution of the PICA by the CT findings. (author)

  20. MR imaging of persistent primitive trigeminal artery

    International Nuclear Information System (INIS)

    Ashikaga, Ryuichiro; Araki, Yutaka; Ono, Yukihiko; Ishida, Osamu; Mabuchi, Nobuhisa.

    1997-01-01

    The persistent trigeminal artery is the most common anomaly of the primitive carotid-vertebrobasilar anastomoses. We reviewed MR images and MR angiographies of 11 patients with primitive trigeminal artery. In 8 of the 11 cases, PTA were identified with conventional long TR spin-echo images. In 8 of 11 cases, a hypoplastic basilar trunk associated with PTA was seen on both MR images and MR angiographies. In 7 of 11 cases, a hypoplasia or agenesis of the ipsilateral posterior communicating artery was seen on MR angiographies. (author)

  1. 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).

  2. Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

    International Nuclear Information System (INIS)

    Miyayama, Shiro; Yamashiro, Masashi; Okuda, Miho; Yoshie, Yuichi; Sugimori, Natsuki; Igarashi, Saya; Nakashima, Yoshiko; Matsui, Osamu

    2010-01-01

    This study evaluated the clinical features of hepatocellular carcinoma (HCC) supplied by the right lumbar artery. Eleven patients with HCC supplied by the right lumbar artery were treated with chemoembolization. The patients' medical records were retrospectively analyzed. All patients underwent 6.7 ± 3.7 (mean ± SD) chemoembolization sessions, and the hepatic arterial branches were noted as being attenuated. The right inferior phrenic artery (IPA) was also embolized in 10 patients. The interval between initial chemoembolization and chemoembolization of the lumbar artery supply was 53.2 ± 26.9 months. Mean tumor diameter was 3.1 ± 2.4 cm and was located at the surface of S7 and S6. The feeding-branch arose proximal to the bifurcation of the dorsal ramus and muscular branches (n = 8) or from the muscular branches (n = 3) of the right first (n = 10) or second lumbar artery (n = 1). The anterior spinal artery originated from the tumor-feeding lumbar artery in one patient. All feeders were selected, and embolization was performed after injection of iodized oil and anticancer drugs (n = 10) or gelatin sponge alone in a patient with anterior spinal artery branching (n = 1). Eight patients died from tumor progression 10.1 ± 4.6 months later, and two patients survived 2 and 26 months, respectively. The remaining patient died of bone metastases after 32 months despite liver transplantation 10 months after chemoembolization. The right lumbar artery supplies HCC located in the bare area of the liver, especially in patients who undergo repeated chemoembolization, including chemoembolization by way of the right IPA. Chemoembolization by way of the right lumbar artery may be safe when the feeder is well selected.

  3. 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

  4. Bilateral Medial Medullary Infarction with Nondominant Vertebral Artery Occlusion.

    Science.gov (United States)

    Zhang, Lei; Zhang, Gui-lian; Du, Ju-mei; Ma, Zhu-lin

    2015-09-01

    Bilateral medial medullary infarction (MMI) is a rare stroke subtype. Here, we report a case with bilateral MMI caused by nondominant vertebral artery occlusion confirmed by brain digital subtraction angiography and magnetic resonance imaging basi-parallel-anatomical-scanning. We highlight that anterior spinal arteries could originate from a unilateral vertebral artery (VA). Radiologists and neurologists should pay attention to the nondominant VA as bilateral MMI may be induced by occlusion of nondominant VA that supplies the bilateral anteromedial territories of the medulla. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Stress thallium-201 myocardial scintigraphy for the detection of individual coronary arterial lesions in patients with and without previous myocardial infarction

    International Nuclear Information System (INIS)

    Rigo, P.; Bailey, I.K.; Griffith, L.S.; Pitt, B.; Wagner, H.N. Jr.; Becker, L.C.

    1981-01-01

    The value of stress thallium-201 scintigraphy for detecting individual coronary arterial stenoses was analyzed in 141 patients with angiographically proved coronary artery disease, 101 with and 40 without a previous myocardial infarction. In patients without infarction, the sensitivity for detecting greater than 50 percent narrowing in the left anterior descending, the right and the left circumflex coronary artery was 66, 53 and 24 percent, respectively. In those with a previous infarction, the sensitivity for demonstrating disease in the artery corresponding to the site of infarction was 100 percent for the left anterior descending, 79 percent for the right and 63 percent for the left circumflex coronary artery. In patients with a prior anterior infarction, concomitant right or left circumflex coronary arterial lesions were detected in only 1 of 12 cases, whereas in those with previous inferior or inferolateral infarction, the sensitivity for left anterior descending coronary artery disease was 69 percent. Because of the reasonably high sensitivity for detecting left anterior descending arterial disease, irrespective of the presence and location of previous infarction, myocardial scintigraphy was useful in identifying multivessel disease in patients with a previous inferior infarction. However, because of its relative insensitivity for right or left circumflex coronary artery disease, scintigraphy proved to be a poor predictor of multivessel disease in patients with a prior anterior infarction and in patients without previous myocardial infarction

  6. Right bundle branch block and anterior wall ST elevation myocardial infarction.

    Science.gov (United States)

    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  7. Unilateral anterior ischemic optic neuropathy

    DEFF Research Database (Denmark)

    Herbst, Kristina; Sander, Birgit; Lund-Andersen, Henrik

    2013-01-01

    of this study was to investigate the ipRGC mediated pupil response in patients with a unilateral non-arteritic anterior ischemic optic neuropathy (NAION). Consensual pupil responses during and after exposure to continuous 20 s blue (470 nm) or red (660 nm) light of high intensity (300 cd/m(2)) were recorded...

  8. Quantitative Measurement of Dissection Resistance in Intimal and Medial Layers of Human Coronary Arteries

    OpenAIRE

    Wang, Ying; Johnson, John A.; Spinale, Francis G.; Sutton, Michael A.; Lessner, Susan M.

    2013-01-01

    The left anterior descending (LAD) coronary artery is the most frequently involved vessel in coronary artery dissection, a cause of acute coronary syndrome or sudden cardiac death. The biomechanical mechanisms underlying arterial dissection are not well understood. This study investigated the dissection properties of LAD specimens harvested from explanted hearts at the time of cardiac transplantation, from patients with primary dilated cardiomyopathy (n=12). Using a previously validated appro...

  9. 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.

  10. 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.

  11. 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.

  12. MRI and MR angiography of persistent trigeminal artery

    International Nuclear Information System (INIS)

    Piotin, M.; Miralbes, S.; Cattin, F.; Marchal, H.; Amor-Sahli, M.; Moulin, T.; Bonneville, J.F.

    1996-01-01

    We describe the MRA and MR angiography (MRA) features of persistent trigeminal artery (PTA) found incidentally in eight patients, with special attention to its origin, site and course. The different patterns of posterior communicating arteries were also noted. The PTA were shown on sagittal, coronal and axial MRI and on MRA. In four cases, the PTA arose from the lateral aspect of the intracavernous internal carotid artery, ran caudally, passing round the bottom of the dorsum sellae to join the basilar artery. In the other four cases, it arose from the medial aspect, ran caudally through the sella turcica and pierced the dorsum sellae to join the basilar artery. The posterior communicating arteries were present unilaterally in five cases and bilaterally in one, and absent bilaterally in two. Identification of a PTA with a trans-sellar course is crucial if a trans-sphenoidal surgery is planned. (orig.). With 3 figs

  13. 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...

  14. 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)

  15. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants. Comparison with transthoracic echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2018-02-15

    Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT. To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography. The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001). Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. (orig.)

  16. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants. Comparison with transthoracic echocardiography

    International Nuclear Information System (INIS)

    Goo, Hyun Woo

    2018-01-01

    Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT. To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography. The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001). Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. (orig.)

  17. 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.

  18. 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.

  19. The arterial blood supply of the temporomandibular joint: an anatomical study and clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Cuccia, Antonino Marco; Caradonna, Carola; Caradonna, Domenico [Dept. of Surgical and Oncological Disciplines, University of Palermo, Palermo (Italy); Anastasi, Giuseppe; Milardi, Demetrio; Favaloro, Angelo; Caradonna, Luigi; Cutroneo, Giuseppina [Biomorphology and Biotechnologies, University of Messina, Messina (Italy); De Pietro, Anita; Angileri, Tommaso Maurizio [Villa Santa Teresa, Diagnostica per Immagini, Palermo (Italy)

    2013-03-15

    The aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint. Ten patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied. The analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint. The direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint.

  20. The surgical significance of the atrial branches of the coronary arteries.

    Science.gov (United States)

    Busquet, J; Fontan, F; Anderson, R H; Ho, S Y; Davies, M J

    1984-08-01

    The great number of open heart operations now performed via the right atrium, makes knowledge of the arrangement of the atrial arteries, particularly the sinus node artery, every important for the surgeon. Although studied by anatomists, little attention has been paid to the surgical significance of these arteries. We have therefore examined the distribution of the right atrial arteries and the course of the sinus node artery in 50 normal adult hearts by classic dissection following, in 30 cases, postmortem angiographic studies. Two major arteries of the right atrium were found to be nearly constant. The anterior artery was present in 96% of the cases and supplied the sinus node artery in 32 cases. Of most surgical significance was the lateral artery found in 90% of the cases. This lateral artery was the principal artery to the free atrial wall and in one case gave rise to the sinus node artery. The well-established preponderance of origin of the sinus node artery from the right coronary system (66%) as opposed to the left (30%) was confirmed. Infrequently, a double supply (4%) was seen. Variability was found in the course of the nodal artery relative to the cavoatrial junction - precaval (58%), retrocaval (36%) or encircling (6%).

  1. [Surgical angioplasty of the left main coronary artery].

    Science.gov (United States)

    Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

    2010-01-01

    The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

  2. 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.

  3. Three-dimensional anatomical evaluation of bronchial artery with CT angiography

    International Nuclear Information System (INIS)

    Yu Hong; Li Huimin; Xiao Xiangsheng; Liu Shiyuan; Li Chengzhou; Tao Xiaofeng

    2006-01-01

    Objective: To evaluate the ability of CT angiography in identifying and demonstrating the origins and courses of bronchial arteries by using the three-dimensional reformation technique. Methods Four hundred and forty-three eases were examined with thin-section enhanced MSCT. Three-dimensional images of bronchial arteries were processed at the workstation. Spatial anatomical characters of the bronchial arteries using volume rendering(VR), muhiplanar reconstruction (MPR), and maxium intensity projection (MIP) were observed. Results: At least one bronchial artery was clearly displayed in VR in 359 eases. The right bronchial arteries mainly appeared to originate from the right intercostal artery (213/436, 48.85% ) and descending aorta (207/436, 47.48%), while the left bronchial arteries mainly from the descending aorta (363/371, 97.84%). The right bronchial arteries of the descending aorta were mainly arised from fight wall (95/207, 45.89%), and then the anterior wall (88/207, 42.51%), while the left bronchial arteries of the descending aorta mainly arised from anterior wall of the aorta (272/363, 74.93%). The common trunk originated from the descending aorta mainly positioned in the anterior wall (57/77, 74.03%). 49.31% (215/436) of the fight bronchial arteries were coursing across the posterior edge of the right main bronchi, 35.55% (155/436) coursing the inferior edge, while 60.11% (223/371) of left bronchial arteries coursing forward across the superior edger of the left main bronchi, the others coursing the inferior or the posterior edge. There were eleven bronchial artery distribution patterns, with the right and left ones predominating (192/359, 53.48%), and then two right and one left (63/359, 17.55%). Conclusion: The bronchial artery anatomy was complicated, and CT angiography could clearly visualize the features. (authors)

  4. 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...

  5. Intravitreal bevacizumab (Avastin for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity

    Directory of Open Access Journals (Sweden)

    Shah Parag

    2007-01-01

    Full Text Available Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin in a case of anterior segment ischemia.

  6. 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.

  7. 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.

  8. Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

    Directory of Open Access Journals (Sweden)

    Ali Kemal Gür

    2013-12-01

    Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

  9. Analysis of branching patterns of middle hepatic artery using A-P and oblique view hepatic angiography

    International Nuclear Information System (INIS)

    Han, Kun Soo; Chang, Jae Chun; Park, Bok Hwan

    1992-01-01

    A study on branching patterns of middle hepatic artery was performed in 109 patients with A-P and oblique view hepatic angiogram, which refereed to size and location of quadrate lobe in CT and SMA photography. We could analyze the branching patterns of middle hepatic artery (MHA) in 100 among 109 patients. MHA arising as a first branch of left hepatic artery was the most common pattern (50%), and MHA arising from proper hepatic artery separately on from left hepatic artery was the next common pattern (35%). MHA originating from left gastric artery, or from anterior or posterior of the right hepatic artery was not seen. MHA was not found as an accessory or replaced artery except as replaced common hepatic artery

  10. 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.

  11. In vitro evaluation of physiological spiral anastomoses for the arterial switch operation in simple transposition of the great arteries: a first step towards a surgical alternative?

    Science.gov (United States)

    Sievers, Hans-Hinrich; Scharfschwerdt, Michael; Putman, Léon M

    2015-08-01

    The currently most frequently used technique for the arterial switch operation (ASO) in simple transposition of the great arteries (TGA) includes the transposition of the pulmonary artery anterior to the ascending aorta. This arterial arrangement is less anatomical, and although the initial results are excellent, some long-term data are indicating a certain risk of morbidity, encouraging the search for more physiological techniques. As a first step, we studied the feasibility of anatomical spiral anastomoses of the great vessels in vitro. A TGA model was constructed to simulate the different spatial positions of the great arteries followed by ASO with physiological spiral connections of the great arteries. It was possible to perform a physiological spiral connection of the great arteries without tension or torsion when the roots of the great vessels were arranged anterior-posterior and with up to 35° rotation of the aortic root to the right around the pulmonary root. With further rotation of the aorta, patch plasties were required for pulmonary artery elongation. The maximal width of the patch was 5 mm. In this TGA model, it was possible to perform tension- and torsion-free arterial anastomoses for ASO without artificial material, when the aortic root was positioned from 0° up to 35° to the right of the pulmonary root. Evaluation of coronary transfer is the next step. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. Intracranial arteries in individuals with the elastin gene hemideletion of Williams syndrome.

    Science.gov (United States)

    Wint, D P; Butman, J A; Masdeu, J C; Meyer-Lindenberg, A; Mervis, C B; Sarpal, D; Morris, C A; Berman, K F

    2014-01-01

    Williams syndrome, a rare genetic disorder with a striking neurobehavioral profile characterized by extreme sociability and impaired visuospatial construction abilities, is caused by a hemideletion that includes the elastin gene, resulting in frequent supravavular aortic stenosis and other stenotic arterial lesions. Strokes have been reported in Williams syndrome. Although the extracranial carotid artery has been studied in a sample of patients with Williams syndrome, proximal intracranial arteries have not. Using MRA, we studied the intracranial vessels in 27 participants: 14 patients with Williams syndrome (age range, 18-44 years; mean age, 27.3 ± 9.1; 43% women) and 13 healthy control participants with similar age and sex distribution (age range, 22-52 years; mean age, 33.4 ± 7.6; 46% women). All participants with Williams syndrome had hemideletions of the elastin gene. Blinded to group allocation or to any other clinical data, a neuroradiologist determined the presence of intracranial vascular changes in the 2 groups. The Williams syndrome group and the healthy control group had similar patency of the proximal intracranial arteries, including the internal carotid and vertebral arteries; basilar artery; and stem and proximal branches of the anterior cerebral artery, MCA, and posterior cerebral arteries. The postcommunicating segment of the anterior cerebral artery was longer in the Williams syndrome group. Despite the elastin haploinsufficiency, the proximal intracranial arteries in Williams syndrome preserve normal patency.

  13. Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve.

    Science.gov (United States)

    Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

    2015-12-01

    The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus

  14. The angiographic findings of coronary arterial spasm (a report of 37 cases)

    International Nuclear Information System (INIS)

    Kuang Jianyi; Chen Jianhun; Du Zhimin; Li Xiangmin; Hu Chengheng

    2002-01-01

    Objective: The arterial spasm which often seen in the coronary angiography was considered as a result of the pathological spasm of the coronary artery or a complication of catheterization. The coronary arterial spasm is a considerable situation because it increases the danger of stenotic lesions in coronary artery, which should be managed immediately. Methods: In total 37 patients presented with coronary arterial spasm in the coronary angiography (Judkins method): 23 male and 14 female, aged 43-60 years (the 47 years in average). Spasms were relieved in all patients after the administration of glonoin. Results: Solitary spasm were the most common, the angiographic findings were long section (>10 mm) with stenosis of 50%-65% in left anterior descending artery (12 cases), or in the middle and near portion of the right coronary artery (5 cases), where the orifice of the branches were involved; severe stenosis of the orifice of the right coronary artery (3 cases); irregular, mild and local spasm in left anterior descending artery or circumflex (8 cases). And multiple spasm was observed in left anterior descending artery (4 cases) or in the right coronary artery (5 cases). In 19 cases, stenosis accompanying with spasm were revealed and local spasm were observed at the site of arterial sclerosis. Conclusion: The spasm owing to the catheterization doesn't result in chest discomfort and changes in EKG, while pathological spasm occurs in the population with high risk of coronary heart disease, which indicates the potential myocardial infraction. The angiographic findings helps differentiating the two situation

  15. 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.

  16. Medial extent of the anterior Gerota's fascia: An anatomic study using cadaver and CT

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Jae Hoon; Ryu, Kyung Nam; Kim, Ho Kyun; Yoon, Yup; Lee, Sun Wha; Ko, Young Tae; Choi, Woo Suk; Lee, Dong Ho [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    1989-04-15

    To study the anatomy of the perirenal space, authors dissected two cadavers and reviewed 50 computed tomographic (CT) scans, laying special emphasis on the medial extent of the anterior layer of Gerota's fascia. It is concluded that, below the renal hilus level, anterior layers of the right and left Gerota's fascia fuse each other across the midline anterior to the aorta and inferior vena cava. Above the hilus level, anterior layers are very weak and seem to fuse with the parietal peritoneum or adjacent organs. Therefore, the right and left perirenal space may communicate across the midline, anterior to the lower aorta and vena cava. Thus, at least in some subjects, the perirenal fluid or blood of the right or left perirenal space may extend to the opposite perirenal space through the narrow midline extension of each perirenal spaces anterior to the vertebral body.

  17. Systematization and description of the internal carotid arteries and their main ramifications at the brain base in turtles (Trachemys scripta elegans).

    Science.gov (United States)

    Voll, Juliana; Campos, Rui

    2016-08-01

    Thirty turtle brains (Trachemys scripta elegans) were injected with latex to systematize and describe the internal carotid arteries and their main ramifications at the brain base. The internal carotid arteries had one intercarotid anastomosis. At the level of the tuber cinereum, the internal carotid artery bifurcated into its terminal branches, the rostral and the caudal branches. The rostral branch emitted the rostral choroid artery, the orbital artery, and a series of middle cerebral arteries. After giving off the last middle cerebral artery, the rostral branch continued as the rostral cerebral artery in the cerebral longitudinal fissure, and had one anastomosis with its contralateral homologous artery, the rostral communicating artery, making the first rostral closure of the cerebral arterial circle. Next, the rostral cerebral arteries anastomosed forming a rostral interhemispheric artery, making the second rostral closure of the cerebral arterial circle. The internal carotid artery, after emitting its rostral branch, continued caudally as the caudal branch. The caudal branch ran caudally along the ventral surface of the mesencephalic tegmentum, emitted the caudal cerebral artery and the mesencephalic artery, and continued caudomedially while progressively narrowing, and anastomosed with its contralateral homologous artery, forming the basilar artery. The narrower portion also emitted the trigeminal artery. The anastomosis of the caudal branches closed the cerebral arterial circle caudally. The internal carotid arteries exclusively supplied the cerebral arterial circle of the turtle. Anat Rec, 299:1090-1098, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. 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.

  19. 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)

  20. Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract.

    Science.gov (United States)

    Jang, Sung Ho; Kwon, Hyeok Gyu

    2013-05-29

    The anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT). A 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct. It appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

  1. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2014-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  2. Coexistence of Single Coronary Artery Anomaly and Aortic Arch Anomaly

    Directory of Open Access Journals (Sweden)

    Yilmaz Omur Otlu

    2014-03-01

    Full Text Available A 74-year-old male patient was admitted to our hospital for evaluation of recent onset atypical chest pain. His medical history included hypertension, dislipidemia and smoking. Physical examination was unremarkable. The resting electrocardiogram was demonstrated biphasic T waves on lateral derivations. Transthoracic echocardiography showed normal left and right ventricular dimensions and functions. Coronary angiography was planned for the patient. First, right transradial approach tried; but guidewire could not be advanced to ascendig aorta. Coronary angiography was performed through the right femoral artery. Multiple attempts to cannulate the left coronary ostium were unsuccessful. The right coronary artery cannulated from its normal ostium in the right sinus of Valsalva. After a very short common main stem, the artery divided into a right coronary artery, and separate left anterior descending artery and circumflex artery (Figure A. The coronary arteries were normal without any significant stenosis and any extrinsic compression. An aortic root injection confirmed the absence of left coronary ostium. Also, a retroesophageal right subclavian artery originating from the left aortic arch (arteria lusoria was detected as the last branch of aortic arch on contrast enhanced computerized tomography (Figure B-C. The patient discharged with medical teraphy.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. Incremental Value of Increasing Number of Arterial Grafts: The Effect of Diabetes Mellitus.

    Science.gov (United States)

    Schwann, Thomas A; El Hage Sleiman, Abdul Karim M; Yammine, Maroun B; Tranbaugh, Robert F; Engoren, Milo; Bonnell, Mark R; Habib, Robert H

    2018-06-01

    Multiarterial coronary grafting with two arterial grafts leads to improved survival compared with conventional single artery based on left internal thoracic artery to left anterior descending artery and saphenous vein grafts. We investigated whether extending arterial grafting to three or more arterial grafts further improves survival, and whether such a benefit is modified by diabetes mellitus. We analyzed 15-year coronary artery bypass graft surgery mortality data in 11,931 patients (age 64.3 ± 10.5 years; 3,484 women [29.2%]; 4,377 [36.7%] with diabetes mellitus) derived from three US institutions (1994 to 2011). All underwent primary isolated left internal thoracic artery to left anterior descending artery grafting with at least two grafts: one artery (n = 6,782; 56.9%); two arteries (n = 3,678; 30.8%); or three or more arteries (n = 1,471; 12.3%). Long-term survival was estimated by Kaplan-Meier methods. Propensity score matching and comprehensive covariate adjustment (Cox regression) were used to derive long-term risk-adjusted hazard ratio (HR) with 95% confidence interval (CI) for increasing number of arterial grafts in the overall cohort and for diabetes and no-diabetes cohorts. Radial artery (94%) and right internal thoracic artery (6%) were used as additional arterial grafts. Multivariate analysis in all patients showed that diabetes was associated with decreased survival (HR 1.43, 95% CI: 1.34 to 53), whereas increasing number of arterial grafts was associated with decreased mortality (one artery HR 1.0 [reference]; two arteries HR 0.87, 95% CI: 0.80 to 0.95; and three arteries HR 0.83, 95% CI: 0.72 to 0.95). Pairwise comparisons also showed an incremental benefit of additional arterial grafts: two arteries versus one artery, HR 0.89 (95% CI: 0.80 to 0.98); and three arteries versus one artery, HR 0.80 (95% CI: 0.68 to 0.94). A three-artery versus two-artery survival advantage trend was also noted, but was not significant in either the overall study

  9. Jet pump assisted artery

    Science.gov (United States)

    1975-01-01

    A procedure for priming an arterial heat pump is reported; the procedure also has a means for maintaining the pump in a primed state. This concept utilizes a capillary driven jet pump to create the necessary suction to fill the artery. Basically, the jet pump consists of a venturi or nozzle-diffuser type constriction in the vapor passage. The throat of this venturi is connected to the artery. Thus vapor, gas, liquid, or a combination of the above is pumped continuously out of the artery. As a result, the artery is always filled with liquid and an adequate supply of working fluid is provided to the evaporator of the heat pipe.

  10. Supine versus upright anterior images: comparison in T1-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Jacobson, A.F.; Parker, J.A.; Royal, H.D.; Silverman, K.J.; Gervino, E.V.; Kolodny, G.M.

    1987-01-01

    In patients undergoing exercise thallium-201 myocardial scintigraphy, activity in the inferior wall on anterior images may appear diminished when the standard supine view is used, but normal when the view is acquired with the patient upright. To determine the clinical significance of this observation, the distribution of thallium-201 activity was semiquantitatively assessed in supine and upright anterior images obtained immediately after exercise in 93 patients (65 men, 28 women). The presence of inferior wall and coronary artery disease was established with coronary angiography or from documentation of previous myocardial infarction. Supine and upright images were compared with use of receiver operating characteristic curves. In male patients diagnostic accuracy for identification of both inferior wall and coronary artery disease was improved through the use of the upright anterior image. In women, there was no significant difference in reader performance with upright and supine images. Upright anterior images should be routinely obtained in men in order to reduce the frequency of false-positive identification of inferior wall defects

  11. 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.

  12. Open Approaches to the Anterior Skull Base in Children: Review of the Literature.

    Science.gov (United States)

    Wasserzug, Oshri; DeRowe, Ari; Ringel, Barak; Fishman, Gadi; Fliss, Dan M

    2018-02-01

    Introduction  Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the "gold standard" for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective  This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods  Comprehensive literature review. Results  Extensive intracranial-intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion  Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a

  13. 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.)

  14. 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

  15. 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)

  16. 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.

  17. A unique branching pattern of the axillary artery: a case report.

    Science.gov (United States)

    Bagoji, Ishwar B; Hadimani, Gavishiddappa A; Bannur, Balappa M; Patil, B G; Bharatha, Ambadasu

    2013-12-01

    During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

  18. Herniation of the anterior lens capsule

    Directory of Open Access Journals (Sweden)

    Pereira Nolette

    2007-01-01

    Full Text Available Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous in the area of herniation giving it a characteristic appearance.

  19. 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

  20. 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

  1. Toxic Anterior Segment Syndrome (TASS

    Directory of Open Access Journals (Sweden)

    Özlem Öner

    2011-12-01

    Full Text Available Toxic anterior segment syndrome (TASS is a sterile intraocular inflammation caused by noninfectious substances, resulting in extensive toxic damage to the intraocular tissues. Possible etiologic factors of TASS include surgical trauma, bacterial endotoxin, intraocular solutions with inappropriate pH and osmolality, preservatives, denatured ophthalmic viscosurgical devices (OVD, inadequate sterilization, cleaning and rinsing of surgical devices, intraocular lenses, polishing and sterilizing compounds which are related to intraocular lenses. The characteristic signs and symptoms such as blurred vision, corneal edema, hypopyon and nonreactive pupil usually occur 24 hours after the cataract surgery. The differential diagnosis of TASS from infectious endophthalmitis is important. The main treatment for TASS formation is prevention. TASS is a cataract surgery complication that is more commonly seen nowadays. In this article, the possible underlying causes as well as treatment and prevention methods of TASS are summarized. (Turk J Oph thal mol 2011; 41: 407-13

  2. 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.

  3. 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.

  4. Anatomic Patterns of Renal Arterial Sympathetic Innervation: New Aspects for Renal Denervation.

    Science.gov (United States)

    Imnadze, Guram; Balzer, Stefan; Meyer, Baerbel; Neumann, Joerg; Krech, Rainer Horst; Thale, Joachim; Franz, Norbert; Warnecke, Henning; Awad, Khaled; Hayek, Salim S; Devireddy, Chandan

    2016-12-01

    Initial studies of catheter-based renal arterial sympathetic denervation to lower blood pressure in resistant hypertensive patients renewed interest in the sympathetic nervous system's role in the pathogenesis of hypertension. However, the SYMPLICITY HTN-3 study failed to meet its prespecified blood pressure lowering efficacy endpoint. To date, only a limited number of studies have described the microanatomy of renal nerves, of which, only two involve humans. Renal arteries were harvested from 15 cadavers from the Klinikum Osnabruck and Schuchtermann Klinik, Bad Rothenfelde. Each artery was divided longitudinally in equal thirds (proximal, middle, and distal), with each section then divided into equal superior, inferior, anterior, and posterior quadrants, which were then stained. Segments containing no renal nerves were given a score value = 0, 1-2 nerves with diameter 4 nerves or nerve diameter ≥600 µm a score = 3. A total of 22 renal arteries (9 right-sided, 13 left-sided) were suitable for examination. Overall, 691 sections of 5 mm thickness were prepared. Right renal arteries had significantly higher mean innervation grade (1.56 ± 0.85) compared to left renal arteries (1.09 ± 0.87) (P renal artery has significantly higher innervation scores than the left. The anterior and superior quadrants of the renal arteries scored higher in innervation than the posterior and inferior quadrants did. The distal third of the renal arteries are more innervated than the more proximal segments. These findings warrant further evaluation of the spatial innervation patterns of the renal artery in order to understand how it may enhance catheter-based renal arterial denervation procedural strategy and outcomes. The SYMPLICITY HTN-3 study dealt a blow to the idea of the catheter-based renal arterial sympathetic denervation. We investigated the location and patterns of periarterial renal nerves in cadaveric human renal arteries. To quantify the density of the

  5. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

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    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

  6. Communication without communication

    Directory of Open Access Journals (Sweden)

    Bratina Boris R.

    2017-01-01

    Full Text Available This paper analyses the necessary conditions for successful communication. It is well known that post-modernity, described as an era of control, produces only decentralized, imploded subjectivities, who are neither able to question their own being nor to relate one with another in authentic bonds of communication. Today, virtual communication has become an ultimate model of every possible communication whatsoever. The authors, therefore, pose the question of conditions for possibility of subjectivities who would be able and apt for authentic communication, wherein faith, fidelity, truth, and capability of keeping one's word occupy the central place.

  7. 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)

  8. Uncontrolled Epistaxis Secondary to Traumatic Pseudoaneurysm of the Maxillary Artery

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    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.

  9. 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.

  10. Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery

    Directory of Open Access Journals (Sweden)

    Su-Na Lee

    2014-01-01

    Full Text Available Toxic anterior segment syndrome (TASS is an acute sterile postoperative anterior segment inflammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.

  11. Development of a posterior cerebral artery aneurysm subsequent to occlusion of the contralateral internal carotid artery for giant cavernous aneurysm

    International Nuclear Information System (INIS)

    Wolf, R.L.; Hurst, R.W.; Imbesi, S.G.; Galetta, S.L.; Sinson, G.P.; Grossman, R.I.

    2002-01-01

    We report a case of a patient who developed a left posterior cerebral artery aneurysm 5 years after balloon occlusion of the right internal carotid artery for a giant cavernous aneurysm. The location of the new aneurysm was outside of the primary collateral pathways to the contralateral, proximally occluded, anterior circulation, illustrating the complexity of hemodynamic factors contributing to the development of intracranial saccular aneurysms. The appearance of an aneurysm in this setting supports the hypothesis that degenerative factors and hemodynamic stresses are important in the etiology of intracranial aneurysms. (orig.)

  12. 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

  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. Clarifying the anatomy of the fifth arch artery

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    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.

  15. Anterior capsular rupture following blunt ocular injury

    Science.gov (United States)

    Gremida, Anas; Kassem, Iris; Traish, Aisha

    2011-01-01

    Summary A 10-year-old boy suffered a large, oblique anterior capsular tear following blunt injury to his right eye. The boy was followed daily for hyphema resolution and progressive traumatic cataract formation. After the hyphema had resolved, the lens was removed using an anterior approach and an intraocular lens was placed with excellent visual outcome. PMID:23362402

  16. Off-pump supra-arterial myotomy for myocardial bridging.

    Science.gov (United States)

    Crespo, Alejandro; Aramendi, José I; Hamzeh, Gadah; Voces, Roberto

    2008-09-01

    We report the results of surgery and midterm outcome in two patients with symptomatic myocardial bridging who underwent off-pump supra-arterial myotomy. Both patients were operated upon through a median sternotomy. The anterior wall of the heart was exposed in the same manner as in off-pump CABG. The left anterior descending coronary artery is unroofed from its myocardial bridge with the aid of a heart stabilizer and a blower. Neither heparin nor blood transfusion was required. Both patients survived the operation and are asymptomatic. Postoperative coronary angiogram showed good resolution of the muscle bridge in one patient. We conclude that in symptomatic patients with myocardial bridging despite medical therapy, surgical myotomy can be considered an adequate therapy. It can be safely done off-pump.

  17. The evaluation of atherosclerosis in coronary arteries with CT values

    International Nuclear Information System (INIS)

    Takemoto, Akiko

    1990-01-01

    In 50 patients with ischemic heart disease, X-ray computed tomography (CT) and coronary arteriography (CAG) were performed to compare CT values and CAG-proven stenosis in the left main trunk, left anterior descending, left circumflex, and right coronary artery. Luminal stenosis was graded as normal (no stenosis), minimal (between normal and significant), and significant (more than 50% in the left main trunk; more than 75% in the other arteries). CT values were significantly correlated with coronary artery stenosis; -5.4 in the normal group (71 arteries), +5.0 in the minimal group (63 arteries), and +31.8 in the significant group (51 arteries). In the normal group, CT values were independent of aging; -4.9 for patients younger than 50 years, -8.0 for those aged 50 to 59 years, and -0.4 for those more than 60 years. Increased CT values were associated with severer coronary artery disease shown on CAG. In determining significant coronary artery stenosis, CT values of more than 35 had a positive predictive value of 73.3%, a sensitivity of 43.1%, a specificity of 94.0%, an accuracy of 80.0%, and a likelihood ratio of 7.18. Measurement of CT values for the coronary arteries seems to be a noninvasive method for predicting significant stenosis. For patients younger than 60 years, high CT values even in a single artery seem to be associated with a high likelihood of significant stenosis and multivessel disease. (N.K.)

  18. 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).

  19. 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

  20. Atraumatic Anterior Dislocation of the Hip Joint

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    Tadahiko Ohtsuru

    2015-01-01

    Full Text Available Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

  1. Long anterior zonules and pigment dispersion.

    Science.gov (United States)

    Moroi, Sayoko E; Lark, Kurt K; Sieving, Paul A; Nouri-Mahdavi, Kouros; Schlötzer-Schrehardt, Ursula; Katz, Gregory J; Ritch, Robert

    2003-12-01

    To describe pigment dispersion associated with long anterior zonules. Multicenter observational case series. Fifteen patients, seven of whom were treated for glaucoma or ocular hypertension, were identified with long anterior zonules and pigment dispersion. Transmission electron microscopy was performed on one anterior capsule specimen. All patients had anterior zonules that inserted centrally on the lens capsule. Signs of pigment dispersion included corneal endothelial pigmentation, loss of the pupillary ruff, and variable trabecular meshwork pigmentation. Ultrasound biomicroscopy verified the lack of posterior iris insertion and concavity. There was no exfoliation material. Transmission electron microscopy showed zonular lamellae with adherent pigment granules, and no exfoliation material. Long anterior zonules inserted onto the central lens capsule may cause mechanical disruption of the pigment epithelium at the pupillary ruff and central iris leading to pigment dispersion.

  2. Anterior capsulotomy using the CO2 laser

    Science.gov (United States)

    Barak, Adiel; Ma-Naim, Tova; Rosner, Mordechai; Eyal, Ophir; Belkin, Michael

    1998-06-01

    Continuous circular capsulorhexis (CCC) is the preferred technique for removal of the anterior capsule during cataract surgery due to this technique assuring accurate centration of the intraocular lens. During modern cataract surgery, especially with small or foldable intra ocular lenses, centration of the lens is obligatory. Radial tears at the margin of an anterior capsulotomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ('pea pod' effect) and its subsequent decentration. The anterior capsule is more likely to ream intact if the continuous circular capsulorhexis (CCC) technique is used. Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, many ophthalmologists are still uncomfortable with it and find it difficult to perform, especially in complicated cases such as these done behind small pupil, cataract extraction in children and pseudoexfoliation syndrome. We have developed a technique using a CO2 laser system for safe anterior capsulotomy and tested it in animal eyes.

  3. 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.)

  4. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    International Nuclear Information System (INIS)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Zhou, Chun Gao

    2017-01-01

    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. Absence of the genicular arterial anastomosis as generally depicted in textbooks.

    Science.gov (United States)

    Sabalbal, M; Johnson, M; McAlister, V

    2013-09-01

    Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg. Dissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: 'direct communication', 'approaching communication' or 'no evident communication'. A constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation. Modern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray's Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT

  7. 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.

  8. Normal variation of hepatic artery

    International Nuclear Information System (INIS)

    Kim, Inn; Nam, Myung Hyun; Rhim, Hyun Chul; Koh, Byung Hee; Seo, Heung Suk; Kim, Soon Yong

    1987-01-01

    This study was an analyses of blood supply of the liver in 125 patients who received hepatic arteriography and abdominal aortography from Jan. 1984 to Dec. 1986 at the Department of Radiology of Hanyang University Hospital. A. Variations in extrahepatic arteries: 1. The normal extrahepatic artery pattern occurred in 106 of 125 cases (84.8%) ; Right hepatic and left hepatic arteries arising from the hepatic artery proper and hepatic artery proper arising from the common hepatic artery. 2. The most common type of variation of extrahepatic artery was replaced right hepatic artery from superior mesenteric artery: 6 of 125 cases (4.8%). B. Variations in intrahepatic arteries: 1. The normal intrahepatic artery pattern occurred in 83 of 125 cases (66.4%). Right hepatic and left hepatic arteries arising from the hepatic artery proper and middle hepatic artery arising from lower portion of the umbilical point of left hepatic artery. 2. The most common variation of intrahepatic arteries was middle hepatic artery. 3. Among the variation of middle hepatic artery; Right, middle and left hepatic arteries arising from the same location at the hepatic artery proper was the most common type; 17 of 125 cases (13.6%)

  9. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn

    2017-01-01

    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  10. Imaging the vertebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Tay, Keng Yeow; U-King-Im, Jean Marie; Trivedi, Rikin A.; Higgins, Nicholas J.; Cross, Justin J.; Antoun, Nagui M. [Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Davies, John R.; Weissberg, Peter L. [Addenbrooke' s Hospital and University of Cambridge, Division of Cardiovascular Medicine, Cambridge (United Kingdom); Gillard, Jonathan H. [Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Addenbrooke' s Hospitald, University Department of Radiology, Cambridge (United Kingdom)

    2005-07-01

    Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral artery pathology in clinical practice. This paper reviews the current state of vertebral artery imaging from an evidence-based perspective. Normal anatomy, normal variants and a number of pathological entities such as vertebral atherosclerosis, arterial dissection, arteriovenous fistula, subclavian steal syndrome and vertebrobasilar dolichoectasia are discussed. (orig.)

  11. Imaging the vertebral artery

    International Nuclear Information System (INIS)

    Tay, Keng Yeow; U-King-Im, Jean Marie; Trivedi, Rikin A.; Higgins, Nicholas J.; Cross, Justin J.; Antoun, Nagui M.; Davies, John R.; Weissberg, Peter L.; Gillard, Jonathan H.

    2005-01-01

    Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral artery pathology in clinical practice. This paper reviews the current state of vertebral artery imaging from an evidence-based perspective. Normal anatomy, normal variants and a number of pathological entities such as vertebral atherosclerosis, arterial dissection, arteriovenous fistula, subclavian steal syndrome and vertebrobasilar dolichoectasia are discussed. (orig.)

  12. La hemiplejia en el reblandecimiento anterior del bulbo

    Directory of Open Access Journals (Sweden)

    J. O. Trelles

    1971-03-01

    Full Text Available A propósito de un caso de reblandecimiento limitado al territorio arterial anterior y mediano del bulbo que se traducía, clínicamente, por una hemiplejía controlateral con trastornos sensitivos y ausencia de compromiso del facial o de la lengua, y del análisis de 8 casos anatomo-clínicos encontrados en una revisión bibliográfica, los autores discuten el problema de la irrigación arterial del bulbo, el cuadro clínico y el tan debatido asunto de la pretendida flaccidez de estas hemiplejias. Desde el punto de vista de la vascularización arterial del bulbo, se insiste en que ésta es compleja y variable según que se trate del sector oral contiguo a la protuberancia, del sector caudal contiguo a la médula o del sector intermediario a los dos. Desde el punto de vista clínico, en los casos típicos, se trata de una hemiplejia espástica con trastornos sensitivos sin compromiso del facial, ni del hipogloso. De los nueve casos anatomo-clínicos registrados hasta el presente, seis con larga sobrevida, presentaron hemiplejia espástica; dos, con sobrevidas cortas, se encontraban en la etapa de transición hacia la espasticidad; uno con lesiones extensas presentó una flaccidez permanente. En lo que se refiere al problema de la pretendida flaccidez de estas hemiplejias vemos que las hemiplejías bulbares no escapan a la regla de las lesiones del haz piramidal, las que después de una primera etapa de flaccidez evolucionan hacia la espasticidad. Por tanto las conclusiones doctrinarias referentes al haz piramidal basadas en ésta pretendida flaccidez de la hemiplejía bulbar son erróneas y deben revisarse.

  13. Left ventricular diastolic function in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Brugger, P.T.

    1986-01-01

    In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 ± 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 ± 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 ± 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p [de

  14. Scintigraphic anatomy of coronary artery disease in digital thallium-201 myocardial images

    International Nuclear Information System (INIS)

    Wainwright, R.J.

    1981-01-01

    One hundred and eight patients with single and multiple vessel coronary artery disease confirmed by arteriography were evaluated by exercise thallium-201 ( 201 Tl) myocardial scintigraphy to determine the scintigraphic appearances of specific coronary stenoses. In general proximal stenoses caused more widespread, but not necessarily more severe, myocardial tracer deficit, than distal stenoses. In particular, proximal dominant right coronary artery disease was specifically associated with extensive inferior wall tracer deficit in the anterior scintigram, whereas proximal left circumflex disease caused similar tracer depletion best visualised in the left lateral scintigram. A triad of uptake defects was caused by left anterior descending coronary artery disease; one of these defects called 'diagonal window tracer deficit' was the most useful scintigraphic sign distinguishing proximal from distal disease in the left anterior descending coronary artery. Certain scintigraphic patterns of 201 Tl myocardial accumulation appear invaluable in the noninvasive localisation of stenoses within specific coronary arteries and thus may be useful in predicting life-threatening coronary artery disease which should be confirmed by definitive coronary arteriography. The digital 201 Tl myocardial scintigram also provides an independent functional guide to the interpretation of coronary arteriograms and may be helpful in the planning of aortocoronary bypass graft surgery. (author)

  15. Preliminary clinical application in the cranial internal carotid artery of covered stents specially designed for intracranial vasculature

    International Nuclear Information System (INIS)

    Li Minghua; Luo Qiyi; Fang Chun; Xie Zhiyong; Cheng Yingsheng; Gao Bulang; Li Yu; Zhang Beilei; Xie Jian; Wang Yongli

    2007-01-01

    Objective: To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery (CICA) to reach the targeted area, the performance (adherence) of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment. Methods: The covered stents specially designed for use in intracranial vasculature were used to treat 13 patients with CICA diseases using endovascular techniques. There were 4 huge pseudoaneurysms, 4 giant aneurysms, 3 small wide-necked aneurysms, 1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula (CCF), and 1 CCF. Prior to the detachment of the covered stents, balloon occlusion test (BOT) of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography (DSA) were performed in all the patients. Three to 16 months following procedure, DSA and clinical follow-ups were performed. Results: Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries. The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area, with the diseased segments of the internal carotid artery including C3-C4 in 4 cases, C4-C5 in 4 and C6-C7 in 5. Immediately following the detachment of the covered stents, DSA demonstrated that 7 aneurysms were completely occluded, 4 aneurysms had slight endoleak, and 1 CCF had markedly-decreased blood flow through the fistula. In the patient with concurrent pseudoaneurysm and CCF, the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure. Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting

  16. Left ventricular diastolic function in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Brugger, P.T.

    1986-08-01

    In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 +- 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 +- 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 +- 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p < 0.0001), normal patients and patients after inferior wall infarction (p < 0.0001) and normal patients and patients with coronary artery disease (p < 0.0001). The TPFR was 180 +- 37.5 msec after anterior - and 158 +- 50.7 msec after inferior wall infarction and 156 +- 45.2 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 88% after anterior- and in 82% after inferior wall infarction and in 69% in coronary patients without previous myocardial infarction. In comparison with this the ejection fraction was reduced in 66% in anterior- and in 61% inferior wall infarction at rest. These results indicate that the diastolic function at rest appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

  17. Anatomy of right superior septal artery demonstrated on the coronary CT scan

    International Nuclear Information System (INIS)

    Takeguchi, Takaya; Ibukuro, Kenji; Fukuda, Hozumi; Tobe, Kimiko; Abe, Shoko

    2012-01-01

    Background. A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose. To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods. The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results. The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery (n = 40) or the right sinus of Valsalva (n 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16-62 mm (mean 31.2 mm ± 10.5), and the diameter was 0.8-2.0 mm (mean 1.3 mm ± 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries (P < 0.05). Conclusion. The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease

  18. HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

    Directory of Open Access Journals (Sweden)

    Vijayamma K. N

    2018-01-01

    Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

  19. 3D DSA findings of uterine artery and its optimal projection position

    International Nuclear Information System (INIS)

    Lu Weifu; Zhang Aiwu; Zhou Chunze; Lu Dong; Xiao Jingkun; Wang Weiyu; Zhang Xingming; Zhang Zhengfeng; Hou Changlong

    2011-01-01

    Objective: to observe the origin site, anatomic features of uterine artery with 3D DSA and to discuss the optimal projection position in order to improve the success rate of super-selective catheterization of uterine artery. Methods: Prospective pelvic angiography was performed in 42 adult females (a total of 84 uterine arteries). 3D DSA was carried out with 206 ° rotation. 3D reconstruction of the obtained images was performed and the angiographic manifestations of the uterine artery were analyzed. The optimal projection position for the displaying of uterine artery was discussed. The quality of images obtained with the projection angle of 15 °-25 °, 25 °-35 ° and 35 °-45 ° was determined and the results were compared with each other. Results: The orifices of all 84 uterine arteries could be well demonstrated on 3D DSA images. The uterine artery was originated from the anterior trunk of internal iliac artery (n=58, 69%), from main stem of internal iliac artery (n=16, 19.1%), from internal pudenda artery (n=8, 9.5%) and from inferior gluteal artery (n=2, 2.4%). The best projection position to show the opening and route of the uterine artery was contralateral oblique view of 25-35 degrees (P<0.05). Conclusion: 3D DSA can clearly display the anatomy of the uterine artery, which is very helpful for the management of super-selective catheterization of uterine artery. The optimal projection position for uterine artery is contralateral oblique view of 25-35 degrees. (authors)

  20. Anatomy of right superior septal artery demonstrated on the coronary CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Takeguchi, Takaya (Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo (Japan); Tokyo Medical and Dental University, Department of Diagnostic Radiology, Tokyo (Japan)); Ibukuro, Kenji; Fukuda, Hozumi; Tobe, Kimiko; Abe, Shoko (Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo (Japan)), Email: kj-ibkr@qd6.so-net.ne.jp

    2012-02-15

    Background. A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose. To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods. The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results. The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery (n = 40) or the right sinus of Valsalva (n 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16-62 mm (mean 31.2 mm +- 10.5), and the diameter was 0.8-2.0 mm (mean 1.3 mm +- 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries (P < 0.05). Conclusion. The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease

  1. Pulmonary artery aneurysm

    African Journals Online (AJOL)

    Enrique

    Introduction. Pulmonary artery aneurysms are a rare finding in general radiological practice. The possible causes are myriad and diverse in pathophysiolo- gy. Patients with post-stenotic dilata- tion of the main pulmonary artery usually present fairly late with insidi- ous cardiorespiratory symptoms. Diagnosis requires ...

  2. BILATERAL DUPLICATION OF RENAL ARTERIES

    OpenAIRE

    Prajkta A Thete; Mehera Bhoir; M.V.Ambiye

    2014-01-01

    Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

  3. Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen

    Directory of Open Access Journals (Sweden)

    Ziya Ayhan

    2015-01-01

    Full Text Available Optic disc drusen (ODD are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION.

  4. 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.

  5. Bilateral triple renal arteries

    International Nuclear Information System (INIS)

    Pestemalci, Turan; Yildiz, Yusuf Zeki; Yildirim, Mehmet; Mavi, Ayfer; Gumusburun, Erdem

    2009-01-01

    Knowledge of the variations of the renal artery has grown in importance with increasing numbers of renal transplants, vascular reconstructions and various surgical and radio logic techniques being performed in recent years. We report the presence of bilateral triple renal arteries, discovered on routine dissection of a male cadaver. On the right side, one additional renal artery originated from the abdominal aorta (distributed to superior pole of the kidney) and one other originated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been compared with variations described in the literature and their clinical importance has been emphasized. (author)

  6. Intractable epistaxis: which arteries are responsible? An angiographic study.

    Science.gov (United States)

    de Bonnecaze, Guillaume; Gallois, Y; Chaynes, P; Bonneville, F; Dupret-Bories, A; Chantalat, E; Serrano, E

    2017-11-01

    Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

  7. Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment

    NARCIS (Netherlands)

    Notten, K. J. B.; Essers, B. A.; Weemhoff, M.; Rutten, A. G. H.; Donners, J. J. A. E.; van Gestel, I.; Kruitwagen, R. F. M. P.; Roovers, J. P. W. R.; Dirksen, C. D.

    2015-01-01

    We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse. Labelled discrete choice experiment. Three Dutch teaching hospitals. Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or

  8. Radiation-induced bilateral common carotid artery stenosis

    International Nuclear Information System (INIS)

    Kobayashi, Nobuaki; Nakagawa, Yoku; Tashiro, Kunio; Abe, Hiroshi

    1986-01-01

    A case of radiation-induced bilateral common carotid artery stenosis is reported. This 60 years old housewife was hospitalized in 1982 because of sudden onset of mild left hemiparesis. Twenty-five years ago, she underwent radiation therapy of approximately 5,000 rads to the anterior cervical region because of thyroid cancer. Angiograms in 1982 revealed bilateral common carotid artery stenosis, especially in the right common carotid artery, the legion of which were included within the field of radiation performed in 1952. Right thromboendarterectomy was performed in 1983. At operation, slight periarterial fibrosis with calcified arteriosclerotic change was found, and dissection between the thickened intima and the media was not so difficult. Histological change of resected thromboendarterium was similar to the one observed in the pure arteriosclerotic disease. (author)

  9. MRI of tibialis anterior tendon rupture

    International Nuclear Information System (INIS)

    Gallo, Robert A.; DeMeo, Patrick J.; Kolman, Brett H.; Daffner, Richard H.; Sciulli, Robert L.; Roberts, Catherine C.

    2004-01-01

    Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath. One patient demonstrated a partial tear showing an attenuated tendon with increased surrounding fluid. Although rupture of the tibialis anterior tendon is a rarely reported entity, MRI is a useful modality in the definitive detection and characterization of tibialis anterior tendon ruptures. (orig.)

  10. Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

    Science.gov (United States)

    Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

    2013-12-01

    Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Arterial spasm as a finding intimately associated with the onset of vascular headache

    Energy Technology Data Exchange (ETDEWEB)

    Garnic, J.D.; Schellinger, D.

    1983-03-01

    A patient with migraine headaches of the ''cluster'' variant type is presented in whom vasospasm of the middle cerebral artery, the anterior cerebral artery and the internal carotid artery triggered a pain episode identical in character and severity to the headaches which had led to his investigation. Vasospasm associated with the painful phase of headache in this case conflicts with the more accepted theory that the pain phase of a vascular headache is related to vasodilatation of cerebral or extracerebral vessels. The literature is reviewed.

  12. Arterial spasm as a finding intimately associated with the onset of vascular headache

    International Nuclear Information System (INIS)

    Garnic, J.D.; Schellinger, D.

    1983-01-01

    A patient with migraine headaches of the ''cluster'' variant type is presented in whom vasospasm of the middle cerebral artery, the anterior cerebral artery and the internal carotid artery triggered a pain episode identical in character and severity to the headaches which had led to his investigation. Vasospasm associated with the painful phase of headache in this case conflicts with the more accepted theory that the pain phase of a vascular headache is related to vasodilatation of cerebral or extracerebral vessels. The literature is reviewed. (orig.)

  13. Complications of operative treatment of injuries of peripheral arteries.

    Science.gov (United States)

    Velinovic, M M; Davidovic, B L; Lotina, I S; Vranes, R M; Djukic, L P; Arsov, J V; Ristic, V M; Kocica, J M; Petrovic, L P

    2000-06-01

    In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).

  14. Imaging experimental coronary artery thrombosis with indium-111 platelets

    International Nuclear Information System (INIS)

    Riba, A.L.; Thakur, M.L.; Gottschalk, A.; Zaret, B.L.

    1979-01-01

    The ability of cardiac scintigraphy with indium-111 ( 111 In)-labeled platelets to detect coronary artery thrombosis (CAT) was assessed in a canine model. Cardiac imaging and tissue distribution studies were performed shortly after administering 111 In-labeled platelets to 12 dogs (group 1) with acute CAT. Four dogs (group 2) with acute CAT were studied 2 and 22 hours after administering 111 In platelets. In addition, four dogs (group 3) with 24-hour-old CAT were similarly evaluated. In all group 1 animals, in vivo imaging 1 to 2 hours after 111 In platelet administration revealed intense uptake in the region of thrombus-containing left anterior descending arteries that was readily discernible from background blood pool activity. Sequential imaging of the four group 2 animals over a 22-hour period revealed no change in the scintigraphic pattern of the thrombosed arteries. In contrast, 111 In platelet imaging in the four group 3 animals with 24-hour-old CAT failed to reveal enhanced activity within the region of the thrombus-containing coronary artery. In the 12 group 1 animals, the CAT accumulated 69 +- 10 (mean +- SEM) times greater activity than present in blood and 651 +- 135 times greater activity than normal left ventricular myocardium. There was 24 +- 7 times greater 111 In activity in the damaged left anterior descending arteries compared with normal circumflex arteries. Similar uptake ratios were seen in group 2 animals. The 24-hour old thrombi from group 3 animals showed no enhanced 111 In uptake. This study demonstrates that experimental acute CAT can be detected readily with 111 In platelet cardiac scintigraphy

  15. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    International Nuclear Information System (INIS)

    Handa, Toru; Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-01-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  16. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Toru [Akitsu Prefectual Hospital, Hiroshima (Japan); Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-03-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  17. Tratamiento de la mordida cruzada anterior con plano inclinado anterior. Efecto sobre los arcos dentales

    OpenAIRE

    Carolina Rodríguez Manjarrés; Jesús Alberto Hernández Silva

    2017-01-01

    Objetivo: Evaluar los cambios dimensionales de los arcos dentales primarios tratados con plano inclinado anterior como método de corrección de la mordida cruzada anterior. Métodos: Se trataron 10 pacientes con edades entre 3 y 5 años afectados con mordida cruzada anterior completa, se colocó un plano inclinado anterior elaborado en acrílico, que estuvo en posición en promedio 8.5 semanas. Se obtuvieron modelos de estudio en 3 momentos T0: antes del tratamiento; T1: 6 meses después de iniciado...

  18. Renal artery stenosis

    International Nuclear Information System (INIS)

    Desberg, A.; Paushter, D.M.; Lammert, G.K.; Hale, J.; Troy, R.; Novic, A.; Nally, J. Jr.

    1989-01-01

    Renal artery disease is a potentially correctable cause of hypertension. Previous studies have suggested the utility of duplex sonography in accurately detecting and grading the severity of renal artery stenosis. The purpose of this paper is to evaluate color flow Doppler for this use. Forty-three kidneys were examined by color-flow Doppler and conventional duplex sampling in patients with suspected renovascular hypertension or those undergoing aortography for unrelated reasons. Doppler tracings were obtained from the renal arteries and aorta with calculation of the renal aortic ratio (RAR) and resistive index (RI). Results of Doppler sampling with color flow guidance were compared with aortograms in a blinded fashion

  19. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  20. Vertebrobasilar Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Schoen, Jessica

    2011-05-01

    Full Text Available The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion. [West J Emerg Med. 2011;12(2:233-239.

  1. Myocardial imaging by direct injection of thallium-201 into coronary artery

    International Nuclear Information System (INIS)

    Sugihara, Hiroki; Inagaki, Suetsugu; Kubota, Yasushi

    1988-01-01

    Myocardial perfusion images were evaluated by direct injection of Thallium (Tl)-201 into coronary artery. Approximately 0.5 - 1 mCi of Tl-201 were instilled into the right coronary artery and/or the left coronary artery after coronary arteriography. Three images were obtained in the anterior, left anterior oblique and left lateral projections. Myocardial perfusion images of single photon emission computed tomography were also acquired in some patients. An image of supreme quality could be obtained in spite of small dose of Tl-201 since there was a lack of interference from background activity. Myocardial perfusion images corresponded to areas which were supplied by left or right coronary artery respectively. And the regional myocardial blood flow distribution of a coronary artery bypass graft could be revealed by instilling Tl-201 into the graft. Further, contribution of collateral channels to myocardial perfusion was showed. Not only left ventricle but also right ventricle was clearly visualized by injection of Tl-201 into right coronary artery. But in a case with arrhythmogenic right ventricular dysplasia, there was an area of decreased tracer uptake in the apex of the right ven